Opening pathways to cancer screening for Vietnamese-American women: Lay health workers hold a key

Purpose. We describe a controlled trial of a community outreach intervention to promote recognition, receipt, and screening-interval maintenance of clinical breast examinations (CBE), mammograms, and Pap smears among Vietnamese-American women. Methods. Over a S-year period, indigenous lay health workers conducted small-group sessions of Vietnamese women in a low-income district of San Francisco, California. Women in Sacramento, California, served as controls. Lay workers conducted 56 sessions on general prevention, 86 on cervical cancer, and 90 on breast cancer. Surveys of 306 to 373 women were conducted in the study communities in 1992 and 1996. Results. In the intervention community, recognition of screening tests increased significantly between pre- and postintervention surveys: CBE, 50 to 85%; mammography, 59 to 79%; and Pap smear, 22 to 78% (P = 0.001 for all). Receipt of screening tests also increased significantly: CBE, 44 to 70% (P = 0.001); mammography, 54 to 69% (P = 0.006); and Pap smear, 46 to 66% (P = 0.001). Best-fitting logistic regression models, adjusting for preintervention rates and significant covariates, also showed statistically significant odds ratios for the intervention effect (P < 0.0001). Conclusions. Trained Vietnamese lay health workers significantly increased Vietnamese women's recognition, receipt, and maintenance of breast and cervical cancer screening tests. (C) 1998 American Health Foundation and Academic Press.