María E. Fernández ^1*, Alicia Gonzales ², Guillermo Tortolero-Luna ³, Janet Williams ¹, Monica Saavedra-Embesi ², Wenyaw Chan ⁴, Sally W. Vernon ¹

¹ University of Texas-Houston, School of Public Health
² National Center for Farmworker Health, Buda, Texas
³ University of Puerto Rico Comphrensive Cancer Center
⁴ University of Texas-Houston School of Public Health

^* To whom correspondence should be addressed. E-mail: maria.e.fernandez{at}uth.tmc.edu.

	Abstract

Objectives. We tested the effectiveness of a lay health worker intervention to increase breast and cervical cancer screening among low-income Hispanic women.

Methods. Participants were women 50 years and older who were nonadherent to mammography (n=464) or Papanicolaou (Pap) test (n=293) screening guidelines. After the collection of baseline data, lay health workers implemented the Cultivando la Salud (CLS; Cultivating Health) intervention. Data collectors then interviewed the participants 6 months later.

Results. At follow-up, screening completion was higher among women in the intervention group than in the control group for both mammography (40.8% vs 29.9%; P<.05) and Pap test (39.5% vs 23.6%; P<.05) screening. In an intent-to-treat analysis, these differences remained but were not significant. The intervention increased mammography self-efficacy, perceived susceptibility, perceived survivability, perceived benefits of mammography, subjective norms, and processes of change. The intervention also significantly increased Pap test self-efficacy, perceived benefits of having a Pap test, subjective norms, and perceived survivability of cancer. It did not change Pap test knowledge, perceived susceptibility, or perceptions about negative aspects of Pap test screening.

Conclusions. Our results add to the evidence concerning the effectiveness of lay health worker interventions for increasing Pap test screening and mammography. Future research should explore the effectiveness of CLS in other Hispanic groups, the mechanisms through which interpersonal communication influences decisions about screening, and how effective interventions such as CLS can best be adopted and implemented in community-based organizations or other settings.

Key Words: Cancer, Hispanics/Latinos, Rural Health, Screening