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Vietnamese Women’s Health Project
– Reported, May 24, 2013
The Vietnamese Women’s Health Project is a home visitation intervention by female lay health workers for Vietnamese American women aged 20 to 79 who have not adhered to guidelines for interval Pap testing. The lay health workers provide basic information about cervical cancer and the Pap test (within the context of Vietnamese traditional beliefs about women’s health), with an emphasis on the importance of Pap testing for all women (including those who are asymptomatic, not currently sexually active, or postmenopausal). Intervention materials include a Vietnamese-language DVD (with English subtitles) and a pamphlet (with both Vietnamese and English text). The intervention employs several visual aids: a graph showing cervical cancer incidence rates by race/ethnicity, a gynecologic anatomy diagram, and a figure showing how cervical cancer progresses. The intervention is administered by a Vietnamese American female lay health worker who is bilingual and bicultural. Lay health workers are trained to act as role models, give social support, and provide tailored responses to each woman’s individual barriers to Pap testing (for example, believing that Pap testing is unnecessary for asymptomatic women). During home visits, lay health workers offer participants a copy of the DVD and pamphlet, watch the DVD with the participants, and show participants the visual aids. In addition, a follow-up telephone call was made to the participants 1 month after completed home visits to offer further assistance, as necessary.
This program is an example of one-on-one education interventions (Cervical Cancer Screening) and small media interventions (Cervical Cancer Screening), which are recommended by the Community Preventive Services Task Force, as found in the Guide to Community Preventive Services.
The study was a randomized controlled trial to evaluate the effectiveness of the lay health worker-based intervention in improving levels of Pap test receipt among Vietnamese American women. Study participants took part in a community-based survey conducted in metropolitan Seattle, Washington, over a 12-month period during 2006 and 2007. Women were eligible for participation in the community-based survey if they were of Vietnamese descent, aged 20 to 79, and able to speak Vietnamese or English. Survey respondents were eligible for the study if they had a uterus and did not adhere to guidelines for interval Pap testing. Because regular Pap testing is no longer recommended for women aged 70 to 79 who have a history of previous testing, survey respondents in this age group were eligible only if they had never been screened.
Women aged 20 to 69 were eligible if they had not been screened for cervical cancer in the previous 3 years. Participants were 234 Vietnamese American women between the ages of 20 and 79 (45% under the age of 50, 55% aged 50 or older) who were randomized into the trial 6 months after they participated in the community-based survey. Women randomized to the experimental condition received the cervical cancer control lay health worker intervention. The control group participants received a mailing of physical activity print materials (pamphlet and fact sheet) and a pedometer with instructions for use. The primary outcome of interest was completion of Pap testing within 6 months of randomization, determined by a follow-up survey conducted face-to-face in participants’ homes by interviewers who were unaware of each participant’s trial randomization assignment. Each respondent to the follow-up survey was asked whether she had ever had a Pap test and, if so, when she was last screened.
Interventions involving lay health workers represent a promising approach to disease prevention. Lay health workers are community members who are not certified health care professionals but have been trained to promote health or provide health care services within their community. Lay health workers with similar characteristics to the target audience help traditional Vietnamese American women feel comfortable discussing barriers to Pap testing (for example, believing that Pap testing is unnecessary for asymptomatic women; that it is “God’s will” or “fate” if a woman gets cervical cancer; that it is not necessary for older women, single women, and sexually inactive women to get a Pap test).
CREDITS.
Taylor VM, Jackson JC, Yasui Y, Nguyen TT, Woodall E, Acorda E, Li L, Ramsey S. (2010). Evaluation of a cervical cancer control intervention using lay health workers for Vietnamese American women. American Journal of Public Health, 100 (10), 1924-1929.
http://rtips.cancer.gov/rtips/programDetails.do programId=1427816
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