Enhancing the Effectiveness of Community Health Workers to Reduce Cervical Cancer Disparities in African American Women

PROJECT SUMMARY/ABSTRACT The hysterectomy-corrected incidence of cervical cancer (CC) is more than 40% higher among African American women than white women. Black women are also twice as likely to die from CC. It does not have to be this way. Widespread screening and proper follow-up would eliminate most new cases of CC because the natural progression of precancerous cervical lesions is slow, allowing for treatment and cure. The best evidence indicates that this is not happening. Adherence to screening guidelines is too low among Black women. One promising solution to this problem is patient navigation (PN). PN was originally developed to help socioeconomically disadvantaged Black women overcome the systemic, provider, and personal barriers to timely cancer prevention and care using community members as lay navigators. Recently, however, there has been a general shift away from navigating poor and uninsured patients, towards higher SES patients in better funded, more comprehensive cancer care centers. While nearly all can benefit from PN, if not targeted to those most in need, delivering these services to more privileged patients can exacerbate disparities. In previous pilot work, we developed and tested a prototype, mobile PN intervention for both African American women (mNav) and lay navigators (mNav-D) to reduce CC health disparities. These products are front-ends to the same server-based program, and thus fully integrated. For patients, mNav includes an integrated web-based risk assessment that allows our SMS software app to select and deliver videos and text messages specific to each woman’s particular cervical screening challenges. Pilot work with 42 African American women ages 21 to 65 informed the development of this product. For lay navigators, mNav-D provides an “at a glance” overview of key performance metrics while also supporting easy entry of encounter- level patient data. Development of this product was informed by formative research with 16 PNs working in a range of settings. We also interviewed 12 participants who either had upstream or downstream touch points with electronic health record (EHR) workflows. The data across these pilot studies strongly supports the feasibility and potential effectiveness of these products, far exceeding the proposed benchmarks. During Phase II we will complete development of mNav and mNav-D in consultation with our three content experts. We will then examine the effectiveness of mNav and mNav-D to increase adherence to cervical screening guidelines via medical review among nonadherent African American women. Participants will be randomly assigned to either the intervention condition (PN + mNav/mNav-D) or to usual care (PN only). Secondary measures will assess cancer screening knowledge, benefits and barriers of cancer screening, and intentions.