Research article
Papanicolaou Testing Among Vietnamese Americans: Results of a Multifaceted Intervention

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Background

Vietnamese-American women have the highest incidence of cervical cancer of any ethnic group, and they underutilize Papanicolaou (Pap) tests.

Design

Development and implementation of a multifaceted intervention using community-based participatory research (CBPR) methodology and evaluated with a quasi-experimental controlled design with cross-sectional pre-intervention (2000) and post-intervention (2004) telephone surveys. Data were analyzed in 2005.

Setting

Santa Clara County, California (intervention community) and Harris County, Texas (comparison community).

Participants

Vietnamese-American women aged 18 and older (n =1566 at pre-intervention and 2009 at post-intervention).

Intervention

A community–academic coalition developed and implemented six components: Vietnamese-language media campaign, lay health worker outreach, Vietnamese Pap clinic, patient registry/reminder system, restoration of a government-funded low-cost screening program, and continuing medical education for Vietnamese physicians.

Outcome Measure

Pap test receipt.

Results

Overall response rate was 56%. Pap test receipt increased in the intervention (77.5% to 84.2%, p <0.001), but not in the comparison community (73.9% to 70.6%, p >0.05). In multivariate analyses, the intervention was associated with increased Pap test receipt (odds ratio [OR]=2.02, 95% confidence interval [CI]=1.37–2.99). Other factors associated with increased Pap testing included longer U.S. residence, having health insurance, having a regular site of care, having a respectful physician, having a non-Vietnamese or a female Vietnamese physician, and recalling exposure to Vietnamese-language media about Pap testing. Factors associated with reduced likelihood of Pap test receipt were age 65 years and older, never married, less than high school education, and income below poverty level.

Conclusions

A multifaceted CBPR intervention was associated with increased Pap test receipt among Vietnamese-American women in one community.

Introduction

Vietnamese-American women have the highest rate of cervical cancer of any ethnic group,1, 2 yet they underutilize cervical cancer screening.3, 4, 5 Their Papanicolaou (Pap) test receipt has been associated with sociodemographic factors, beliefs, access to care, and physician characteristics.4, 5

Community-based participatory research (CBPR) involves community members in project design, implementation, and interpretation6, 7, 8 to address health disparities in a culturally appropriate manner6, 9, 10 and to produce sustainable community-based solutions.11 Previous interventions to address Pap test receipt among Vietnamese Americans have not used CBPR.12, 13 This article reports quantitative results of a CBPR project to increase Pap testing and build community capacity. Baseline data and CBPR outcomes are reported elsewhere.4, 14

Section snippets

Coalition building and community action plan

In 1999, the Vietnamese Community Health Promotion Project (VCHPP), a community–academic research organization, formed a coalition with ten other organizations in Santa Clara County (SCC), California. The Vietnamese REACH for Health Initiative (VRHI) Coalition (the Coalition) developed a logic model based on the Pathways model to describe barriers to cervical cancer screening. In the model, healthy behaviors occur after the negotiation of complex pathways.15, 16 Community members negotiate a

Results

There were significant differences in sociodemographic and healthcare measures within each community from pre- to post-intervention and between intervention and comparison communities (Table 1). Exposure to Vietnamese-language television or radio advertisements increased in both communities, with increases being significantly greater in SCC compared to HC (Table 2).

Knowledge of the Pap test rose in SCC (76% to 94%, p <0.001), but declined in HC (72% to 67%, p <0.05) (Table 3). Knowledge about

Discussion

Results show that the multifaceted intervention designed and implemented by the VRHI Coalition was successful in increasing cervical cancer screening among Vietnamese-American women. The effect size of 10% is comparable to other community-based interventions.13, 26 Although there are variations in the measurement of CBPR effectiveness, changes in health behaviors are ultimately important.25, 27 This is one of the first reports of a significant community-wide change in behavior resulting from an

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    Copyright © 2006 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.