Addressing Cervical Cancer Disparity in South Florida CBPR in Action

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DESCRIPTION (provided by applicant): The South Florida Center for Reducing Cancer Disparities, also known as SUCCESS, supports a number of campus-community partnerships, or Community Advisory Groups (CAGs), throughout the Miami metropolitan area. Such partnerships were conceived in the spirit of Community-based Participatory Research (CBPR) and facilitate meaningful collaboration between University investigators and community stakeholders in addressing issues of health disparity. The proposed project focuses on cervical cancer, a topic of significant health concern for three communities served by SUCCESS: Little Haiti, Hialeah, and West Perrine. Like other predominately minority, low-income neighborhoods across the United States, these communities contribute to excess cervical cancer incidence and mortality, largely due to lack of access to routine Pap smear screening and timely follow up for detected abnormalities. SUCCESS aims to address this disparity. For the past three years, we have been engaged in a community trial comparing two innovative modalities for disease prevention: navigation to Pap smear screening at local Federally-Qualified Health Centers (FQHC) vs. home-based self-sampling for Human Papillomavirus (HPV), the principal cause of cervical cancer. In both arms, Community Health Workers (CHWs) play a critical role in intervention delivery. However, our preliminary data indicate that CHW involvement may matter less than the method of screening itself. Screening uptake is significantly higher among women randomized to self-sampling in all three communities, likely given the ease of use and participant preference for home-based screening, which circumvents structural and cultural barriers to care. The proposed study will formally test the significance of CHW participation by comparing self-sampling provided by a CHW with self-sampling provided by mail. We will implement a two-arm study of 700 women from across our three target communities, with the CHW-self sampling intervention serving as our control group, or arm. Our primary aim is 1) to determine which method of self-sampling results in a greater proportion of women screened. Secondary outcomes include comparisons of a) knowledge, attitudes and beliefs about cervical cancer and the importance of early detection of disease~ b) access to care (health insurance, having a usual source of care, and visit to provider in six months), particularly among women having abnormal screens and requiring medical intervention~ and the c) relative cost of the two intervention strategies. Consistent with the tenets of CBPR, the focus and scope of such work was informed by the SUCCESS CAGs in Little Haiti, Hialeah, and West Perrine. By enlisting community leadership in study conceptualization, we ensure that we can successfully achieve our intended goal, to identify the most optimal strategy for cervical cancer prevention among women who disproportionately contribute to disease incidence and mortality.