Salud es Vida Cervical Cancer Education
- Need: Hispanic women have the highest incidence rates of cervical cancer among any ethnicity in the United States.
- Intervention: The development of a lay health worker (promotora) curriculum that provides information on cervical cancer, HPV, and the HPV vaccine to Hispanic farmworker women living in rural southern Georgia.
- Results: Significant increases in post-test scores relating to cervical cancer knowledge and increases in positive self-efficacy among promotoras.
Effective (About evidence-level criteria)
Salud es Vida, which translates as Health is Life, is a curriculum and intervention program that was developed for promotora outreach in rural southern Georgia. Promotoras are lay health workers in the Hispanic community who can relay health-related information to community members. Specifically, the promotora training curriculum was designed to provide promotoras with training on cervical cancer, human papillomavirus (HPV), and the HPV vaccine so they could deliver education to Hispanic farmworker women.
Women in rural areas have increased difficulty getting connected to healthcare services, as newer immigrant-receiving areas often have a limited number of Spanish-speaking healthcare professionals. Furthermore, out of all of the ethnic groups in the U.S., Hispanic women have the highest incidence rate of cervical cancer. By providing peer-led education through promotoras, Salud es Vida works to increase cervical cancer awareness and provide information about cervical cancer screening and the HPV vaccine.
In partnership with a Hispanic-serving nonprofit agency in southern Georgia, the study team developed 2 cervical cancer education modules, guided by previously developed curricula for diverse audiences and earlier ethnographic research with Hispanic farmworker women in Florida.
In a later phase of the research, the research team tested the intervention of group-based cervical cancer education sessions led by a promotora compared to a nutrition education control group for changes in Pap test receipt and cervical cancer knowledge among Hispanic women due for cervical cancer screening.
Funding was provided by the National Institutes of Health: National Cancer Institute.
Over a timeframe of 2 weeks, 7 volunteer promotoras
completed 2 cervical cancer education modules, each of
which took 6 hours to complete.
Topics covered in the first module:
- Female anatomy
- Cervical cancer
Topics covered in the second module:
- Cervical cancer screening
- HPV vaccine
- Community health resources
- Slide presentations
- Vocabulary cards
- Discussion problem cards
- Cervical cancer screening resource list
- Icebreaker activities
The outreach toolkit for promotoras to conduct 2-hour group education sessions, or “charlas,” with community participants consists of a flipchart, a DVD video, and a brochure. There is a cervical cancer knowledge pre-test and post-test as well as other activities that are part of the toolkit. View the following video (in Spanish) to see one way these promotoras receive training:
Promotoras scored an average of 66% on their cervical cancer awareness pre-test. They performed significantly higher on their post-test, averaging a score of 80%. This indicates a significant increase in their cervical cancer knowledge.
All of the promotoras conveyed positive self-efficacy in terms of receiving future Pap tests on a regular basis. They also expressed a willingness to promote positive awareness behaviors to the members in their community, such as promoting cancer screening.
A positive study outcome was the increase in community collaboration in research by involving the community partner in the design of the curriculum. Importantly, the community partner valued the program, and the promotoras are involved with regular migrant health education and outreach activities.
Testing of the intervention with 90 women (38 women in the intervention group and 52 women in the control group) found significantly increased knowledge among intervention participants compared with the control participants. Increasing awareness and access to screening and the HPV vaccine through peer education is critical to reducing the cervical cancer burden in medically underserved Hispanic communities.
The intervention program has been replicated in Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, as part of its NCI National Outreach Network, Community Health Educator program's education and outreach activities.
For more detailed program results:
Luque, J., Mason, M., Reyes-Garcia, C., Hinojosa, A., & Meade, C. (2011). Salud es Vida: Development of a Cervical Cancer Education Curriculum for Promotora Outreach With Latina Farmworkers in Rural Southern Georgia. American Journal of Public Health, 101(12), 2233-2235. Free Full-text
Luque, J., Tarasenko, Y., Reyes-Garcia, C., Alfonso, M., Suazo, N., Rebing, L., & Ferris, D. (2016). Salud es Vida: A Cervical Cancer Screening Intervention for Rural Latina Immigrant Women. Journal of Cancer Education. Article Abstract
Luque, J., Tarasenko, Y., Maupin, J., Alfonso, M., Watson, L., Reyes-Garcia, C., & Ferris, D. (2015). Cultural beliefs and understandings of cervical cancer among Mexican immigrant women in Southeast Georgia. Journal of Immigrant and Minority Health, 17(3), 713-721. Article Abstract | Free Full-text
Watson, L., Bhagatwala, J., Reyes-Garcia, C., Hinojosa, A., Mason, M., Meade, C., & Luque, J. (2012). Refinement of an educational toolkit to promote cervical cancer screening among Hispanic immigrant women in rural southern Georgia. Journal of Health Care for the Poor and Underserved, 23(4), 1704-1711. Article Abstract | Free Full-text
Luque, J., Castañeda, H., Martinez Tyson, D., Vargas, N., & Meade, C. (2012). Formative research on HPV vaccine acceptability among Latina farmworkers. Health Promotion Practice, 13(5), 617-625. Article Abstract | Free Full-text
Luque, J., Castañeda, H., Tyson, D., Vargas, N., Proctor, S., & Meade, C. (2010). HPV awareness among Latina immigrants and Anglo American women in the southern U.S.: cultural models of cervical cancer risk factors and beliefs. NAPA Bulletin, 34(1), 84–104. Article Abstract | Free Full-text
The promotoras felt that they would have benefited from having more time to complete some of the activities throughout the training modules.
Cultural barriers to cervical cancer screening identified by the promotoras included:
- Feelings of embarrassment
- Fear of the procedure
- Lack of permission from spouse to go to the clinic
- Financial burden
- Lack of transportation
- Language barrier
- Lack of motivation
- Time constraints
The toolkit may be adapted to specific areas according to demographics of the Latina population and level of education.
Promotoras must be selected from the local Hispanic population by leadership skills, breadth of networks, and availability.
Promotoras received a $75 stipend for the training session. Other incentives could include on-site childcare, transportation assistance, and meals.
Dr. John S. Luque, PhD, MPH, Associate Professor
Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina
Community health workers
Farmers and farmworkers
Hispanics and Latinos
Sexual and reproductive health
Wellness, health promotion, and disease prevention
January 13, 2016
January 5, 2017
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