Applying Intervention Mapping to Adapt a Community-Based Education Program to Promote Breast and Cervical Cancer Prevention and Early Detection Among Latinas

Background: Latinas have higher incidence rates in cervical cancer and later stage diagnosis of breast cancer compared to non-Hispanic whites. To increase prevention and early detection in Latinas residing in urban and suburban areas, we used the Intervention Mapping (IM) framework to adapt an evidence-based program originally developed for migrant farmworkers. The overall goal is to identify the salient program elements while adapting others to ensure relevance for the new target population among diverse groups of low-income Latinas. Methods: This program development and adaptation work is guided by IM Steps 1 through 4. IM provides a systematic approach based on theory and evidence to adapt the original breast and cervical cancer education prevention program. Each step includes specific tasks: Step 1: Establish a planning committee, conduct a needs assessment that includes a literature review and review of evidence from the previous program, Cultivando la Salud (CLS). Additionally, in Step 1, we produce a logic model of the problem and identify determinants of breast and cervical cancer screening and human papillomavirus (HPV) vaccination among Latinas; Step 2: Produce a logic model of change, including construction of matrices, creation of program outcomes and objectives; Step 3: Create program themes, components, choose theory and practical applications; and Step 4: Prepare program materials and protocols and pretest materials. Results: In Step 1, we produced the logic model of the problem using input from the literature review and the planning group, which included the UTHealth team, community health worker organization partners and community stakeholders. In Step 2, we stated the behavioral outcomes and the three performance objectives. The performance objectives are: 1) participant makes appointment for screening/vaccination; 2) participant completes screening/vaccination; and 3) participants obtains results of the screening and follows recommendations for next exam, including diagnostic follow-up. Next, we expanded and adapted the logic model of change to include the HPV vaccination. Then, we constructed matrices of change for each behavioral outcome. In Step 3, we identified the theme “Health in My Hands” and the methods and practical applications to obtain the change objectives. We expanded the education session and adapted the in-personal education for phone education. Then, we expanded and adapted the telephone support. In Step 4, we produced the design documents for the expanded education session, and after completing pre-testing, the program materials were produced. Discussion: Using Intervention Mapping as a systematic process to guide adaptation and expansion of a breast and cervical screening education program including HPV vaccination addressed the determinants of screening and HPV vaccination among low-income Latinas disconnected from healthcare services. We used an iterative process focused on updating matrices as aspects were added to the education session as needed