title: Evaluating the efficacy of lay health advisors for increasing risk-appropriate Pap test screening: a randomized controlled trial among Ohio Appalachian women.
abstract: BACKGROUND
  Cervical cancer is a significant health disparity among women in Ohio Appalachia. The goal of this study was to evaluate the efficacy of a lay health advisor (LHA) intervention for improving Papanicolaou (Pap) testing rates, to reduce cervical cancer, among women in need of screening.
  
  
  METHODS
  Women from 14 Ohio Appalachian clinics in need of a Pap test were randomized to receive either usual care or an LHA intervention over a 10-month period. The intervention consisted of two in-person visits with an LHA, two phone calls, and four postcards. Both self-report and medical record review (MRR) data (primary outcome) were analyzed.
  
  
  RESULTS
  Of the 286 women, 145 and 141 were randomized to intervention and usual care arms, respectively. According to MRR, more women in the LHA arm had a Pap test by the end of the study compared with those randomized to usual care (51.1% vs. 42.0%; OR = 1.44, 95% CI: 0.89-2.33; P = 0.135). Results of self-report were more pronounced (71.3% vs. 54.2%; OR = 2.10, 95% CI: 1.22-3.61; P = 0.008).
  
  
  CONCLUSIONS
  An LHA intervention showed some improvement in the receipt of Pap tests among Ohio Appalachian women in need of screening. Although biases inherent in using self-reports of screening are well known, this study also identified biases in using MRR data in clinics located in underserved areas.
  
  
  CONCLUSIONS
  LHA interventions show promise for improving screening behaviors among nonadherent women from underserved populations.
authors: Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43201, USA. Electra.Paskett@osumc.edu
authors: Electra D
authors: ED
authors: Paskett
authors: John M
authors: JM
authors: McLaughlin
authors: Amy M
authors: AM
authors: Lehman
authors: Mira L
authors: ML
authors: Katz
authors: Cathy M
authors: CM
authors: Tatum
authors: Jill M
authors: JM
authors: Oliveri
mesh_terms: D000293:Adolescent; D000328:Adult; D001061:Appalachian Region; D003150:Community Health Workers / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D009820:Ohio; D065006:Papanicolaou Test; D012107:Research Design; D018570:Risk Assessment; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology*; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D014932:Women's Health Services; D000078329:Workforce; D055815:Young Adult