Abstract A22: The Kin KeeperSM Intervention: Women move beyond psychological barriers to Pap screening
Authors: Williams Julie I. , Lee Charles K. , Williams Karen Patricia 
Published: June 2012

Cancer health disparities are underlined by structural and conceptual barriers, such as: Adequate cancer awareness and education, functional cancer literacy, appropriate and timely access to cancer screening and follow-up care, and psychological aspects of the decision to undergo cancer screening. Cervical cancer health disparities can be impacted by early detection and screening with the Papanicolaou (Pap) test. The Kin KeeperSM Cancer Prevention Intervention is a culturally and linguistically tailored breast and cervical cancer educational intervention designed to improve functional cancer literacy. The Health Belief Model (HBM) was used as a framework to explore potential associations between responses to a cervical Cancer Literacy Assessment Tool (C-CLAT) item assessing a psychological barrier to Pap screening and a woman's screening accomplishments.

Methods: The Kin KeeperSM model has three levels of participants: community health worker (CHW), CHW's female clients (“kin keepers”), and female family members of female clients. Trained CHWs recruited 543 Black, Latina, and Arab women from Detroit and Dearborn, MI to participate in the two-year study. Analysis included only women with two years of data, thus the final number of participants was 446 (117 Black, 157 Latina, 172 Arab). Kin keepers recruited female family members in year one and delivered the cervical cancer educational intervention in year two. After recruitment, CHWs from three local agencies administered the C-CLAT to all participants in English, Spanish, or Arabic before administering an educational intervention (pre-C-CLAT) and after the educational intervention (post-C-CLAT 1); and provided women with Personal Action Plans (PAPs) to identify screening goals based on three statements: Find a health care provider to do first-ever Pap; schedule first-ever Pap; and continue getting yearly Pap. The outcome of interest was indication of these goals as accomplishments in year two. After kin keepers delivered the educational intervention in year two, CHWs administered a post-C-CLAT 2 and an accomplishment-oriented PAP to all participants. Using multivariable logistic regression, we observed the potential effect of responses to a C-CLAT item and sociodemographic covariates on PAP accomplishments. The C-CLAT item “Getting a Pap test is very painful,” suggests a psychological barrier to screening, thus it is relevant to a classic HBM construct, perceived barriers. Post-C-CLAT 1 responses to this item were scored with an answer key and SPSS (PASW Statistics 18) was used for statistical analyses.

Results: In year one, the most significant covariates affecting the goals women selected were race, relationship to the kin keeper, and health insurance status. Response to the C-CLAT item “Getting a Pap test is very painful” was not significant to the goal to continue annual Pap tests, yet race and possibly relationship to the kin keeper were significant (with an alpha of .105, p-values were .038 and .104, respectively). Analysis of women's PAP accomplishments 12 months later indicates the majority of women found a health care provider for a first-ever Pap test, scheduled a Pap in the past 12 months, and had a Pap in the past 12 months. Relationship to the kin keeper was the only statistically significant covariate (p = .035) in analysis of having had a Pap test in the last 12 months.

Conclusions: Future interventions designed to impact cervical cancer health disparities should support women's intentions to pursue screening despite potential psychological barriers. Such studies should explore dynamics between female family members and how these relationships might modify screening decisions and accomplishments. This research was funded by National Institutes of Health (NIH), National Institute for Nursing Research (NINR), 1R01NR011323.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A22.