Pilot Project 1: Reducing Cervical Cancer Screening Health Disparities among Pacific Islanders Living in Guam (GU) and Hawaii (HI)

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Project Summary/Abstract Pilot 1 is a 3 year hypothesis-driven research project aimed at decreasing cervical cancer screening disparities in Chuukese and Marshallese Pacific Islander women. This group of women has among the highest incidence rates of cervical cancer in the world (79.7 per 100,000 and 42.4 per 100,000 (2007-2011)) in the Republic of the Marshall Islands (RMI) and Pohnpei, Federated States of Micronesia (FSM) respectively, compared to 9.9 per 100,000 women in the US(1). Therefore, identifying culturally appropriate methods to increase screening for this preventable disease is essential for these women and the welfare of their family. Prior work has persuaded us that text messaging on mobile phones is an effective method for reaching this population of Pacific Islanders. Pilot Project 1 has three objectives: 1) to understand the knowledge, attitudes, and beliefs of Micronesian Pacific Islander migrant populations that affect cervical cancer screening behavior; 2) to develop SMS (Short Message Service) strategies that will lead to increased screening rates in the target populations; 3) to support an environment for community-based participatory research and engagement for this study. Target Population: The intervention will focus on women ages 21-65 (inclusive) from two migrant groups of Pacific Islanders who bear a disproportionate burden of cervical cancer morbidity and mortality: 1) the indigenous Chuukese women of the Federated States of Micronesia (FSM) who recently migrated to GU and 2) women from the RMI who recently migrated to HI. The overarching goal of the project is to evaluate the effectiveness of community-based SMS strategies to increase cervical cancer screening rates in underserved Pacific Islander populations who have migrated to GU and HI within the last 5 years. Specific Aim 1 Evaluate the effectiveness of community-based SMS strategies to increase cervical cancer screening rates in underserved indigenous Chuukese and Marshallese populations who have migrated to GU and HI within the last 5 years Aim 1.1: Develop SMS messaging materials encouraging cervical cancer screening in three languages: English, Chuukese and Marshallese. Aim 1.2: Implement a randomized delayed control intervention to assess the effectiveness of SMS to increase completion of cervical cancer screening among Marshallese in HI and Chuukese in GU. Hypothesis: Cervical cancer screening completion will be higher for recently migrated (2007-2014) Chuukese and Marshallese women, ages 21-65, who received the peer-led, SMS-based intervention compared to those who did not receive the intervention. The efficacy of the intervention will be assessed by comparing the prevalence of completion of cervical cancer screening between the two randomized groups in an intention-to-treat analysis at 9 months post- randomization; we will also compare the change in these outcomes before and after intervention in women across both randomized groups. As a secondary outcome, intent to screen will be tracked; the study participants who intend to obtain cervical cancer screening following the intervention but ultimately do not receive cervical cancer screening to understand what other factors, such as transportation, cultural barriers, or a low priority of screening, influence their completion of cervical cancer screening. Knowledge these barriers will be used to develop and design a more robust cervical cancer screening program in the future. SMS health messages directed to this population may be an effective method to reach these culturally isolated and vulnerable Pacific Islander populations. The pilot project will support the overall goals of the Comprehensive Partnership to Advance Cancer Health Equity (CPACHE) by focusing on decreasing the disparity in cancer burden in under-served Pacific Islanders in HI and GU. The pilot will draw support from the Community Outreach Core (COC) and Shared Resources (Biostatistics, Information Technology and Cancer Registry). Pilot project personnel are well-versed in working with Pacific Islander community coalitions, and with the implementation of CBPR within these communities. This design is consistent with the mission and overarching goals of Healthy People 2020 and its Community-Based Objectives to expand culturally relevant approaches to health promotion and disease prevention (www.healthypeople.gov). Most importantly, this project addresses an urgent need to act to reduce the extremely high risk for cervical cancer, which is a preventable disease, in at-risk under-served Pacific Islander women.