Feasibility study, research efforts to identify and reach Portuguese-speaking women who are underscreened for cervical cancer

grantor: University of TorontoThe value of secondary prevention of cervical cancer by screening with the Pap test is well-recognized, but women at greatest risk for cervical cancer (older, poorer, not speaking an official language) continue to be least well-screened. This study investigated the use of quantitative and qualitative research to identify and reach Portugese-speaking women who are underscreened with respect to cervical cancer. Traditional epidemiologic approaches were seriously constrained, but conceptual synthesis using qualitative approaches provided a resolution. The project was developed, implemented and reviewed, in iterations, with Portuguese-speaking women and those who care for them in Toronto, Ontario. Many approaches to identify and reach underscreened women were considered; two approaches (health events and physicians' offices) were evaluated. Questionnaires, surveys and physicians' logs revealed misclassification of "eligibility for screening", "interval since last Pap test", and "intentions regarding Pap tests". Not all underscreened women identified by their doctors or friends wished to attend health events or have Pap tests. A pilot trial of appointment scheduling (now versus later) and brochure language (Portuguese versus English and Portuguese) showed that randomization, consent forms and follow-up interviews were largely acceptable to participants, but data validation (requested on follow-up) was not. Barriers and facilitators of Pap testing were categorized using the PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluations) model. A theoretical model integrates elements of others, including the Health Belief Model, and social learning theory. This "Two Streams" model explains perceptions of need and value for Pap testing in the context of the test and understandings (including myths) about cancer and health care. This model explains how age, fear, and lack of symptoms impede screening Pap tests. Time, contact and communication are proposed to develop trusting relationships and understandings about health behaviour and health outcomes. Public health's role in developing and implementing strategies for improving screening to prevent invasive cervical cancer is affirmed. Recommended strategies, which should contribute to social marketing, include: scheduling appointments for prevention counselling, dispelling myths (e.g., Pap tests are for young and sexually active women) with their complements, and developing narrative or dramatic scenarios to model patient-provider interactions.Ph.D