title: A community-based randomized trial of a faith-placed intervention to reduce cervical cancer burden in Appalachia.
abstract: OBJECTIVE
  Faith Moves Mountains assessed the effectiveness of a faith-placed lay health advisor (LHA) intervention to increase Papanicolaou (Pap) test use among middle-aged and older women in a region disproportionately affected by cervical cancer and low screening rates (regionally, only 68% screened in prior 3 years).
  
  
  METHODS
  This community-based RCT was conducted in four Appalachian Kentucky counties (December 2005-June 2008). Women aged 40-64 and overdue for screening were recruited from churches and individually randomized to treatment (n=176) or wait-list control (n=169). The intervention provided LHA home visits and newsletters addressing barriers to screening. Self-reported Pap test receipt was the primary outcome.
  
  
  RESULTS
  Intention-to-treat analyses revealed that treatment group participants (17.6% screened) had over twice the odds of wait-list controls (11.2% screened) of reporting Pap test receipt post-intervention, OR=2.56, 95% CI: 1.03-6.38, p=0.04. Independent of group, recently screened participants (last Pap >1 but <5 years ago) had significantly higher odds of obtaining screening during the study than rarely or never screened participants (last Pap ≥5 years ago), OR=2.50, 95% CI: 1.48-4.25, p=0.001.
  
  
  CONCLUSIONS
  The intervention was associated with increased cervical cancer screening. The faith-placed LHA addressing barriers comprises a novel approach to reducing cervical cancer disparities among Appalachian women.
authors.affiliation: Department of Behavioral Science, University of Kentucky, Lexington, KY 40536-0086, USA. tina.studts@uky.edu
authors.forename: Christina R
authors.initials: CR
authors.lastname: Studts
authors.forename: Yelena N
authors.initials: YN
authors.lastname: Tarasenko
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Schoenberg
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Shelton
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hatcher-Keller
authors.forename: Mark B
authors.initials: MB
authors.lastname: Dignan
mesh_terms: D000328:Adult; D001061:Appalachian Region; D003150:Community Health Workers / Q000706:statistics & numerical data; D055812:Community-Based Participatory Research; D017281:Cost of Illness; D029221:Faith Healing / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007629:Kentucky; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D000073718:Pancreatitis-Associated Proteins; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D010353:Patient Education as Topic; D018579:Patient Selection; D012923:Social Class; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D014626:Vaginal Smears / Q000523:psychology / Q000706:statistics & numerical data*; D014850:Waiting Lists