Abstract A32: Adaptation of an effective cervical cancer screening intervention: Assessing barriers and facilitators to screening among Latinas and African American women
Authors: Smith Judith Lee , Ghaffarzadeh Ashley , Wilson Katherine M. 
Published: May 2016

Background: Research suggests that evidence-based, culturally appropriate, and theoretically-based interventions promote behavior change. The process of developing such an intervention may be time and labor intensive, as well as costly. When these interventions are successful, it may be useful to adapt the intervention for a different population. Limited literature exists documenting the process of adapting cervical cancer screening interventions. AMIGAS, Ayudando a Las Mujeres con Información, Guía y Amor para su Salud, is a theoretically- and evidence-based intervention, delivered by community health workers, that was designed to increase cervical cancer screening among Latinas of Mexican descent that have been never or rarely screened for cervical cancer. A randomized controlled trial demonstrated that AMIGAS significantly increased the use of Pap tests by trial participants and was cost effective. The next step in the evolution of AMIGAS is a revision of this intervention for African American women. Community health workers can be an effective mode of health information transmission in African American communities. African American women and Latinas may share similar facilitators and barriers to cervical cancer screening, but may also have a few important differences that should be addressed in the revised intervention.

Methods: A literature review was conducted to determine what facilitators and barriers to cervical cancer screening among African American women were similar to or different from Latinas. We searched MEDLINE, CINAHL, and PsychInfo for English language articles with samples that included and reported data on African American women aged 21-64, were studies conducted in the US, were focused on cervical cancer screening, and were published from 2004-2014. Findings were compared with a similar literature review conducted to assess facilitators and barriers to cervical cancer screening among Latinas.

Findings: We identified 471 articles that met the inclusion criteria. Similar facilitators of cervical cancer screening for Latinas and African American women included the recognition that taking care of oneself helps the family and a supportive medical care provider. A notable facilitator for Latinas that was not evident for African American women was the presence of a supportive partner. Several similar barriers existed including limited knowledge and awareness about cervical cancer and cervical cancer screening, embarrassment, lack of insurance, and lack of child care. There were, however, a number of different barriers, not previously identified as barriers among Latinas, that warrant our attention during the adaptation process. Barriers to cervical cancer screening specific to African American women were history of trauma, fear related to the harms of screening, concerns about privacy, belief that a higher power is in control, assertion that cancer cannot be prevented, and cancer fatalism.

Implications: Adapting AMIGAS for African American women will be a complex process. The evidence base and theoretical constructs for the intervention will remain the same. The revised intervention will feature materials that have been adapted to address language, literacy, health literacy, and social context and experiences, including important barriers to cervical cancer screening not identified as barriers for Latinas. The features of the intervention that are expected to be most significantly modified include logos and images and messages to address barriers to cervical cancer screening. It is expected that the resulting revised intervention will be a useful tool to increase cervical cancer screening among African American women who have rarely or never been screened for cervical cancer.

Citation Format: Judith Lee Smith, Ashley Ghaffarzadeh, Katherine M. Wilson. Adaptation of an effective cervical cancer screening intervention: Assessing barriers and facilitators to screening among Latinas and African American women. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A32.