Esperanza y Vida: A Culturally and Linguistically Customized Breast and Cervical Education Program for Diverse Latinas at Three Different United States Sites (original) (raw)
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Progress in Community Health Partnerships: Research, Education, and Action, 2008
H ispanics/Latinas (referred to as Latinas throughout this paper) in the United States have higher morbidity and mortality rates for breast and cervical cancer than do non-Hispanic Whites. Studies show this may be due to lower screening rates and that culturally appropriate interventions may improve these rates. The Centers for Disease Control and Prevention data from 11 geographic areas indicate that, despite an overall decrease in the rate of new cases of invasive cervical cancer, rates for Latinas are about twice as abstract Background. Latinas in the United States have higher morbidity and mortality rates for breast and cervical cancers (compared with non-Latina Whites), often due to lower screening rates. A community-based participatory research (CBPR) approach could help to improve screening rates by creating a culturally customized educational program for Latino men and women addressing low knowledge, gender roles, and spirituality.
American Journal of Public Health, 2009
Although incidence and mortality rates for breast cancer are lower among Hispanic women than among non-Hispanic women, Hispanic women are more likely to be diagnosed at a later stage of the disease and have lower survival rates. 1-6 Cervical cancer incidence and mortality rates are nearly twice as high for Hispanic women as they are for non-Hispanic White women; in addition, Hispanic women are diagnosed at later stages and have poorer survival rates. Lower levels of cancer screening among Hispanic women are the result of psychosocial factors including fear of cancer, invasive procedures, and pain; lack of knowledge about cancer and its screening methods; attitudes of fatalism; religious or spiritual beliefs; concerns over confidentiality; language barriers and perceived discrimination; embarrassment; and partner disapproval. 1,7-24 External factors also influence screening, such as a lack of health insurance, regular sources of health care, and physician referral; transportation barriers; cost; and restrictive work policies. 7-12, 14, 15,25-38 Successful cancer-control programs for Hispanic women have used (1) Spanish-language media; (2) role models appearing in mass media (newspapers, television) with social reinforcement by community volunteers; (3) ''small media,'' such as videos delivered in group settings or kiosks; (4) multimethod approaches; and (5) lay health workers or promotoras. [38] The lay health worker or promotora model, which was first developed in Latin America, is a peer health education model whereby respected community members educate peers in a culturally appropriate manner. A recent Cochrane review documented the effectiveness of lay health worker programs for increasing immunization uptake, promoting breastfeeding, improving tuberculosis outcomes, and reducing morbidity and mortality as the result of childhood illnesses. 50,51 In another systematic review, the US Preventive Services Task Force identified 1-on-1 education as an effective strategy for increasing both breast and cervical cancer screening. 52 The task force was unable to make a recommendation about the use of lay health worker programs specifically because there were insufficient numbers of published studies evaluating their effectiveness.
Journal of Racial and Ethnic Health Disparities, 2014
Objectives Interventions are needed to reduce disparities in breast and cervical cancer (BCC) for Latinas in the USA. This study compares screening adherence between two educational outreach messages followed by navigation support to increase BCC screening for Latinas. Methods A cluster-randomized study (by group) of 1,333 diverse Latinas in Arkansas, Buffalo, and New York City (2007-2009) attending group educational programs on cancer or diabetes screening was conducted. Screening adherence by each program type was analyzed at 2 months followed by analysis of navigation support for non-adherent women at 8 months. Results Participation in educational programs alone significantly increased mammography (O.R.=2.16), clinical breast exams (O.R.=2.14), and Pap tests (O.R.=2.14) from baseline to 2 months with no significant differences by message type. Screening further increased with the addition of navigation. Conclusions Specific health messaging may not be as critical to increasing BCC screening behaviors as cultural-and language-specific outreach into the community disseminating resources about accessing services. Moreover, the addition of navigation services and, potentially, the time lapse between follow-up intervals, significantly increased screening regardless of country of birth, documentation status, insurance status, or geographic location.
From ethnography to intervention: developing a breast cancer control program for Latinas
Journal of the National Cancer Institute. Monographs, 1995
Latinas are less likely than Anglo women to have appropriate breast cancer screening for reasons that may include culturally based beliefs as well as socioeconomic factors. This study employed ethnographic methods to explore breast cancer-related knowledge, attitudes, and behaviors among Latinas, Anglo women, and physicians, tested the generalizability of the findings in a telephone survey of randomly selected women, and used the results to design a culturally sensitive breast cancer control intervention in Orange County, Calif. Respondents for the ethnographic interviews included 28 Salvadoran immigrants, 39 Mexican immigrants, 27 Chicanas (U.S.-born Latinas of Mexican heritage), 27 Anglo women, and 30 physicians selected through organization-based network sampling. Latinas had very different beliefs about risk factors for breast cancer and held more fatalistic attitudes about the disease. For example, they believed that trauma to the breast was among the most important risk factor...
Hispanic Women's Breast and Cervical Cancer Knowledge, Attitudes, and Screening Behaviors
American Journal of Health Promotion, 2000
Purpose. This study examined breast and cervical cancer knowledge, attitudes, and screening behaviors among different Hispanic populations in the United States. Design. Data were collected from a random digit dial telephone survey of 8903 Hispanic adults from eight U.S. sites. Across sites, the average response rate was 83%. Setting. Data were collected as part of the baseline assessment in a national Hispanic cancer control and prevention intervention study. Subjects. Analysis was restricted to 2239 Hispanic women age 40 and older who were self-identified as either Central American (n = 174), Cuban (n = 279), Mexican American (n = 1550), or Puerto Rican (n = 236). Measures. A bilingual survey instrument was used to solicit information on age, education, income, health insurance coverage, language use, U.S.-born status, knowledge of screening guidelines, attitudes toward cancer, and screening participation. Differences in knowledge and attitudes across Hispanic groups were assessed ...
A cancer screening intervention for underserved Latina women by lay educators
Objectives: Inadequate screening adherence for breast, cervical, and colorectal cancer among Latinas places them at greater risk for poor survival rates, once diagnosed. The purpose of this study was to examine two delivery methods of lay health educators ( promotoras de salud) to increase screening behavior and evaluate costs. Methods: This community-based group randomized trial assigned Latinas due for breast, cervical, or colorectal cancer screening (n = 1006) to promotora-taught cancer screening/prevention classes delivered individually (IND) or in social support groups (SSG) over 8 weeks. Screening behaviors were assessed immediately after and 3 and 15 months after intervention. Intervention costs per study arm were compared. Results: Screening and maintenance behaviors were not significantly different between SSG and IND for any one type of cancer screening, but with a study entry requirement that participants were either never screened or due for screening, postintervention screening rates (that is, completing a screening that was due) were notable (39.4% and 45.5%, respectively). The cost of achieving any one screening was much higher for IND participants. Conclusions: SSG vs. IND delivery did not significantly affect cancer screening behaviors, but both interventions produced robust achievement of screenings for previously nonadherent participants. Group-based promotora-led interventions supporting social involvement are recommended as a more cost-effective approach to achieving cancer screening among Latina women.
Purpose: Although deaths from cervical cancer are declining, Latinas are not benefiting equally in this decline. Incidence of invasive cervical cancer among Los Angeles', California Latinas is much higher than among non-Latina Whites (14.7 versus 8.02 per 100,000). This paper examines cervical cancer screening among Latinas. Methods: Ninety-seven women of Mexican origin participated in 12 focus groups exploring barriers to screening. Saturation was reached. Results: All participants knew what a Pap test was and most knew its purpose. More acculturated participants understood the link between HPV and cervical cancer. More recent immigrants did not. There was confusion whether women who were not sexually active need to be screened. Most frequently mentioned barriers were lack of time and concern over missing work. Lower income and less acculturated women were less likely to be aware of free/lowcost clinics. Older and less acculturated participants held more fatalistic beliefs, were more embarrassed about getting a Pap test, were more fearful of being perceived as sexually promiscuous, and were more fearful of receiving disapproval from their husbands. Conclusions: Latinas are informed regarding cervical cancer screening; rather they encounter barriers such as a lack of time, money and support. Health promotion interventions can be enhanced via peer-to-peer education, by addressing barriers to cervical cancer screening with in-language, culturally tailored interventions, and working with clinics on systemic changes, such as extended clinic hours.
CAPRELA (Cancer Prevention for Latinas): Findings of a Pilot Study in Winston-Salem, Forsyth County
North Carolina medical journal, 2006
Objective: To evaluate knowledge and attitudes that affect cervical and breast cancer screening among uninsured Hispanic women. Study Design: Cross-sectional, descriptive study of uninsured Latino women in Forsyth County, North Carolina. Data Sources/Study Setting: A convenience sample of Hispanic women who immigrated to the United States within the last ten years, primarily from Mexico (N = 70). Data Collection Methods: Two trained lay health advisors (promotoras) administered in-person, structured surveys to 70 women in the community. All interviews were conducted in Spanish. Additionally, two focus groups were conducted in Spanish to elucidate cultural beliefs and barriers to cancer screening not otherwise captured in the standardized surveys. Quantitative data were analyzed using logistic regression analysis. Qualitative data were transcribed and analyzed using a multi-step framework approach to identify and validate themes. Principal Findings: Of 70 women, 42 (60%) reported a Pap smear within the last year; 26 (37%) reported two exams within the past three years. Among women aged 40 and older, 10 of 18 (56%) reported ever having a mammogram. Being married (OR=4.05, CI 1.07-15.25) and having the same healthcare provider (OR 5.64, CI 1.04-30.56) predicted better Pap smear screening in multivariate analyses. Limited knowledge about breast cancer and needing an interpreter to communicate reduced the likelihood that women received a mammogram. Qualitative results indicated that women had poor prior experiences with Pap smears, held several misconceptions about cancer etiology and risk factors, and expressed distinct gender roles for Latina women and men that may affect healthcare utilization. Conclusions: Screening rates for cervical and breast cancer are low among uninsured Latina women. Therefore, community and clinic-based interventions are needed to improve underutilization of and satisfaction with cancer screening practices among uninsured Latina women.
Journal of Racial and Ethnic Health Disparities, 2015
This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targeting HL, women's health, BC risk reduction, and patient-provider communication; sessions include cooking demonstrations of recipes with cancer-risk-reducing ingredients. A pilot study with 47 community health center Latina patients was conducted to examine the program's acceptability, feasibility, and ability to impact knowledge and skills. Preand post-analyses demonstrated that participants improved their self-reported cancer screening, BC knowledge, daily fruit and vegetable intake, and ability to read a nutrition label (p<0.05). Results of the pilot study demonstrate the importance of utilizing patient-centered culturally appropriate noninvasive means to educate and empower Latina patients.
Journal of Health Care for the Poor and Underserved, 2016
Objective-Although cervical cancer can be prevented through screening and follow-up, Latinas' rate of Pap tests remains low due to knowledge gaps and cultural and attitudinal factors. Methods-This study used a single-group pre-/post-test design to evaluate the effectiveness of Mujer Sana, Familia Fuerte (Healthy Woman, Strong Family), an intervention intended to improve Latinas' cervical cancer prevention knowledge, attitudes, self-efficacy to obtain a Pap test, and intention to get tested. The intervention is delivered through a single session by promotores de salud, who use a culturally competent, linguistically appropriate toolkit. A total of 5,211 Latinas participated in the study. Results-The evaluation indicated that participants had increases in knowledge, positive attitudes, self-efficacy, and intention to test. Conclusion-Latinas have a low rate of cervical cancer screening but a high rate of cervical cancer, and Mujer Sana, Familia Fuerte shows promise as a public health practice for use with this population.