Assessing promotoras as an intervention to increase cervical cancer screening in a community-based participatory randomized control trial with Latinas in urban South Florida

Background: Cervical cancer disproportionately affects Latinas. Promotoras are a promising approach to increase screening, but evidence from rigorous randomized studies is limited. Our goal is to assess the effectiveness of a promotora-led intervention and determine if an HPV self-sampler test is of incremental benefit. Methods: We are conducting an RCT of 600 Haitian, Black, and Hispanic women who have not been screened for cervical cancer within 3 years. CBPR principles guided the design and conduct of the study in 3 target communities; one being Hialeah (90% Latino). The study arms are: a) standard educational materials (control) b) home-based promotora education and navigation c) promotora-faciliated HPV self-sampling. Findings: Community partnership activities have enhanced researchers' ability to understand community priorities and engage in fruitful dialogue. Hiring our 3 promotoras through community health centers and regular meetings of our Community Advisory Boards have facilitated (a) the exchange of information and resources, (b) the development of culturally, linguistically, and community responsive cancer education initiatives. In 4 months, the promotoras have evaluated over 500 women in the target communities. Over 33% of the women approached had not been adequately screened, including 20% of Latinas. CHWs have identified 181 women who are eligible and willing to participate; 55 have already been randomized (of these 20 are Latinas or 37%). Conclusion: CBPR principles are critical in planning and implementing such rigorous studies in ethnically diverse and underserved communities. Promotoras can efficiently identify a large sample of underserved minority women for inclusion in an RCT of cancer screening.