A Multifaceted Culturally Appropriate Intervention to Increase Cervical Cancer Screening among Vietnamese Americans

Background: Vietnamese American women represent the ethnic subgroup at greatest risk for cervical cancer, but have the lowest cervical cancer screening rates.

Objective: To evaluate the impact of a multifaceted community-based participatory intervention on increasing cervical cancer screening and reducing healthcare access barriers among medically underserved and low income Vietnamese women.

Methods: This was a community-based group randomized controlled trial, built on our success in pilot studies among Vietnamese and other Asian Americans. Vietnamese women (n=1,450) were recruited into the study from 30 Vietnamese community-based organizations in U.S. mid-Atlantic region, 15 sites were assigned as culturally appropriate intervention group and the other 15 as control. The intervention group received Vietnamese community health educator-led group cervical cancer education, client-physician interaction, and patient navigation. The control group received general cancer education, including cervical cancer and screening. Assessments including screening behavior were obtained at baseline, postintervention and12 months.

Results: At 12 months postintervention, 60.1% of the women in the intervention group had obtained screening compared with 1.6% in the control group. The difference was 58.5% (95% CI: 44.7-72.3%), P < 0.001. The difference of Pap test rates adjusted from a GLIMMIX covariate model was 64%, similar to the difference of unadjusted raw rates. The covariate adjusted odd ratio is 191 (95% CI: 171-212).

Conclusion: A multifaceted intervention emphasizing both individual and healthcare system access barriers resulted in significantly increased cervical cancer screening rates. Future studies should focus on testing the adherence of Pap test and other cervical cancer tests among Vietnamese Americans.