Promotora intervention to reduce cervical cancer disparities in Latinas

Cervical cancer disproportionately affects U.S. Latina women, with incidence and mortality rates almost twice that of white women. Community health workers (CHWs), often called promotoras in Latino communities, provide one potential model for reducing cervical cancer disparities. We recruited 4 promotoras to lead 2, 180-minute workshops with community members about cervical cancer. This study is a randomized trial of this educational intervention, with 60 participants in each arm. Cervical cancer risk, previous screening history, baseline cervical cancer knowledge, and self-efficacy were measured by a pre-intervention questionnaire. The post-intervention questionnaire measured the following outcomes: cervical cancer knowledge, self-efficacy, and receipt of Pap smear screening during the previous 6 months. Univariate analyses were performed using chi square, t-test, and the Mann-Whitney test. There were no statistically significant differences between the 2 experimental groups at baseline, including the proportion of women who received Pap smear screening, cervical cancer knowledge (on a 0-6 scale), and self-efficacy (on a 0-6 scale). Follow-up data revealed significant improvements in all outcome measures: Pap smear screening (65% vs. 36%, p-value 0.02), knowledge (5.4 vs. 3.5, p-value 0.02), and self-efficacy (4.7 vs. 4.0, p-value 0.01). Many healthcare stakeholders have advocated for CHWs to reduce health disparities and lower healthcare costs. However, there is a paucity of rigorous data to support such recommendations. Our randomized trial of a promotora-led educational intervention demonstrated potential for reducing disparities. Future research should evaluate such programs on a larger scale, and explore factors that predict cervical cancer screening to identify novel targets for intervention.