title: Interventions that increase use of Pap tests among ethnic minority women: a meta-analysis.
abstract: OBJECTIVE
  Although a variety of intervention methods have been used to promote Pap test screening among ethnic minority women in the US, the effectiveness of such interventions is unclear. We performed a meta-analysis to examine the overall effectiveness of these interventions in increasing Pap test use by ethnic minority women in the US.
  
  
  METHODS
  A search of databases (MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Science Citation Index-Expanded) and review articles for articles published between 1984 and April 2009 identified 18 randomized and non-randomized controlled trials. The primary study outcome was the difference in the proportion of Pap tests between the treatment and comparison groups.
  
  
  RESULTS
  The pooled mean weighted effect size (d) for the 18 studies was 0.158 (95% confidence interval [CI]=0.100, 0.215), indicating that the interventions were effective in improving Pap test use among ethnic minority women. Among the intervention types, access enhancement yielded the largest effect size (0.253 [95% CI=0.110, 0.397]), followed by community education (0.167 [95% CI=0.057, 0.278]) and individual counseling or letters (0.132 [95% CI=0.069, 0.195]). Combined intervention effects were significant for studies targeting Asian (0.177 [95% CI=0.098, 0.256]) and African American women (0.146 [95% CI=0.028, 0.265]), but not Hispanic women (0.116 [95% CI=-0.008, 0.240]).
  
  
  CONCLUSIONS
  Pap test use among ethnic minority women is most likely to increase when access-enhancing strategies are combined. Further research is needed to determine whether more tightly controlled trials of such interventions might reveal an improved rate of cervical cancer screening in Hispanic women as well.
authors.affiliation: The Johns Hopkins University, School of Nursing, Baltimore, MD 21205-2110, USA. hhan@son.jhmi.edu
authors.forename: Hae-Ra
authors.initials: HR
authors.lastname: Han
authors.forename: Jiyun
authors.initials: J
authors.lastname: Kim
authors.forename: Jong-Eun
authors.initials: JE
authors.lastname: Lee
authors.forename: Haley K
authors.initials: HK
authors.lastname: Hedlin
authors.forename: Heejung
authors.initials: H
authors.lastname: Song
authors.forename: Youngshin
authors.initials: Y
authors.lastname: Song
authors.forename: Miyong T
authors.initials: MT
authors.lastname: Kim
mesh_terms: D005260:Female; D006801:Humans; D008913:Minority Groups; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data*