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A Community Health Worker–Led Multicomponent Program to Promote Cervical Cancer Screening in South Asian Women: A Cluster RCT

      Introduction

      South Asian women in Hong Kong have low cervical cancer screening uptake because of multiple barriers to utilizing health resources. Interventions that effectively modify the cancer screening behaviors of this population are warranted. This study evaluates the effects of a community health worker–led multicomponent intervention on improving cervical cancer screening uptake among South Asian women in Hong Kong.

      Study Design

      This study was an assessor-blind, cluster RCT that included a waitlist control group.

      Setting/participants

      Recruitment of eligible subjects took place in 6 nongovernmental organizations; these organizations were randomized into intervention and control groups with a 1:1 allocation ratio.

      Intervention

      Participants in the intervention group received a 3-month multicomponent intervention comprising health education, monthly telephone follow-ups, and navigation assistance.

      Main outcome measures

      Participants’ cervical cancer screening utilization and beliefs were assessed at baseline, after intervention, and 3 months after intervention. A longitudinal outcome comparison between the 2 groups was performed with generalized estimating equation analysis. Data were collected between September 2018 and January 2020 and were analyzed in 2019–2020.

      Results

      A total of 387 participants completed the intervention. A significantly higher cervical cancer screening uptake was observed among participants in the intervention group (97.9%, 191 of 195) than among participants in the control group (52.6%, 101 of 192) at 3 months after intervention (p=0.005). Significantly greater decrements in perceived barriers to cervical cancer screening were found in the intervention group after intervention (−0.68, 95% CI= −1.35, −0.01, p=0.047) and 3 months after intervention (−0.86, 95% CI= −1.69, −0.04, p=0.041).

      Conclusions

      A community health worker–led multicomponent intervention is effective in promoting cervical cancer screening uptake and in reducing barriers to cancer screening utilization among South Asian women in Hong Kong. Combining a community health worker–led intervention with multiple intervention components could be an effective strategy for developing interventions to increase cervical cancer screening in underserved populations.

      Trial registration

      This study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn) ChiCTR1800017227 on July 18, 2018.
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      REFERENCES

        • Bray F
        • Ferlay J
        • Soerjomataram I
        • Siegel RL
        • Torre LA
        • Jemal A.
        Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [published correction appears in CA Cancer J Clin. 2020;70(4):313].
        CA Cancer J Clin. 2018; 68: 394-424https://doi.org/10.3322/caac.21492
        • Cohen PA
        • Jhingran A
        • Oaknin A
        • Denny L.
        Cervical cancer.
        Lancet. 2019; 393: 169-182https://doi.org/10.1016/S0140-6736(18)32470-X
        • Landy R
        • Pesola F
        • Castañón A
        • Sasieni P.
        Impact of cervical screening on cervical cancer mortality: estimation using stage-specific results from a nested case-control study.
        Br J Cancer. 2016; 115: 1140-1146https://doi.org/10.1038/bjc.2016.290
      1. Cervical cancer screening: who needs cervical cancer screening? Cervical Screening Programme, Department of Health, The Government of the Hong Kong Special Administrative Region. https://www.cervicalscreening.gov.hk/english/cs/cs_who.php Updated November 19, 2019. Accessed November 27, 2020.

        • Marlow LA
        • Wardle J
        • Waller J.
        Understanding cervical screening non-attendance among ethnic minority women in England.
        Br J Cancer. 2015; 113: 833-839https://doi.org/10.1038/bjc.2015.248
        • So WKW
        • Wong CL
        • Chow KM
        • et al.
        The uptake of cervical cancer screening among South Asians and the general population in Hong Kong: a comparative study.
        J Cancer Policy. 2017; 12: 90-96https://doi.org/10.1016/j.jcpo.2017.03.015
        • Marlow LA
        • Waller J
        • Wardle J.
        Barriers to cervical cancer screening among ethnic minority women: a qualitative study.
        J Fam Plann Reprod Health Care. 2015; 41: 248-254https://doi.org/10.1136/jfprhc-2014-101082
        • Chan DNS
        • So WKW.
        A systematic review of the factors influencing ethnic minority women's cervical cancer screening behavior: from intrapersonal to policy level.
        Cancer Nurs. 2017; 40: E1-E30https://doi.org/10.1097/NCC.0000000000000436
        • Kolahdooz F
        • Jang SL
        • Corriveau A
        • Gotay C
        • Johnston N
        • Sharma S.
        Knowledge, attitudes, and behaviours towards cancer screening in indigenous populations: a systematic review.
        Lancet Oncol. 2014; 15: e504-e516https://doi.org/10.1016/S1470-2045(14)70508-X
        • Rees I
        • Jones D
        • Chen H
        • Macleod U.
        Interventions to improve the uptake of cervical cancer screening among lower socioeconomic groups: a systematic review.
        Prev Med. 2018; 111: 323-335https://doi.org/10.1016/j.ypmed.2017.11.019
        • Bellhouse S
        • McWilliams L
        • Firth J
        • Yorke J
        • French DP.
        Are community-based health worker interventions an effective approach for early diagnosis of cancer? A systematic review and meta-analysis.
        Psychooncology. 2018; 27: 1089-1099https://doi.org/10.1002/pon.4575
        • Chan DNS
        • So WKW
        A systematic review of randomised controlled trials examining the effectiveness of breast and cervical cancer screening interventions for ethnic minority women.
        Eur J Oncol Nurs. 2015; 19: 536-553https://doi.org/10.1016/j.ejon.2015.02.015
        • Han HR
        • Kim J
        • Lee JE
        • et al.
        Interventions that increase use of Pap tests among ethnic minority women: a meta-analysis.
        Psychooncology. 2011; 20: 341-351https://doi.org/10.1002/pon.1754
        • Chan DNS
        • So WKW.
        The impact of community-based multimedia intervention on the new and repeated cervical cancer screening participation among South Asian Women.
        Public Health. 2020; 178: 1-4https://doi.org/10.1016/j.puhe.2019.08.015
        • Han HR
        • Song Y
        • Kim M
        • et al.
        Breast and cervical cancer screening literacy among Korean American women: a community health worker-led intervention.
        Am J Public Health. 2017; 107: 159-165https://doi.org/10.2105/AJPH.2016.303522
        • Olaniran A
        • Smith H
        • Unkels R
        • Bar-Zeev S
        • van den Broek N.
        Who is a community health worker? - a systematic review of definitions.
        Glob Health Action. 2017; 101272223https://doi.org/10.1080/16549716.2017.1272223
        • O'Brien MJ
        • Squires AP
        • Bixby RA
        • Larson SC.
        Role development of community health workers: an examination of selection and training processes in the intervention literature.
        Am J Prev Med. 2009; 37 (suppl 1): S262-S269https://doi.org/10.1016/j.amepre.2009.08.011
        • Schoenberg NE
        • Hatcher J
        • Dignan MB
        • Shelton B
        • Wright S
        • Dollarhide KF.
        Faith Moves Mountains: an Appalachian cervical cancer prevention program.
        Am J Health Behav. 2009; 33: 627-638https://doi.org/10.5993/ajhb.33.6.1
        • So WKW
        • Kwong ANL
        • Chen JMT
        • et al.
        A theory-based and culturally aligned training program on breast and cervical cancer prevention for South Asian community health workers: a feasibility study.
        Cancer Nurs. 2019; 42: E20-E30https://doi.org/10.1097/NCC.0000000000000543
        • Wong CL
        • So WKW
        • Chan DNS
        • Choi KC
        • Rana T
        A community health worker-led multimedia intervention to increase cervical cancer screening uptake among South Asian women: study protocol for a cluster randomized wait-list controlled trial.
        Trials. 2019; 20: 270https://doi.org/10.1186/s13063-019-3378-4
        • Wong CL
        • Choi KC
        • Law BMH
        • Chan DNS
        • So WKW.
        Effects of a community health worker-led multimedia intervention on the uptake of cervical cancer screening among South Asian women: a pilot randomized controlled trial.
        Int J Environ Res Public Health. 2019; 16: 3072https://doi.org/10.3390/ijerph16173072
        • Donner A
        • Klar N.
        Cluster randomization trials in epidemiology: theory and application.
        J Stat Plann Inference. 1994; 42: 37-56https://doi.org/10.1016/0378-3758(94)90188-0
        • Adams G
        • Gulliford MC
        • Ukoumunne OC
        • Eldridge S
        • Chinn S
        • Campbell MJ.
        Patterns of intra-cluster correlation from primary care research to inform study design and analysis.
        J Clin Epidemiol. 2004; 57: 785-794https://doi.org/10.1016/j.jclinepi.2003.12.013
        • Ma GX
        • Gao W
        • Fang CY
        • et al.
        Health beliefs associated with cervical cancer screening among Vietnamese Americans.
        J Womens Health (Larchmt). 2013; 22: 276-288https://doi.org/10.1089/jwh.2012.3587
        • So WKW
        • Law BMH
        • Choi KC
        • Chan DNS
        • Chan CWH.
        A mixed-method study examining cancer screening uptake among South Asian ethnic minorities in Hong Kong.
        Asia Pac J Oncol Nurs. 2019; 7: 12-17https://doi.org/10.4103/apjon.apjon_36_19
        • Leyrat C
        • Morgan KE
        • Leurent B
        • Kahan BC.
        Cluster randomized trials with a small number of clusters: which analyses should be used?.
        Int J Epidemiol. 2018; 47: 321-331https://doi.org/10.1093/ije/dyx169
        • Mancl LA
        • DeRouen TA.
        A covariance estimator for GEE with improved small-sample properties.
        Biometrics. 2001; 57: 126-134https://doi.org/10.1111/j.0006-341x.2001.00126.x
        • Fernández ME
        • Gonzales A
        • Tortolero-Luna G
        • et al.
        Effectiveness of Cultivando la Salud: a breast and cervical cancer screening promotion program for low-income Hispanic women.
        Am J Public Health. 2009; 99: 936-943https://doi.org/10.2105/AJPH.2008.136713
        • Mock J
        • McPhee SJ
        • Nguyen T
        • et al.
        Effective lay health worker outreach and media-based education for promoting cervical cancer screening among Vietnamese American women.
        Am J Public Health. 2007; 97: 1693-1700https://doi.org/10.2105/AJPH.2006.086470
        • Menon U
        • Szalacha LA
        • Prabhughate A.
        Breast and cervical cancer screening among South Asian immigrants in the United States.
        Cancer Nurs. 2012; 35: 278-287https://doi.org/10.1097/NCC.0b013e31822fcab4
        • Thompson B
        • Carosso EA
        • Jhingan E
        • et al.
        Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas.
        Cancer. 2017; 123: 666-674https://doi.org/10.1002/cncr.30399
      2. About cervical screening programme: screening policy. Cervical Screening Programme, Department of Health, The Government of the Hong Kong Special Administrative Region. https://www.cervicalscreening.gov.hk/english/about/abt_screening.html. Updated September 20, 2018. Accessed November 27, 2020.