Cambodian Women's Health Project

Most Cambodian Americans are refugees, relocated primarily from agrarian communities. Accordingly, Cambodian Americans are unfamiliar with Western medicine, services, and prevention. Low levels of acculturation and limited English-language skills also keep Cambodian women from accessing such preventive health care services as the Pap test. Southeast Asian (Cambodian, Hmong, Laotian, and Vietnamese) women in general have markedly elevated invasive cervical cancer incidence and mortality rates. Between 1992 and 1998, age-adjusted incidence rates were 35.2 per 100,000 women for Southeast Asians compared with 7.5 per 100,000 women for non-Latina Whites. Fewer than 16% of Cambodian women receive annual Pap tests.

The neighborhood-based program aims to increase cervical cancer screening rates among Cambodian American women, aged 18 years and older. The intervention includes a home visit, group meetings in neighborhood settings, and logistic assistance accessing screening services. This multi-faceted program is delivered by bilingual, bicultural, female Cambodian outreach workers. Workers serve as role models, provide social support, and serve as cultural mediators between women and health care facilities. During home visits, workers and women watch a Khmer-language video about Pap tests, address individual barriers to screening, and offer logistical assistance. After the home visit, workers invite women to attend a neighborhood group meeting to further discuss fears, concerns and barriers related to Pap testing.

Time required varies based on number of attempts needed to reach women at home (for the study, up to 10 attempts were made), duration of home visit, and duration of the group meeting. The video is 20 minutes in length.

Participants were Cambodian American women, aged 18 years and older in the Seattle, WA area. Women were excluded if they had a history of cervical cancer or a previous hysterectomy.

This intervention is suitable in home and community-based settings.

Required resources include the Khmer-language video, "The Preservation of Traditions," the Outreach Worker Manual, and a clinic resource manual.  Costs associated with the program's implementation are not provided.

Three hundred and seventy Cambodian women living in 17 neighborhoods were randomized to the intervention or control group. Intervention women received a home visit from a bicultural, bilingual female outreach worker. Outreach workers delivered the intervention with visual aids and provided tailored responses to individual barriers to cancer screening. During the home visit, the outreach worker and the participant together watched the Khmer-language video about Pap testing. The outreach worker also offered clinic referrals, assistance with appointment scheduling, medical interpretation during clinic visits for Pap testing, and transportation assistance as necessary. After completing a home visit, outreach workers invited intervention women to one of several group meetings scheduled in their neighborhood. During the neighborhood meetings, outreach workers made a short presentation about cervical cancer and pap testing, answered questions, and again, showed the video about Pap testing. Outreach workers attempted to provide telephone follow-up to intervention women who completed a home visit but did not attend a group meeting.

Results:

• The proportion of women in the intervention group reporting recent cervical cancer screening increased from 44% at baseline to 61% at follow-up, compared with an increase of 51% to 62% respectively for the control condition.