Effectiveness of Cultivando La Salud: A Breast and Cervical Cancer Screening Promotion Program for Low-Income Hispanic Women

María E. Fernández, PhD; Alicia Gonzales, MSW; Guillermo Tortolero-Luna, MD, PhD; Janet Williams, MPH; Monica Saavedra-Embesi, MPH; Wenyaw Chan, PhD; Sally W. Vernon, PhD

Disclosures

Am J Public Health. 2009;99(5):936-943. 

In This Article

Results

The demographic information of the women participating in the intervention trial is provided in Table 1 . The intervention and control groups were equivalent in demographic characteristics and most psychosocial constructs measured at baseline. In the mammography cohort, the intervention group had significantly higher baseline scores for self-efficacy (P=.01) and mammography knowledge (P=.014) and lower scores for perceived pros (P<.001) and cons (P<.001) of mammography screening. In the Pap test cohort, the intervention group had significantly lower scores for perceived pros (P=0.03) and cons (P=.001) of Pap test screening. We controlled for pretest scores in the analysis of the intervention effect on intermediate variables.

During the intervention phase, lay health workers attempted to deliver the program to all women participating in the cohort study. Process evaluation measures showed that 138 women (61%) received the required intervention strategies (either video or flipchart) and at least the minimum (30 minutes) face-to-face time with the lay health worker. These measures indicated high levels of intervention fidelity across both intervention sites: 99% of contacts received required intervention materials, 97% lasted 1 hour or more, and 99% lasted 30 minutes or more.

The overall 6-month follow-up rate was 66.9%. There were no statistically significant differences in demographic variables or acculturation between women contacted for follow-up and those lost to follow-up. There was also no significant difference in the follow-up rate by study arm among women in the mammography cohort (63.3% and 70.8% for the intervention and control sites, respectively; P=.085). However, there were differences in follow-up rate by study arm in the Pap cohort (61.4% and 80.2% for the intervention and control sites, respectively; P=.001). Across study groups, there were no significant differences in demographic characteristics among those lost to follow-up.

The proportion of women by intervention group who completed the recommended screening among those reached for follow-up is shown in Table 2 . In the mammography cohort, a significantly higher percentage of women in the intervention group than in the control group completed screening (40.8% vs 29.9%; P<.05). In the Pap cohort, a significantly higher percentage of women in the intervention group than in the control group completed screening (39.5% vs 23.6%; P<.05).

We also calculated screening completion by using an intent-to-treat analysis. For mammography (n=464), although a higher percentage of women in the intervention group than in the control group reported mammography screening (25.6% vs 20.6%), this difference was not significant (P>.05). Similarly, for Pap test screening (n=243) although a higher proportion of women in the intervention group than in the control group completed a Pap test within 6 months (24.2% vs 18.9%), this difference was not significant (P>.05).

The intervention appeared to be equally effective among women with low levels of acculturation and those who were bicultural. In fact, although not statistically significant, a somewhat higher percentage of women with low levels of acculturation (42.5%) than bicultural women (33.3%) reported being screened (P=.28) in the intervention group. Among women in the Pap test cohort, 39.7% of women with low levels of acculturation completed screening compared with 41.2% of bicultural women (P=.562) in the intervention group. Thus, acculturation had no effect on intervention effectiveness.

The mean posttest score for both the intervention and the control groups for the intermediate variables and the results of the adjusted linear regression analyses are shown in Table 3 . Women in the intervention group had significantly higher mean scores for mammography self-efficacy, perceived susceptibility to breast cancer, perceived survivability of breast cancer, perceived mammography pros, mammography subjective norms, and mammography processes of change. Scores on the breast cancer knowledge scale were higher for women in the intervention group, but this difference was not significant. Nevertheless, when asked about ways breast cancer could be detected, women in the intervention group were more likely than were those in the control group to mention mammography (42.3% vs 28.8%; P=.014).

Scores on Pap test self-efficacy, perceived pros, subjective norms, and processes of change were significantly higher among women in the intervention group. There were no statistically significant posttest differences in perceived Pap test cons, cervical cancer knowledge, or perceived survivability of cervical cancer between the intervention and control groups. There were also no significant posttest differences between the intervention and control groups in knowledge of the Pap test.

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