Taylor VM, Jackson JC, Yasui Y, Nguyen TT, Woodall E, Acorda E, Li L, Ramsey S. (2010). Evaluation of a cervical cancer control intervention using lay health workers for Vietnamese American women. American Journal of Public Health, 100 (10), 1924-1929.
Designed to increase cervical cancer screening among Vietnamese American women, this home visitation intervention is led by female bilingual and bicultural lay health workers who provide basic information about cervical cancer and the Pap test using materials (e.g., DVD, pamphlet, visual aids); act as a role model, give social support, and address the woman’s individual barriers to Pap testing; and conduct a follow-up telephone call to offer further assistance. The study showed an increase in Pap testing.
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Cancer registry data show that in the United States, the incidence rate of cervical cancer among Vietnamese American women is five times that of Caucasian women (43.0 vs. 8.7 per 100,000). Further, the President's Advisory Commission on Asian Americans recently identified cervical cancer among Vietnamese women as one of the most important health disparities experienced by Asian American populations. The United States Preventive Services Task Force strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix. According to American Cancer Society guidelines, women should be screened for cervical cancer every 1 to 3 years, depending on their risk factors for disease and previous screening history. National cervical cancer screening goals for the year 2010 specified that at least 97% of women should have received a Papanicolaou (Pap) test on at least one occasion, and 90% of women should have received a Pap test within the previous 3 years. However, California survey data for 2003 indicated that only 70% of Vietnamese women aged 18 and older had received Pap testing in the previous 3 years, compared with 84% of White, 87% of Black, and 85% of Hispanic women.
Interventions involving lay health workers represent a promising approach to disease prevention. Lay health workers are community members who are not certified health care professionals but have been trained to promote health or provide health care services within their community. Lay health workers with similar characteristics to the target audience help traditional Vietnamese American women feel comfortable discussing barriers to Pap testing (for example, believing that Pap testing is unnecessary for asymptomatic women; that it is "God's will" or "fate" if a woman gets cervical cancer; that it is not necessary for older women, single women, and sexually inactive women to get a Pap test).
The Vietnamese Women's Health Project is a home visitation intervention by female lay health workers for Vietnamese American women aged 20 to 79 who have not adhered to guidelines for interval Pap testing. The lay health workers provide basic information about cervical cancer and the Pap test (within the context of Vietnamese traditional beliefs about women's health), with an emphasis on the importance of Pap testing for all women (including those who are asymptomatic, not currently sexually active, or postmenopausal). Intervention materials include a Vietnamese-language DVD (with English subtitles) and a pamphlet (with both Vietnamese and English text). The intervention employs several visual aids: a graph showing cervical cancer incidence rates by race/ethnicity, a gynecologic anatomy diagram, and a figure showing how cervical cancer progresses. The intervention is administered by a Vietnamese American female lay health worker who is bilingual and bicultural. Lay health workers are trained to act as role models, give social support, and provide tailored responses to each woman's individual barriers to Pap testing (for example, believing that Pap testing is unnecessary for asymptomatic women). During home visits, lay health workers offer participants a copy of the DVD and pamphlet, watch the DVD with the participants, and show participants the visual aids. In addition, a follow-up telephone call was made to the participants 1 month after completed home visits to offer further assistance, as necessary.
Community Preventive Services Task Force Finding
Home visits usually last between 30 and 45 minutes (including viewing the 15-minute DVD).
The intended audience for this intervention is Vietnamese American women aged 20 to 79 who have not adhered to guidelines for interval Pap testing.
Suitable settings for this intervention are in participating women's homes.
--Outreach Worker Manual
--Prevent Cervical Cancer: Take Care of Yourself and Those You Love, brochure
--Good Health for New Years, video
--Project personnel who have direct contact with participants are lay health workers who are
bicultural, bilingual, Vietnamese American women
About the Study
The study was a randomized controlled trial to evaluate the effectiveness of the lay health worker-based intervention in improving levels of Pap test receipt among Vietnamese American women. Study participants took part in a community-based survey conducted in metropolitan Seattle, Washington, over a 12-month period during 2006 and 2007. Women were eligible for participation in the community-based survey if they were of Vietnamese descent, aged 20 to 79, and able to speak Vietnamese or English. Survey respondents were eligible for the study if they had a uterus and did not adhere to guidelines for interval Pap testing. Because regular Pap testing is no longer recommended for women aged 70 to 79 who have a history of previous testing, survey respondents in this age group were eligible only if they had never been screened.
Women aged 20 to 69 were eligible if they had not been screened for cervical cancer in the previous 3 years. Participants were 234 Vietnamese American women between the ages of 20 and 79 (45% under the age of 50, 55% aged 50 or older) who were randomized into the trial 6 months after they participated in the community-based survey. Women randomized to the experimental condition received the cervical cancer control lay health worker intervention. The control group participants received a mailing of physical activity print materials (pamphlet and fact sheet) and a pedometer with instructions for use. The primary outcome of interest was completion of Pap testing within 6 months of randomization, determined by a follow-up survey conducted face-to-face in participants' homes by interviewers who were unaware of each participant's trial randomization assignment. Each respondent to the follow-up survey was asked whether she had ever had a Pap test and, if so, when she was last screened.
Other questions assessed exposure to the Pap testing educational materials. Respondents to the follow-up survey who reported they had received Pap testing in the 6-month interval since their random assignment were asked to provide information about the date of testing and the name and location of the clinic or doctor's office where testing was performed. Each of these participants was also asked to sign a medical release form giving project staff permission to request medical record verification of her self-reported Pap test. A copy of the Pap test result was then requested from the relevant clinic or doctor's office via a form that provided the participant's name, age, and self-reported date of testing.
- Among women who had received at least one Pap test during their lifetime (but had not received a Pap test in the 3 years prior to randomization), 31% of the experimental group reported Pap testing after randomization, compared with 13% of the comparison group (p=.02).