Claudia Reyes-Garcia

Salud es vida: development of a cervical cancer education curriculum for promotora outreach with Latina farmworkers in rural Southern Georgia.

We developed and evaluated a lay health worker curriculum intended to educate Hispanic farmworker women on cervical cancer, human papillomavirus (HPV), and the HPV vaccine. We pilot tested the curriculum in 2010 with 7 volunteer promotoras for readability, attractiveness, content, comprehension, cultural appropriateness, persuasion, structure and organization of lessons, balance between didactic and participatory activities, and ease of diffusion to community members. Peer-led cervical cancer prevention education is a practical option for low-income, Hispanic farmworker women in newer immigrant-receiving areas of the United States with fewer Spanish-speaking health professionals.

Refinement of an educational toolkit to promote cervical cancer screening among Hispanic immigrant women in rural southern Georgia.

Cervical cancer incidence and mortality continue to affect Hispanic women in the U.S. disproportionately. Our project sought to refine a cervical cancer intervention designed for use by community health workers, or promotoras, in rural southern Georgia. We collaborated with Hispanic promotoras to refine a Spanish language educational flipchart featuring cervical cancer topic areas for use in screening promotion.

Efficacy Study of a Group-based Promotora Intervention to Increase Cervical Cancer Screening among Immigrant Latina Women

Background: This study evaluates the feasibility and efficacy of a promotora-led, Spanish-language educational group session on cervical cancer screening (Pap tests), self-efficacy (belief in ability to schedule and complete a Pap test), and knowledge among Latina immigrants compared to a control condition. Methods: The group-based promotora intervention, Salud es Vida, consisted of a toolkit of materials which includes a curriculum guide, a brochure, a flipchart, a short animated video, and in-class activities. Data from baseline and follow-up/post-intervention surveys were used to assess differences in obtaining a Pap test using the Chi-square test of independence and in self-efficacy and knowledge scores using t-tests. Results: We recruited 38 women to the intervention and 52 women to the control who were due for Pap test screening. After an average of 8 months until the follow-up assessment, twelve (32%) intervention participants received the Pap test and 10 (19%) control participants received the Pap test (p = .178). At follow-up, the intervention group participants had higher total cervical cancer knowledge and higher self-efficacy scores, adjusting for the posttest scores, respectively (p9s Conclusions: The findings from this feasibility study using a group intervention approach suggest intervention efficacy for increasing cervical cancer knowledge and self-efficacy; however, these secondary outcomes alone were not sufficient to increase cervical cancer screening rates in this Latina immigrant population during the study period. Citation Format: John S. Luque, Yelena N. Tarasenko, Moya L. Alfonso, Claudia Reyes-Garcia, Laura Rebing, Daron G. Ferris. Efficacy study of a group-based promotora intervention to increase cervical cancer screening among immigrant Latina women. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A29.

Abstract A53: Causes and barriers associated with the Pap test among Latina farmworkers in Georgia

Background: Latinas are disproportionately burdened with cervical cancer, with mortality rates 50% higher for Latinas than non-Latina whites, largely due to differences in screening rates. Particular Latino subgroups, such as those from migrant farmworker backgrounds, have less access to health services and lower education than other subgroups. In this study, we report survey findings examining knowledge, beliefs and perceptions about causes of cervical cancer and barriers related to use of the Pap test among Mexican farmworker women in South Georgia. Methods: We employed cultural consensus analysis methods to calculate the level of shared knowledge among a convenience sample of 40 Mexican immigrant women (20 women who have been living in the U.S. >10 years; 20 women who have been living in the U.S. ≤10 years) who had not received a Pap test in over 2 years. In a previous study using free lists, we identified 15 causes of cervical cancer and 15 barriers to screening among Latino immigrant populations. We used several types of questions to assess consensus regarding understanding of 15 causes of cervical cancer and 15 barriers to completing the Pap test. For the causes, we asked participants to rank the severity of the items, sort them into no more than four piles, and label each pile. For the barriers, we asked participants to sort them into piles only and label each pile. This methodology allows for the direct measurement of inter-participant agreement regarding the structure and organization of the knowledge domain and the calculation of both individual estimates of cultural competency and the average level of competency for the group on the knowledge domain. We used UCINET to analyze the rank data and Visual Anthropac to analyze the pile sort data to assess the level of cultural model sharing and to visualize categories using multidimensional scaling and cluster analysis. Results: There was consensus among respondents for the rank order of causes of cervical cancer (Eigenratio = 4.9). Out of the 15 culturally identified causes of cervical cancer, the top five were multiple sex partners, HPV, HIV, lack of a regular Pap test, and sexual relations before 16 years of age. When respondents completed the 15 item pile sort for causes, there was also consensus (Eigenratio = 7.4). Using cluster analysis, the items formed 5 clusters: (1) family history, destiny; (2) chemicals in food, poor diet, smoking; (3) birth control pills, abortion, multiple pregnancies; (4) not using condoms, poor hygiene; and (5) multiple sex partners, sexual relations before age 16, HPV, HIV, not getting a regular Pap test. When respondents completed the 15 item pile sort for reasons not to get the Pap test, there was very high consensus (Eigenratio = 14.2). Using cluster analysis, the 5 clusters were: (1) knowledge (do not know the purpose, do not know the cost, do not know where to get it, lack of knowledge about the test), (2) fear (fear of positive results, fear of the exam, wait for symptoms to appear), (3) social and environmental constraints (too expensive, no insurance, no transportation, do not know English); (4) do not have a regular doctor in U.S. and prefer to use services in Mexico; and (5) not convenient and my husband won9t let me go. Conclusions: There was cultural consensus for all three methods among the respondents irrespective of length of time residing in the U.S. There remains possible confusion between HIV and HPV, since these items were sorted into the same piles and ranked high for cervical cancer risk factors. The aggregate findings suggest that cultural models for causes and barriers persist throughout the immigrant9s acculturation process in the U.S. According to this study, barriers to screening encountered constituted a shared cultural domain despite varying time residing in the U.S. Citation Format: John S. Luque, Jonathan Maupin, Yelena Tarasenko, Moya Alfonso, Lisa Watson, Claudia Reyes-Garcia. Causes and barriers associated with the Pap test among Latina farmworkers in Georgia. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A53. doi:10.1158/1538-7755.DISP13-A53

Abstract B54: Latina farmworkers: Relationships between Pap screening behaviors, acculturation, and cultural cancer screening scales

Background: Latinas are disproportionately burdened with cervical cancer, with incidence rates of 11.5 per 100,000 and the second highest mortality rates of 4 per 100,000, yet they have the lowest participation rates in national cervical cancer screening programs. Psychosocial factors have been identified as one of the main barriers for low cancer screening rates among Latinas. In this study, we explored cultural cancer screening beliefs (CCSB), acculturation levels, past Pap screening behavior and intent to undergo Pap tests among Mexican farmworker women in South Georgia. Methods: We screened 252 Latinas using our eligibility criteria which specified 1) Mexican immigrant, 2) no Pap test in over 2 years, 3) 20 women who lived >10 years in the U.S. and 20 women who lived ≤10 years in the U.S, and 4) had a farmworker background. We recruited a quota sample of 40 Mexican immigrant women meeting eligibility criteria. We administered questionnaires to collect demographic information and Pap screening behaviors. We also used the Acculturation Scale for Mexican Americans (ASMA) to measure acculturation behaviors and the Cultural Cancer Screening Scale (CCSS) scale (20-item scale with 5 constructs).We assessed the internal consistency of the scales and constructs using Cronbach9s alphas. Differences between the groups of women given their prior screening behaviors or intent to undergo screening with respect to each of cultural cancer screening or acculturation scale measures, respectively, were assessed using the Kruskal-Wallis rank test. When the test was statistically significant, post-hoc pairwise comparisons were performed. Results: Out of 40 women, 7(18%) never had a Pap; 2 (5%) had it less than 3 years ago, and 31 (78%) had it more than three years ago. Thirty-two (80%) women expected to have their next Pap smear 1 yr. or less; 4 women (10%) >1 not more than 3 years; 1 (3%) woman reported that it was their first time getting a Pap smear, and 3 (8%) women did not respond. With the exception of sociocultural deterrents (alpha = 0.67), internal consistency of cancer screening fatalism (alpha = 0.94), symptomatic deterrents (alpha = 0.95), catastrophic disease expectations (alpha = 0.87), and negative beliefs about health professionals (alpha = 0.77) were high. Internal consistency of CCSS was 0.91. The estimated mean score for acculturation was 0.98 (SD =0.77; range: 0 – 2). Women who reported never having a Pap test compared to women who reported having their Pap test more than three years ago were more likely to consider health professionals performing screening examinations to not be trustworthy (mean ranks=32 and 18 respectively, p= 0.003). Women who reported never having a Pap test compared to women who reported having their Pap test more than three years ago were more likely to believe that health professionals inappropriately touch their patients during screening examinations (mean ranks 33 and 18, respectively; p = 0.001). Other associations were not statistically significant. The difference between the groups of women based on their intent to undergo future Pap tests and each of cultural cancer screening scale measures was not significant. No statistically significant associations were found between acculturation measures and past or intended screening behavior of women, respectively. Conclusions: The two psychosocial factors associated with lack of past screening behavior reflect the negative beliefs about health professionals among Mexican immigrant farmworker women. Despite variability in time spent living in the U.S. and scores on an acculturation scale, these variables were not related to past screening or intent to screen. Other factors, such as access to health care, discrimination, and transportation issues need to be explored in future studies to understand their relationship with low screening rates in Latina subpopulations such as low-income Mexican farmworkers. Citation Format: Lisa C. Watson, Yelena Tarasenko, Moya Alfonso, Claudia Reyes-Garcia, John S. Luque. Latina farmworkers: Relationships between Pap screening behaviors, acculturation, and cultural cancer screening scales. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B54. doi:10.1158/1538-7755.DISP13-B54