Developing and pretesting cervical cancer education tools with promotoras de salud

Background: Salud es Vida is a community-based research project aimed to develop theory-based, lay health worker (promotora) curriculum modules and flip-charts for Hispanic farmworker women on cervical cancer, HPV, and the HPV vaccine working collaboratively with an established local nonprofit and a group of promotoras in rural, southern Georgia. Methods: Draft curriculum modules were pilot tested with seven volunteer promotoras for readability, attractiveness, content, comprehension, cultural appropriateness, persuasion, organization, balance between didactic and participatory activities, and ease of diffusion to community members. The curriculum content and delivery was evaluated through a 20-item pre-test/post-test instrument and a post-training focus group, written evaluations, and telephone exit interviews. Results: There was significant increase in post-training cervical cancer knowledge based on an average pre-test score of 66.4%, and an average post-test score of 80.0% (p < 0.05). The focus group discussion and exit interviews highlighted particular cultural barriers for cervical cancer screening, such as embarrassment, fear of the procedure, or not having permission from husbands to go to the clinic. The promotoras were eager to share the information they learned, assuage fears related to screening, and inform others about preferred health care providers. Based on ease of administration, the study team is adapting the curriculum to a flip-chart format to facilitate the delivery of promotora-led classes. Conclusion: Peer-led education on cervical cancer prevention is needed for low-income, Hispanic farmworker women in newer immigrant-receiving areas of the United States where there are fewer Spanish-speaking health professionals to connect women to health services.