Better Breast and Cervical Cancer Control for Korean American Women

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DESCRIPTION (provided by applicant): Despite considerable progress made in U.S. cancer control during the past 20 years, certain ethnic minority groups continue to experience significant health disparities. Breast and cervical cancer screening rates for Korean American (KA) women are far below the national goal, and below rates reported for other ethnic groups. As a result, KA women are often diagnosed at a later stage of cancer which can lead to a poor prognosis, high mortality, and subsequent emotional and financial burdens. Limited health literacy is emerging as a far-reaching, major barrier to cancer prevention behaviors, particularly among non-English speaking immigrant populations. This research application is formulated to answer research questions that address critical knowledge gaps in cancer control intervention research for linguistically and/or socially isolated ethnic minority communities using the KA community as an example. These questions are: (1) whether a health literacy-focused intervention using a community-based participatory research (CBPR) process will be effective in promoting health literacy and increasing breast and cervical cancer screening rates among KA women; and (2) whether a tailored intervention delivered by community health workers (CHWs) will be effective in such a community. The proposed study is a community-based, cluster-randomized clinical trial with two parallel arms, with a delayed intervention. A longitudinal repeated measures design will allow us to determine the effectiveness of the proposed health literacy-focused tailored cancer control intervention delivered by CHWs. A total of 480 KA women will participate in the study. The primary outcome of this study will be adherence to breast and cervical cancer screening. We hypothesize that, as compared to KA women in the control (delayed intervention) group, KA women who receive our literacy-focused tailored CHW intervention will demonstrate higher levels of adherence to screening for breast and cervical cancer. Through implementation of these research activities, we expect to establish a mechanism for disseminating critical health information for this population and to enhance a community network which will facilitate community access to breast and cervical cancer screening. While the focus of this research project is health literacy promotion and breast and cervical cancer screening among KA women, the core principles and methodology of this intervention can provide insights toward development of effective, culturally sensitive health literacy programs to meet the needs of socially and/or linguistically isolated minority groups with inadequate cancer control throughout the United States. PUBLIC HEALTH SIGNIFICANCE: Korean American (KA) women have the second highest incidence of cervical cancer nationally and are experiencing rapid increases in breast cancer incidence. Limited capacity to obtain, process, and understand basic health information and services to make appropriate health decisions (i.e., limited health literacy) is a major barrier to early detection of cancer among KA women. This study proposes to test if a health literacy-focused intervention using a community- based participatory research process will be effective in promoting health literacy and increasing breast and cervical cancer screening rates among KA women; and (2) whether a tailored intervention delivered by trained community health workers will be effective in such a community.