Cultural constructs critical to breast and cervical cancer interventions for diverse Latino communities

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The higher incidence of cervical cancer, higher mortality rate for breast cancer and lower cancer screening rates for Latinas in the U.S., has drawn attention to developing better methods to increase cervical and breast screening and reduce these disparities. Moreover, little research has examined differences by ethnic subgroup within this diverse group labeled “Hispanic/Latino.” The purpose of this study was to develop a culturally competent community-based breast and cervical cancer screening intervention that would produce positive behavior change in diverse groups of Latinas in Arkansas and New York. It was hypothesized that there would be measurable variation by country of origin, and therefore different program requirements for various groups across the Hispanic population. The first phase of the study was to define and classify variations in critical cultural constructs for Mexican, Dominican, and Puerto Rican women. Methods included qualitative findings derived from 13 focus groups consisting of 112 women in New York City (9 groups) and sites in Arkansas (4 groups), followed by analysis using the PEN-3 model (Airhihenbuwa 1992). Analysis of the findings demonstrated that Mexican (n=50) and Dominican (n=29) women indicated the lowest level of knowledge and understanding about anatomy and cancer screening procedures, assumed death as a consequence, experienced diminished power, expressed lack of support from spouses/partners regarding any type of health screening, and had significant access and conceptual challenges with the medical system due to cultural and language barriers. All three subgroups reported the primacy of God in their lives and the reliance on other women for their support system. Mexican women residing in rural areas reported local churches as greater sources of trustworthy resources for health information than any Latina women residing in New York City area. These critical constructs were incorporated into the intervention protocol in the following ways: a) focusing a significant time (>1.5 hours) on basic education and information related to breast and cervical anatomy, and screening procedures; b) including narratives by breast and cervical cancer survivors to demonstrate survivability; c) crafting the program to include and be promoted for Latino men and women rather than just women; d) allowing questions and discussion to be conducted in gender-specific groups; e) conducting programs, especially in urban areas, in a variety of secular community locations; and f) providing navigational resources to mediate access and language barriers. The intervention program, named Esperanza y Vida (Hope and Life), has been offered to 847 Latino participants, and consent and data were collected on 669 participants from 69 programs in Arkansas (n=373) and New York City (n=296). Baseline knowledge scores were the lowest and post-intervention knowledge scores increased the most for Mexican (45% to 63% correct) and Dominican (55% to 79% correct) women compared with Puerto Rican (63% to 77%) women. Mexican participants averaged the fewest years in U.S. This presentation will apply these results to demonstrate ways to tailor screening interventions in light of critical cultural constructs for diverse Latino communities. Additional results on Pap screening outcomes from this intervention are presented in a separate abstract.