A community intervention to increase cervical cancer screening among Korean women.

B37

Despite the proven survival benefits associated with cervical cancer screening, utilization of the Pap test continues to be suboptimal in certain populations. Asian Americans have the lowest rates of screening compared to all other ethnic/racial groups. Yet Asian Americans, who comprise one of the fastest growing populations in the U.S., have received the least attention in cancer control research. Objective: Korean American women, in particular, have very low rates of screening. Thus, the purpose of this study was to evaluate a culturally-appropriate cervical cancer screening intervention for Korean women. The multifaceted intervention was guided by Social Cognitive Theory and the Health Belief Model and was designed to target both individual-level factors (e.g., health beliefs) and system-level barriers. Methods: Using a community-based approach, we developed an educational curriculum and behavioral intervention, which was then evaluated among 102 women recruited from Korean community organizations. Women assigned to the intervention group (n = 52) received cervical cancer education delivered by Korean health educators, written handouts, and a Korean-language video. Assistance with arranging appointments and language translation was provided upon request. The control group (n = 50) received written materials on general health and cancer screening, including the Pap test. Psychosocial beliefs and access barriers were measured at baseline (pre-intervention) and post-intervention. Screening behavior was assessed at 6-months post-intervention and verified by medical chart review. Results: At baseline, 17% of all women reported having had a Pap test in the past year. The intervention program was associated with screening uptake, χ2(1) = 41.22, p < .01. A significant increase in screening was observed in the intervention group (from 12% to 83%), but not in the control group, which remained stable at 22%. In addition, significant increases in self-efficacy and decreases in barriers to screening were observed in the intervention group (p < .01), but not in the control group. To examine whether health beliefs and barriers were associated with screening uptake, multivariate logistic regression analyses were conducted with screening behavior as the outcome variable. Controlling for age, education, and number of years in the U.S., results indicated that women who reported fewer psychosocial barriers (e.g., embarrassment) were more likely to be screened (OR = 1.80, 95% CI = 1.04-3.12). Similarly, having fewer language barriers was associated with screening uptake (OR = 2.10, 95% CI = 1.13-3.91). Conclusion: The findings highlight the need to address both individual- and system-level barriers to screening. Our program provides a model for collaborating with community-based organizations to deliver cancer prevention education and to enhance utilization of cancer screening services in underserved communities.