Implementation Strategies Addressing Caribbean Stigma to Improve the Woman-to- Woman Cervical Cancer Prevention Intervention

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PROJECT SUMMARY This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA- 23-036”. The overall objective of the proposed study is to build upon our program of Caribbean stigma research relevant to cancer prevention. Our preliminary study shows that in the Caribbean, stigma bars preventive care including cervical cancer screening and HPV vaccination. In response, to address cancer stigma for the Caribbean contexts, we will employ implementation science approaches to improve the evidenced Woman to Woman intervention (W2W) to reduce stigma and increase cancer prevention. Rooted in implementation science, we will be guided by diverse stakeholder perspectives, and the preliminary results of our recent population-based Caribbean stigma survey (CCSS, N=2233) to enhance the W2W intervention by including a stigma reduction component to the curriculum. We will leverage our vast African Caribbean Cancer Consortium (AC3) of community partners including Lay Health Advisors and clinicians to inform and guide the improvements to W2W using implementation science approaches to enhance the curriculum and strategies of W2W to reduce cancer stigma, and increase cervical cancer screening and HPV vaccination. To accomplish this objective, we propose the following specific aims: Aim 1: Informed by our Caribbean Cancer and Stigma Study survey (N= 2233) and qualitative results, using the Evidenced Based Process (EBP) modification strategies to improve the current W2W intervention with a stigma reduction curriculum. Aim 2: Engage multi-stakeholder perspectives using community health workers focus groups and clinician interviews to further refine the improved Aim 1 W2W intervention. We will incorporate cultural stigma consideration and reduction domain and content derived from the clinician and community health workers; address HPV vaccination improvements, and enhance implementation strategy to create the enhanced W2W_End Stigma-End Cervical Cancer intervention. Multi-sectoral stakeholders will ensure W2W_End Stigma-End Cervical Cancer intervention’s cultural congruence to reduce cancer stigma as a barrier to cervical cancer screening and HPV vaccination. This implementation science research will be the first to provide novel and requisite stakeholder results to inform co- created (community advocate, clinician, and researcher) stigma reduction curriculum and communication strategies for optimal provider and patient activation for increased uptake of cervical cancer screening and HPV vaccination. Therefore, our study findings will improve the evidenced W2W intervention creating the W2W_End Stigma-End Cervical Cancer to eliminate stigma as a barrier to cervical cancer screening and HPV vaccination, for near future Caribbean intervention dissemination.