Evidence-based intervention to reduce access barriers to cervical cancer screening among underserved Chinese American women

Objective: The primary objective of the present study was to evaluate the effects of a community-based pilot intervention that combined cervical cancer education with patient navigation on cervical cancer screening behaviors among Chinese American women residing in New York City. Methods: Chinese women (n=134) who had not had a Pap test within the previous 12 months were recruited from four Asian community-based organizations (CBOs). Women from two of the CBOs received the intervention (n=80) consisting of education, interaction with a Chinese physician, and navigation assistance, including help in identifying and accessing free or low-cost screening services. The control group (n=54) received education delivered by Chinese community health educators and written materials on general health and cancer screening, including cervical cancer, the Pap test, and information about sites that provided free screening. Study assessments were obtained in-person at baseline and postintervention. Screening behavior was self-reported at 12-month postintervention and verified by medical staff. Results: In the 12-month interval following the program, screening rates were significantly higher in the intervention group (70%) compared to the control group (11.1%). Hierarchical logistic regression analyses indicated that screening behavior was associated with older age (OR=1.08, 95% CI=1.01-1.15, p<.05). In addition, women with poorer English language fluency (OR=0.30, 95% CI=0.10-0.89, p<.05) and who did not have health insurance were less likely to obtain screening (OR=0.15, 95% CI=0.02-0.96, p<.05). Among health beliefs, greater perceived severity of disease was positively associated with screening behavior (OR=4.26, 95% CI=1.01-18.04, p<.05). Conclusions: Community-based programs that provide combined education and patient navigation may be effective in overcoming the extensive linguistic and access barriers to screening faced by Chinese American women.