AMIGAS: Testing an intervention to increase cervical cancer screening in Hispanic women

Hispanic women in the United States have higher rates of cervical cancer morbidity and mortality, and lower rates of cervical cancer screening than non-Hispanic whites. The AMIGAS intervention is a promotora-led intervention developed with the involvement of the community to increase cervical cancer screening in Hispanic women. The objective of our study was to test the efficacy of the AMIGAS program for increasing cervical cancer screening in three populations of women of Mexican origin (US/Mexico border, urban, and rural) using a controlled randomized design. In this multi-site (El Paso, Houston and Yakima Valley) study, 600 women were randomly assigned to one of four study arms: the full AMIGAS program delivered in the home by a trained promotora (150); the AMIGAS program without the video delivered in the home by a trained promotora (150); the AMIGAS program without the flipchart delivered in the home by a trained promotora (150); and the usual care control group (150). Women in the control group received the usual education about cervical cancer screening delivered by clinics and media. Overall, 29% of women in the control group and 62% of women in the full AMIGAS group received cervical cancer screening 6 months after entry into the study (p<0.001). The AMIGAS program minus the video and minus the flipchart were also significantly different from the controls (51% and 56% respectively; p<0.001). This intervention was found to be very effective in our communities. We believe that the involvement of the community in the development of the materials and the use of trained promotores de salud to deliver the intervention helped to assure efficacy, and this model may be useful for others working in Hispanic communities.