Table 21CHW cancer screening: Pap smears

Author, Year
Study Design
Population Setting
Sample Size
Quality
Intensity of CHW InterventionStudy GroupsResults
Taylor, et al., 200263

RCT

Chinese- American women, Seattle, Washington, and Vancouver, British Columbia

402 (181 Seattle, 221 Vancouver)

Fair
LowG1: Introductory mailing, CHW visit with multimedia and tailored counseling, telephone followup and tailored counseling, logistic assistance as needed

G2: Direct mail multimedia materials

G3: Usual care at local clinics and doctors’ offices (control)
Self-reported Pap testing completed since intervention: G1: 39%, G2: 25%, G3: 15% (G1 vs. G3, P < 0.001; G2 vs. G3, P = 0.03; G1 vs. G2, P = 0.02)

Medical records for Pap screening received between randomization and followup, using intention-to-treat:

Results not provided, significant differences between outreach worker versus control (P <.001), direct mail versus control (P =.07), and outreach worker versus direct mail (P =.04)

Medical records for Pap screening received in the past 2 years, using intention-to-treat:

Results not provided, significant differences between outreach worker versus control (P <.001) and direct mail versus control (P =.03)
Hiatt et al., 2008125

Prospective cohort

Public health clinics and the low-income neighborhoods in San Francisco and Contra Costa County, California

1,616

Fair
ModerateG1: One-on-one visits at various events and locations; presentations to community-based organizations (agencies); and Women’s Health Days, offering free mammograms, Pap tests, and breast self-examination instruction

G2: No intervention (control)
Ever completed Pap smear (logistic regression, 95% CI)
Residence in outreach area over time: 1.5 (0.6–4.2)

Completed Pap smear in the past 3 years (logistic regression, 95% CI)
Residence in outreach area over time: 0.9 (0.6–1.3)
Mock et al., 2007109

RCT

Vietnamese-American women, Santa Clara County, California

968

Fair
ModerateG1: CHW small group meetings, direct contact with subjects, Vietnamese language ads for TV/radio/newspaper, booklets and printed materials in various community locations

G2: Vietnamese-language ads for TV/radio/newspaper, booklets and printed materials in various community locations, delayed educational session
Self-report of having ever had Pap (baseline/followup): G1: 65.8%/81.8% (P < 0.001);
G2: 70.1%/75.5% (P < 0.001);
Z test P = 0.001

Self-report of Pap in past year: G1: 45.7%/67.3% (P < 0.001);
G2: 50.9%/55.7% (P = 0.035);
Z test P < 0.001

Ever had Pap test (among those who had not had Pap test pre-outreach): G1: 46.0 (N = 144);
G2: 27.1 (N = 161) P < 0.001
Navarro et al., 1998;111
Navarro et al., 1995;110
Navarro et al., 2000112

RCT

Low-income Latinas, southeast San Diego County, California

365

Poor
ModerateG1: CHW delivering community living skills sessions, details NR

G2: CHW delivering cancer education sessions, 12 weekly group sessions conducted over 3 months plus 2 additional sessions offered within a year of beginning of group meetings
Pretest-posttest changes in percentages of women who had a Pap test within past year:

Participant unit of analysis (n = 360)
G1: 16.2
G2: 23.1
P = 0.096
t = 1.67

CHW unit of analysis (n = 35)
G1: 18.4
G2: 23.4
P = 0.369
t = 0.91

Odds of Pap smear 1-year and 2-year followup for cancer screening group (P value): Year 1: 2.10 (0.017)
Year 2: 1.70 (0.082)
Paskett et al., 2006;17
Katz et al., 200718

RCT

Community health centers, Robeson County, North Carolina

820

Good
HighG1: Control sent letter and NCI brochure about the need for regular cervical cancer screening 6 months after random assignment, followed by letter and NCI brochure about the need for mammography 3 months after followup assessment

G2: Individualized health education program that was culturally acceptable and tailored to meet the needs of each woman, intensive face-to-face interactive educational program administered over a 9- to 12- month period, consisting of 3 in- person visits, with educational materials provided each visit and followup telephone calls and mailings after
Cervical cancer screening rates within risk-appropriate guidelines:

Significant differences between baseline and followup for both groups, no significant differences between intervention and control groups
Sung et al., 1997;61
Sung et al., 199262

RCT

Inner-city African Americans, state unspecified

195

Fair
HighG1: CHW home visits, education on breast and cervical cancer, breast self-exam, educational materials on screening, facilitation to address logistical barriers to screening

G2: Mailed educational materials on cancer screening
Pretest/posttest change in self-report of receiving Pap smears for entire sample: G1: 50.3%/58.7%
G2: 51.9%/62.1%, difference in change: −1.8 (95% CI, −8.0–4.4)

Pretest/posttest change in self-report of receiving Pap smears, postintervention respondents only: G1: 52.7%/63.4%
G2: 50.0%/62.7%, difference in change: −2.0 (95% CI, −11.0–7.0)

Posttest rate of self-report of receiving Pap smears, women not previously on recommended screening schedules, whole sample: G1: 33.3%
G2: 34.2%, difference in change: −0.9 (95% CI, −15.7–13.9)

Posttest rate of self-report of receiving Pap smears, women not previously on recommended screening schedules, postintervention respondents only: G1: 61.4%
G2: 51.0%, difference in change: 10.4 (95% CI, −9.5–30.0)

CHW, community health worker; CI, confidence interval; G, group; N, number; NCI, National Cancer Institute; NR, not reported; RCT, randomized controlled trial; TV, television.

From: 3, Results

Cover of Outcomes of Community Health Worker Interventions
Outcomes of Community Health Worker Interventions.
Evidence Reports/Technology Assessments, No. 181.
Viswanathan M, Kraschnewski J, Nishikawa B, et al.

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