De Casa en Casa: Cervical Cancer Screening Program

Each year in the United States, nearly 13,000 women are diagnosed with cervical cancer. Although cervical cancer is one of the most treatable forms of cancer, only 78% of women aged 21 to 65 years report being up to date with cervical cancer screening. Cervical cancer disproportionately affects Hispanic women, and Hispanic women are more likely to be overdue for cervical cancer screening.

De Casa en Casa is a bilingual multi-component intervention to promote cervical cancer screening. Adapted from AMIGAS (Ayudando a las Mujeres con Información, Guía, y Amor para su Salud—Helping Women with Information, Guidance, and Love for Their Health), an intervention for Hispanic women, this program is grounded in the health belief model and social cognitive theory. The intervention components, which were informed by recommendations of the Community Preventive Services Task Force, include outreach and education on cervical cancer screening through trained promotoras (bilingual community health workers), navigation (e.g., assistance with scheduling and overcoming barriers to screening) through trained patient navigators, and no-cost screening. The components—delivered over the course of 2 months to over a year, depending on the services needed—are as follows: 

-- Outreach and education: The promotora provides a 1-hour, in-person education session. Promotoras can use a 17-minute narrative video adapted from the AMIGAS program or a 35-page flipchart to aid with the lesson. The materials provide information on cervical cancer risk factors, the screening process, and local resources, as well as testimonials to encourage screening. 

-- Navigation: The patient navigator provides a series of 5- to 30-minute telephone calls and a 1-hour home visit, as needed. The navigator calls participants within a week after the education session to schedule a screening, making two follow-up calls if needed until an appointment is made. Navigation calls also serve to remind the patient about the appointment and address individual barriers to screening. Following the screening, the patient navigator provides the patient with screening results and supports any follow-up testing processes. 

-- Screening: The patient accesses a no-cost Papanicolaou (Pap) smear and human papillomavirus (HPV) testing, as well as no-cost colposcopy (diagnostic) testing as needed. This component is designed to reduce expenses and structural barriers to screening.

-- 40 hours for the promotora and patient navigator training
-- 1 hour for the patient education session provided by the promotora
-- 5 to 30 minutes for each navigation call and 1 hour for each home visit

The population included in the study reviewed for this summary was predominantly women who identified as Hispanic and preferred to communicate in Spanish. The intervention is intended to be used more broadly, with any women aged 21 to 65 who are due for cervical cancer screening.

The program is suitable for implementation in community settings.

Required resources to implement the program include the following:
-- De Casa en Casa Training Manual
-- Recruitment Materials
-- Education Materials

For costs associated with this program, please contact the developer, Navkiran Shokar. (See products page on the EBCCP website for developer contact information.)

A nonrandomized prospective study used a delayed intervention design and compared two arms: the control group before the intervention was implemented and the intervention group after the intervention was implemented. Promotoras recruited participants from 37 community-based sites (e.g., food pantries, learning centers, nonprofit organizations, churches) who were aged 21 to 65, uninsured or under-insured, and due for cervical cancer screening, excluding women with a history of cervical cancer or hysterectomy. Eligible participants first were enrolled in the control group (n=299); these participants completed baseline and follow-up surveys and did not receive any intervention components until after the intervention group (n=300) completed the baseline survey, intervention, and follow-up surveys. 

Across the two groups, the average age of participants was 44.7 years; 98% identified as Hispanic, 79% were born in Mexico, and 86% had a Spanish language preference. The following statistically significant group differences were identified at baseline between the control and intervention groups: Hispanic ethnicity, health status, birth in Mexico, Spanish language preference, acculturation, and marital status. 

At 4-month follow-up, participants reported if they completed a cervical cancer screening.

• The cervical cancer screening rate was higher in the intervention group (62.7%) than in the control group (4.4%) at 4-month follow-up (p<.001).