Evaluating the stage of change model to a cervical cancer screening intervention among Ohio Appalachian women

Background: Cervical cancer incidence and mortality rates are disproportionally higher among women living in Ohio Appalachia.  Lay health advisor (LHA) interventions among underserved populations have been successful because they typically use trusted community members who serve as a liaison to the health care system and provide information, support, and encouragement.

Purpose:  To describe the Transtheoretical Model staging before and during a LHA intervention to increase cervical cancer screening rates, and explore the role of reported barriers on stage of change.

Methods: Ohio Appalachian women (n=90) who were in need of a Pap test were randomized to a 10-month LHA intervention which consisted of two in-person visits, two phone calls, and four mailed postcards targeted to the participant’s stage of change.

Results: Sixty-three percent of participants had forward stage movement after the intervention. The most common reported screening barriers were time constraints, forgetting to make an appointment, and cost. Women reporting the following barriers: doctor not recommending the test, unable to afford the test, and being embarrassed, nervous, or afraid of getting a Pap test were less likely to be in the action stage.

Conclusions:  Relative to usual care, LHAs accelerate patient movement up the stages of change related to Pap smear testing and help patients to successfully address reported barriers among this underserved population.