title: Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas.
abstract: BACKGROUND
  Latinas have the highest rates of cervical cancer in the United States and the second highest rate of cervical cancer mortality. One factor in the disparity is the relatively low rate of screening for cervical cancer in this population.
  
  
  METHODS
  Eligible women who were out of adherence with cervical cancer screening (>3 years since their last Papanicolaou [Pap] test) were identified via medical record review by a federally qualified local health center. The effects of a low-intensity intervention (video delivered to participants' homes; n = 150) and a high-intensity intervention (video plus a home-based educational session; n = 146) on cervical cancer screening uptake in comparison with a control arm (usual care; n = 147) were investigated. A cost-effectiveness analysis of the interventions was conducted: all intervention costs were calculated, and the incremental cost-effectiveness ratio was computed. Finally, women with positive Pap tests were provided navigation by a community health educator to ensure that they received follow-up care.
  
  
  RESULTS
  A total of 443 Latinas participated. Seven months after randomization, significantly more women in the high-intensity arm received a Pap test (53.4%) in comparison with the low-intensity arm (38.7%; P < .001) and the usual-care arm (34.0%; P < .01). The incremental cost-effectiveness ratio for high-intensity women versus the control group amounted to $4.24. Twelve women had positive Pap tests, which encompassed diagnoses ranging from atypical squamous cells of unknown significance to invasive cancer; these women received navigation for follow-up care.
  
  
  CONCLUSIONS
  A culturally appropriate, in-home, promotora-led educational intervention was successful in increasing cervical cancer screening among Latinas. Cancer 2017;123:666-674. © 2016 American Cancer Society.
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Beti
authors: B
authors: Thompson
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Elizabeth A
authors: EA
authors: Carosso
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Esther
authors: E
authors: Jhingan
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Lei
authors: L
authors: Wang
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Sarah E
authors: SE
authors: Holte
authors: Health Sciences Center, Texas Tech University, Lubbock, Texas.
authors: Theresa L
authors: TL
authors: Byrd
authors: Yakima Valley Farm Workers Clinic, Toppenish, Washington.
authors: Maria C
authors: MC
authors: Benavides
authors: Breast, Cervical, Colon Health Program, Yakima Health District, Union Gap, Washington.
authors: Cathy
authors: C
authors: Lopez
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Javiera
authors: J
authors: Martinez-Gutierrez
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Genoveva
authors: G
authors: Ibarra
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Virginia J
authors: VJ
authors: Gonzalez
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Nora E
authors: NE
authors: Gonzalez
authors: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Catherine R
authors: CR
authors: Duggan
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D065006:Papanicolaou Test; D012424:Rural Population; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology
keywords: Latinas; cervical cancer; community health workers; education intervention; randomized controlled trial (RCT); screening