title: CBPR-Informed Recruitment and Retention Adaptations in a Randomized Study of Pap Testing Among Pacific Islanders in Southern California.
abstract: BACKGROUND
  Pacific Islanders (PIs) experience high cervical cancer rates in the United States. Stage of diagnosis is also later for PIs than non-Hispanic Whites. The Pap test is severely underutilized among PIs: only 71% of Asian American and Pacific Islander women age 25 years or older received a Pap test within the last 3 years (U.S. average, 82%). Community-based participatory research (CBPR) is increasingly seen as an essential approach in designing and conducting culturally relevant and appropriate studies that reduce cancer incidence and other health disparities among minority and other medically underserved populations.
  
  
  OBJECTIVE
  The purpose of this article is to describe the lessons learned thus far regarding the identification, recruitment, and retention of PI community organizations and members into a CBPR-informed, randomized, community trial promoting Pap testing.
  
  
  METHODS
  This 5-year study used CBPR to develop and test the efficacy of a social support intervention for Chamorro, Samoan, and Tongan women to increase Pap testing in southern California. Eligible women were between the ages of 21 and 65, and married or in a long-term relationship with a man for at least 5 years. Women and their husbands or significant others received a 2-hour, culturally tailored workshop that include a group activity, information on Pap testing, a video, and corresponding materials. Comparison participants received a brochure about Pap testing. Three waves of data are collected from all participants: pretest (before workshop or brochure), posttest 1 (immediately after workshop or brochure), and posttest 2 (6 months follow-up).
  
  
  RESULTS
  Of the 76 organizations approached to participate in the study, 67 (88.2%) eventually agreed to participate. Thus far, 473 women and 419 men completed the study pretest, post-test, education, and 6-month follow-up. Only 242 women and 204 men of the eligible participants have completed the follow-up survey (63.5% of women and 60.5% of men retained after 6 months).
  
  
  CONCLUSIONS
  The main strategy to overcome initial recruitment challenges was study staff persistence, because they averaged five contacts with each church or clan leader before receiving confirmation that an educational session can be scheduled. Personal connections provided an introduction to the most appropriate church or clan leader. Other efforts for retention include creation of an online version of the survey, re-attending church services, and creating special events organized around clan activities.
  
  
  CONCLUSIONS
  Although CBPR improves the cultural competence and relevance of study activities for ethnically diverse populations, selected past research shows that it does not ensure that such designs overcome all of the unique challenges in ethnically diverse communities. PI-specific organizational recruitment and individual retention is influenced by study issues and cultural factors in each community.
authors.forename: Sora Park
authors.initials: SP
authors.lastname: Tanjasiri
authors.forename: Jie W
authors.initials: JW
authors.lastname: Weiss
authors.forename: Lola
authors.initials: L
authors.lastname: Santos
authors.forename: Peter
authors.initials: P
authors.lastname: Flores
authors.forename: Preciosa
authors.initials: P
authors.lastname: Flores
authors.forename: Jasmine DeGuzman
authors.initials: JD
authors.lastname: Lacsamana
authors.forename: Ciara
authors.initials: C
authors.lastname: Paige
authors.forename: Michele
authors.initials: M
authors.lastname: Mouttapa
authors.forename: Lourdes
authors.initials: L
authors.lastname: Quitugua
authors.forename: Peniamina
authors.initials: P
authors.lastname: Taito
authors.forename: Vanessa Tui
authors.initials: VT
authors.lastname: May
authors.forename: Marina
authors.initials: M
authors.lastname: Tupua
authors.forename: Elenoa
authors.initials: E
authors.lastname: Vaikona
authors.forename: Dorothy
authors.initials: D
authors.lastname: Vaivao
authors.forename: Isileli
authors.initials: I
authors.lastname: Vunileva
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D055812:Community-Based Participatory Research / Q000379:methods*; D054521:Cultural Competency; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data*; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data; D010358:Patient Participation / Q000706:statistics & numerical data*; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D012944:Social Support; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult