title: Social network characteristics and cervical cancer screening among Quechua women in Andean Peru.
abstract: BACKGROUND
  Peru has high cervical cancer incidence and mortality rates compared to other Andean countries. Therefore, partnerships between governmental and international organizations have targeted rural areas of Peru to receive cervical cancer screening via outreach campaigns. Previous studies have found a relationship between a person's social networks and cancer screening behaviors. Screening outreach campaigns conducted by the nonprofit organization CerviCusco created an opportunity for a social network study to examine cervical cancer screening history and social network characteristics in a rural indigenous community that participated in these campaigns in 2012 and 2013. The aim of this study was to explore social network characteristics in this community related to receipt of cervical cancer screening following the campaigns.
  
  
  METHODS
  An egocentric social network questionnaire was used to collect cross-sectional network data on community participants. Each survey participant (ego) was asked to name six other women they knew (alters) and identify the nature of their relationship or tie (family, friend, neighbor, other), residential closeness (within 5 km), length of time known, frequency of communication, topics of conversation, and whether they lent money to the person, provided childcare or helped with transportation. In addition, each participant was asked to report the nature of the relationship between all alters identified (e.g., friend, family, or neighbor). Bivariate and multivariate analyses were used to explore the relationship between Pap test receipt at the CerviCusco outreach screening campaigns and social network characteristics.
  
  
  RESULTS
  Bivariate results found significant differences in percentage of alter composition for neighbors and family, and for mean number of years known, mean density, and mean degree centrality between women who had received a Pap test (n = 19) compared to those who had not (n = 50) (p's < 0.05). The final logistic regression model was statistically significant (χ2 (2) = 20.911, p < .001). The model included the variables for percentage of family alter composition and mean density, and it explained 37.8% (Nagelkerke R(2)) of the variance in Pap test receipt, correctly classifying 78.3% of cases. Those women with higher percentages of family alter composition and higher mean density in their ego networks were less likely to have received a Pap test at the CerviCusco campaigns.
  
  
  CONCLUSIONS
  According to this exploratory study, female neighbors more than family members may have provided an important source of social support for healthcare related decisions related to receipt of a Pap test. Future studies should collect longitudinal social network data on participants to measure the network effects of screening interventions in rural indigenous communities in Latin American countries experiencing the highest burden of cervical cancer.
authors.affiliation: Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, 135 Cannon Street, Ste. 303, MSC 835, Charleston, SC, 29425, USA. luquej@musc.edu.
authors.forename: John S
authors.initials: JS
authors.lastname: Luque
authors.affiliation: Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA, USA. sopoku@georgiasouthern.edu.
authors.forename: Samuel
authors.initials: S
authors.lastname: Opoku
authors.affiliation: Augusta University, GRU Cancer Center, Augusta, GA, USA. dferris@gru.edu.|CerviCusco, Cusco, Peru. dferris@gru.edu.
authors.forename: Daron G
authors.initials: DG
authors.lastname: Ferris
authors.affiliation: CerviCusco, Cusco, Peru. wendy_s14@hotmail.com.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Guevara Condorhuaman
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D006801:Humans; D007199:Indians, South American / Q000523:psychology*; D008875:Middle Aged; D065006:Papanicolaou Test; D010568:Peru; D012111:Residence Characteristics; D012424:Rural Population / Q000706:statistics & numerical data; D012944:Social Support; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000208:ethnology*