Table 4 Breast and cervical cancer intervention studies: evidence on effectiveness
Study* | Study Design & Sample Size | Description of Intervention | Outcomes (Post-Intervention screening rate, Intervention vs. Control) | Recommendations |
|---|---|---|---|---|
Thailand 2006 [43] | Non-Equivalent Control Group | An in-home visit by one of the researchers and provided culturally sensitive health education and invitation for cervical cancer screening | Self-reported Pap test: 43.6 vs. 34.9% (p = 0.119) | No significant evidence to support the effectiveness of home visit and invitation. |
304 Thai women in Khon Kaen | ||||
Pennsylvania 2004 [45] | Non-Equivalent Control Group | Participants received cervical cancereducation and patient navigation provided by bilingual Korean health educators. | Self-reported and verified Pap test: 82.7% vs. 22.0% (p < 0.001) | A combination of providing assistance in scheduling/attending screening, community based group education, and culturally sensitive audiovisual materials was recommended. |
102 Korean American women | ||||
Non-Equivalent Control Groups | Lay health worker outreach (LHWO) that includes small group gatherings, outreach materials, and questions and answers, as well as media education campaign (ME) vs. media education campaign only. | 2003 Evaluation results Self-reported Pap test: LHWO + ME from 62.1% to 76.9% (p < 0.001);ME from 70.2 to 72.8% (p < 0.001). 2006 evaluation resultsLHWO + ME: from 65.8 to 81.8% (p < 0.001); ME: from 70.1 to 75.5% (p < 0.001) | Combining the approach of Lay health workers and media education campaign was more effective than media education campaign alone. | |
400 (2003 evaluation); 968 (2006 evaluation) Vietnamese Americans | ||||
Seattle 2000-2001[72] | Cluster Randomized Trial | Home visits by outreach workers and invited to group meetings in neighborhood settings. | Self-reported Pap test: increased from 44% to 61% in the intervention group and from 51% to 62% in the control. No significant difference in the increase of the odds of having a Pap test in the two groups | No evidence to support the effectiveness of home visits by outreach workers. |
370 Cambodian American in Seattle, US | ||||
Randomized Controlled Trial | Outreach intervention which involves tailored counseling and logistic assistance during home visits by trilingual, bicultural outreach workers vs. direct mail intervention vs. no intervention (control) | Self-reported Pap test: Outreach intervention group 39%; direct mail intervention: 25%; control group 15%. The cost effectiveness (cost per additional woman obtaining a Pap test) is less ($304.42) in the outreach arm as compared with direct mail ($485.40). | Outreach intervention which involves tailored counseling and logistic assistance during home visits by trilingual, bicultural outreach workers was found to be more cost effective than direct mail intervention. | |
482 (2002 evaluation);139 (2007 cost-effectiveness evaluation) Chinese women in Seattle, Washington, US; and Vancouver, British Columbia, Canada | ||||
Non-Equivalent Control Group | Direct-mail campaigns of cervical cancer screening and a phone counseling (intervention) vs. monthly newsletter (control). | Self-reported Pap test: 50% vs. 32% (p = 0.002) | Intervention targeting individual such as direct mail campaigns and phone counseling was found to be more effective than monthly newsletter intervention. | |
424 Chinese women in Taiwan. | ||||
Los Angeles 1998-2000[62] | Cluster Randomized Trial | Group sessions conducted at community based organizations, churches, or private homes with some of their peers and a female Filipino health educator; women within each site randomized to receive a cancer screening module (intervention) or a physical activity module (control). | Self-reported mammogram:59% vs. 57% (p = 0.7);Reported Pap test: 56% vs. 52% (p = 0.4) | Small group discussion intervention with health professional was not found to be effective. |
530 Filipino American in Los Angeles, US | ||||
Los Angeles 1998-2000 [36] | Cluster Randomized Trial | An on-site multi-component educational program with on-site mobile mammography at community-based sites where older women gather (intervention) vs. health education only (control). | Self-reported Mammography: 70% vs. 35% (p = 0.015) | The combination of on-site mobile mammography health and education was more effective than health education only. |
499 Older women that include Asian Americans (10% of sample) Women who could not speak English or Spanish were excluded. | ||||
Taiwan 1997-98[56] | Randomized controlled trial | Group teaching program in the workplace on married women’s knowledge, health beliefs and behavior regarding cervical cancer screening (intervention group) vs. pamphlet by mail (control group). | Self-reported Pap test: 90.9% vs. 77.5% (p < 0.05) | Group teaching program in workplace was found to be more effective than pamphlet by mail. |
333 Chinese women in Taiwan: 66(pre-tested experimental group; 57(pretested control group); 64 (nonpretested experimental group; 63(nonpretested control group) | ||||
Alameda 1996-1998[37] | Non Equivalent Control Group – counties 384(intervention); 404(control) Vietnamese Americans in Alameda country, California | Neighborhood-based intervention which involved establishing a Vietnamese Women’s Center in a storefront. Education activities include dissemination of health education materials on breast cancer screening, media campaign, and screening education for Vietnamese physicians. | Self-reported mammogram: 69.6% vs. 58.8%; Reported pap test: 66.9% vs. 65.1%. None of the between-group differences of the differences was statistically significant. | County-wide neighborhood-based intervention involving education, media campaign and screening education for Vietnamese physicians was not found to be effective. |
Newham 1995 [38] | Cluster Randomized Trial 2,046 women in Newham, UK: including Indian 348; Pakistani 204; Bangladeshi 123; Chinese 20 | A two hour training programme for general practice reception staff | Increase in mammographic screening attendance in general: 9% vs. 4% (p = 0.04); Indian population: 19% vs. 5% (p = 0.005)) Cost: 13 pounds per additional woman screened. | Cultural awareness training for health care professionals was recommended. |
Singapore 1994-1996[39] | Randomized Controlled Trial 1500 women in Singapore: Chinese (72.3%); Malays (17.8%); Indians (9.0%) | A routine one-page second reminder letter (R) vs. reminder letter and health education booklet (RP) vs. home visit by a female field worker delivering invitation letter and educational folder (RV) | Mammography attendance: R 7%; RP 7.6%; RV 13.3%. RV vs. R: RR = 1.90 (95% CI 1.27 to 2.84); RV vs. RP: RR = 1.75 (1.19 to 2.59); R vs. RP: RR = 1.09 (0.70 to 1.70) | Home visit delivering the routine second-reminder letter and health educational booklet was more effective than mailing the routine reminder and/or health education booklet; health education booklet did not increase uptake above what can be achieved by routine letter reminder. |
Tell a Friend –Alameda 1994-2002 [66] | Non-Equivalent Control Groups – Intervention and Control communities 818 (1994 survey); 72 (1997 survey); 1084 (2002 survey) Korean Americans in Alameda county, California | Community-based interventions that include: 1. delivery of workshops in Korean American churches and distribution of educational materials; 2. adaptation of the American Cancer Society’s “Tell A Friend” program; 3. financial incentives for screening; 4. health councellors were recruited and trained to help organize the church workshops, link women with regular providers and health insurance, promote health as a priority within their churches; 5. educational workshops; and 6. media campaign | Recorded mammogram: 38% vs. 32% (p = 0.108) | Community-based interventions were not shown to be effective in enhancing breast or cervical cancer screening at the community level. |
Lay Health Workers Outreach 1992-1996 [69] | Non-Equivalent Control Group – intervention and control cities Vietnamese Americans: 306 (1992 survey); 373 (1996 survey) | Community based small-group sessions conducted by lay health workers; culturally sensitive print materials; media campaigns. | Self-reported Mammogram: 69% vs. 47% (p = 0.006); Self-reported Pap test: 66% vs. 42% (p = 0.001) | A combination of community based group education, culturally sensitive print materials, and media campaigns was recommended. |
Media-Led Education Campaign 1992-1994 [70] | Non-Equivalent Control Groups – Intervention and Control counties. 451 (intervention); 482 (control) Vietnamese Americans in California, US | Media-led community culturally sensitive education campaign for breast and cervical cancer screening | Self-reported mammogram: 67.5% vs. 62.6% (p = 0.260); Self-reported Pap test: 66.5% vs. 58.1% (p = 0.014) | Media-led community culturally sensitive education campaign was not found to be effective. |
Oldham 1991 [41] | Randomized Controlled Trial 527 Pakistani and Bangladeshi women in Oldham, UK | Two health workers experienced in working with Asian women give encouragement and explanations about breast screening during a home visit. | Self-reported mammogram: 49% vs. 47% (p = 0.53) | Home visit was not found to be effective. |
New Zealand 1987-1988 [60] | Prospective Cohort 737 Indian, Pakistani, Bangladeshi in Leicester, New Zealand | Visited and showed a video on the uptake of smear testing vs. visited and shown a leaflet and fact sheet on cervical cancer screening vs. posted a leaflet and fact sheet vs. no intervention (control) | Laboratory computer recorded pap test: 30% of those who received videos; 26% of those who received leaflets; 11% of those mailed leaflets; and 5% of the control group. (p < 0.001) | Personal visits (with video or leaflets) were found to be effective; written translated materials sent by post were found to be ineffective. |
Let’s Talk Between Women 2002 [26] | Non-Equivalent 3 Group Design 147 Korean Americans in South California. | Peer-group educational program and low-cost mammography (Let’s Talk group) vs. access to a low-cost mammography alone (Mobile mammography only) vs. no intervention (control) | Self-reported mammogram in Let’s Talk intervention group: 87% (vs. 47% in control group, p < 0.05%); Mobile mammography-only intervention group: 72% (vs. control group, p < 0.05%) | Peer-group educational program was not shown to increase screening more significantly than only providing low-cost mobile mammography. |