Abstract
Introduction: This study highlights results of the adaptation and implementation of the “Con Amor Aprendemos” (CAA) education intervention in El Salvador, illustrating how the CAA program effectively increased participants' knowledge and modified behavior.
Cervical cancer has the highest incidence and mortality rates of all cancers affecting Salvadoran women. The associated morbidity and mortality is disconcerting since the majority of cervical cancer cases could be prevented through an organized screening program and use of the human papillomavirus (HPV) vaccine. Educational interventions targeting community leaders, women, and their male partners play a key role in improving acceptability of these medical interventions and allow for a higher uptake of services.
Methods: CAA is a seven-week faith-based education intervention designed to reduce HPV-related disease in Latino populations. Instructors are trained in two-day workshops and deliver CAA through faith-based organizations. Culturally engaging, learner-center activities address issues such as cervical cancer prevention, screening, diagnosis and treatment to promote self-efficacy in health-related decision-making.
Cultural differences with Latino populations outside the US required adaptation of the intervention. A committee of health care providers, community health and faith-based leaders in El Salvador reviewed the CAA program and offered recommendations for modification.
187 individuals were trained as CAA instructors and 1,296 community members participated in the intervention between 2011 and 2013. All program participants were recruited through a network of churches.
Pre- and post-intervention evaluations were used to assess the overall impact of CAA on participants' knowledge and behavior. To assess long-term knowledge retention and behavior change, a knowledge, attitudes, and practices (KAP) survey was developed in July 2012 to re-evaluate a cohort of past CAA participants six to 12 months post-intervention.
Results: Focus group discussions addressing modifications for implementation of CAA in El Salvador highlighted the need to change terminology in the program manual; disseminate CAA through the faith-based community; and integrate the health care system as a referral center for delivery of medical services. All recommended changes were implemented.
The pre- and post-intervention evaluation was given to all 1,296 CAA program participants. There were statistically significant changes in the ability to label female reproductive anatomy and significant increases in knowledge about HPV and cervical cancer. For example, the number of people correctly responding to the statement “HPV infection can cause cervical cancer.” increased from 47.0% on the pre-test to 85.2% on the post-test. The KAP survey affirmed that the knowledge of CAA participants was sustained over time. Stratifying data by age, gender, income, and education did not significantly impact results.
Discussion: CAA greatly enhances the knowledge of participants and emphasizes the importance of educating couples. According to the Guide to Community Preventive Services, additional evidence is needed to demonstrate the effectiveness of group-based education for cancer prevention. Evaluation studies such as this are important to build evidence for the impact of group-based education programs on cervical cancer knowledge and screening behavior. CAA helps to enhance public health literacy and increase uptake of medical services, thereby preventing the morbidity and mortality associated with cervical cancer.
Citation Format: Lisa C. Flowers, MD, Logan J. Kirsch, MPH, CHES, Cam Escoffery, PhD, MPH, CHES. An evaluation of the “Con Amor Aprendemos” cervical cancer education intervention for Latino couples in El Salvador. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A52. doi:10.1158/1538-7755.DISP13-A52
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