ASPO Abstracts
A RCT of Two Interventions to Usual Care for Increasing Cervical Cancer Screening
Category: Behavioral Science & Health Communication
Conference Year: 2023
Abstract Body:
Purpose Rural women have increased incidence and mortality from cervical cancer (CC) compared to urban women indicating a lack of cervical cancer screening (CCS), an important component of CC control. The objective of this study was to examine the comparative effectiveness of a mailed DVD vs. DVD plus telephonic patient navigation (PN) vs. Usual Care (UC) for increasing the percentage of rural Midwestern women up to date (UTD) with 2018 United States Preventive Services Task Force CCS guidelines. Methods As part of a larger study, 553 women (aged 50-74) who were not UTD for CCS were consented and randomized to one of the three study arms, DVD, DVD+PN, UC. Participants were assessed for baseline characteristics including sociodemographics, health status, and CCS beliefs by self-reported survey. Baseline and 12-month screening status were assessed by medical record review. Results The mean age of participants was 59.8 years. When controlling for covariates in a logistic regression model, women had 4.52 (95% Confidence Interval [CI]=2.09,10.7,p<.001) greater odds of being UTD with CCS in the DVD+PN group vs. UC and 2.93 (95%CI=1.63,5.25, p<.001) greater odds of being UTD in the DVD+PN vs. DVD group. Other significant covariates included having higher odds (Odds Ratio[OR]=4.76;95%CI=1.27,.33.33;p=.045) of becoming UTD if on private vs. public insurance; being normal (OR=2.71;95%CI=1.14, 6.37;p=.022) or underweight (OR=2.38;95%CI=1.12,5.09;p=.024) vs. obese; and planning to have a Papanicolaou (Pap) test within the next six months (contemplation) (OR=2.25;95%CI=1.23,4.08;p=.008). Conclusions A PN plus an interactive DVD intervention significantly improved the proportion of Midwestern rural women who became UTD with CCS compared to UC. Certain groups of women may be more at risk for not obtaining a CCS such as those who are on public insurance, obese, and not planning CCS. Future interventions should focus on women with these characteristics to increase CCS rates. A limitation of this study is that behavioral variables, such as contemplation, were measured in relation to Pap testing and did not include human papillomavirus (HPV) testing. As HPV testing/co-testing becomes more widely used, future interventions should examine behaviors specific to this screening.
Keywords: Cervical cancer screening; rural health; behavioral intervention