title: Addressing multilevel barriers to cervical cancer screening in Korean American women: A randomized trial of a community-based intervention.
abstract: BACKGROUND
  Korean American women have among the lowest rates of cervical cancer screening in the United States. The authors evaluated a multicomponent intervention combining community education with navigation services to reduce access barriers and increase screening rates in this underserved population. It was hypothesized that cervical cancer screening rates would be higher among women who received the intervention program compared with those in the control program.
  
  
  METHODS
  Korean American women (N = 705) were recruited from 22 churches. In this matched-pair, group-randomized design, 347 women received the intervention, which consisted of a culturally relevant cancer education program combined with provision of navigation services. The control group (N = 358) received general health education, including information about cervical cancer risk and screening and where to obtain low-cost or no-cost screening. Screening behavior was assessed 12 months after the program.
  
  
  RESULTS
  Screening behavior data were obtained from 588 women 12 months after the program. In both site-level and participant-level analyses, the intervention program contributed to significantly higher screening rates compared with the control program (odds ratio [OR], 25.9; 95% confidence interval [CI], 10.1-66.1; P < .001). In sensitivity analysis, the treatment effect remained highly significant (OR, 16.7; 95% CI, 8.1-34.4; P < .001).
  
  
  CONCLUSIONS
  A multicomponent intervention combining community cancer education with navigation services yielded significant increases in cervical cancer screening rates among underscreened Korean American women. Community-accessible programs that incorporate cancer education with the delivery of key navigation services can be highly effective in increasing cervical cancer screening rates in this underserved population. Cancer 2017;123:1018-26. © 2016 American Cancer Society.
authors.affiliation: Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Carolyn Y
authors.initials: CY
authors.lastname: Fang
authors.affiliation: Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.|Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
authors.forename: Grace X
authors.initials: GX
authors.lastname: Ma
authors.affiliation: Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Handorf
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ziding
authors.initials: Z
authors.lastname: Feng
authors.affiliation: Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
authors.forename: Yin
authors.initials: Y
authors.lastname: Tan
authors.affiliation: Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
authors.forename: Joanne
authors.initials: J
authors.lastname: Rhee
authors.affiliation: Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Miller
authors.affiliation: Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
authors.forename: Charles
authors.initials: C
authors.lastname: Kim
authors.affiliation: First Korean United Methodist Church of Cherry Hill, Cherry Hill, New Jersey.
authors.forename: Han Seung
authors.initials: HS
authors.lastname: Koh
mesh_terms: D000328:Adult; D000368:Aged; D001213:Asian; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D065006:Papanicolaou Test; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D014626:Vaginal Smears
keywords: Korean American; cervical cancer screening; community-based participatory research; intervention; navigation