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Effectiveness of Cultivando Los Angeles Salud: A Breast and Cervical Cancer Screening Promotion Program for Low-Income Hispanic Females

Effectiveness of Cultivando Los Angeles Salud: A Breast and Cervical Cancer Screening Promotion Program for Low-Income Hispanic Females


M. E FernГЎndez, A. Gonzales, and G. Tortolero-Luna originated the research, created the dimension instruments and research protocols, and oversaw research implementation. A. Gonzales and M. Saavedra-Embesi, our community partners through the nationwide Center for Farmworker Health, drafted the explanations regarding the system and in addition took part in the utilization of the research. J. Williams drafted the dimension parts of the content in addition to tables. W. Chan assisted within the analysis associated with information when it comes to article that is revised contributed towards the analysis and outcomes chapters of this article. All writers took part in conceptualization of a few ideas, interpretation of outcomes, and article review and modifying.

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Goals. We tested the potency of a health that is lay intervention to boost breast and cervical cancer tumors testing among low-income Hispanic ladies.

Practices. Individuals had been females 50 years and older who have been nonadherent to mammography (letter = 464) or Papanicolaou (Pap) test (letter = 243) assessment instructions. Following the number of standard information, lay wellness workers applied the Cultivando la Salud (CLS; Cultivating Health) intervention. Information enthusiasts then interviewed the individuals a few months later on.

Outcomes. At follow-up, assessment conclusion had been greater among ladies in the intervention team compared to the control team both for mammography (40.8% vs 29.9%; P 1–6 Cervical cancer tumors incidence and mortality prices are almost two times as high for Hispanic women since they are for non-Hispanic White women; in addition, Hispanic women can be identified at later on stages and possess poorer survival prices. 1,6

Reduced quantities of cancer tumors testing among Hispanic women can be the result of psychosocial facets including anxiety about cancer, invasive procedures, and discomfort; not enough understanding of cancer as well as its testing practices; attitudes of fatalism; spiritual or religious values; concerns over privacy; language obstacles and sensed discrimination; embarrassment; and partner disapproval. 1,7–24 outside factors also influence testing, such as for instance too little medical health insurance, regular types of healthcare, and doctor referral; transportation obstacles; price; and restrictive work policies.

Successful cancer-control programs for Hispanic ladies used (1) Spanish-language news; (2) part models showing up in advertising (papers, tv) with social reinforcement by community volunteers; (3) “small media,” such as videos delivered in team settings or kiosks; (4) multimethod approaches; and (5) lay wellness workers or promotoras. 38–47 The lay wellness worker or promotora model, that has been first developed in Latin America, is really a peer wellness education model whereby respected community people educate peers in a manner that is culturally appropriate. 48,49

A current Cochrane review reported the potency of lay wellness worker programs for increasing immunization uptake, marketing nursing, enhancing tuberculosis results, and reducing morbidity and mortality because of youth conditions. 50,51 an additional systematic review, the usa Preventive Services Task Force identified 1-on-1 training as a successful technique for increasing both breast and cervical cancer tumors testing. 52 the duty force had been not able to create a suggestion in regards to the utilization of lay health worker programs especially since there had been inadequate variety of published studies assessing their effectiveness.

The effectiveness of this model for increasing cancer screening has yet to be fully explored although evidence suggests that lay health worker programs can improve some health behaviors. To fill this space when you look at the literary works, we applied and evaluated Cultivando los angeles Salud (Cultivating wellness), a lay health worker–delivered academic intervention for breast and cancer screening that is cervical. We expected the intervention would increase mammography and Papanicolaou (Pap) test testing among low-income Hispanic farmworker women whom did perhaps perhaps not stick to recommended testing directions.

We developed a academic intervention (Cultivando la Salud) in 2004 to improve breast and cervical cancer tumors assessment among low-income, low-literacy, Hispanic feminine farmworkers aged 50 years and older. And even though Pap test assessment is preferred for more youthful females, we decided to consist of only women 50 years and older because proof implies that prices of invasive cancer that is cervical greater, prices of assessment are lower, and obstacles to assessment differ among older Hispanic females than among more youthful ladies. 13,18,53–57 We developed the intervention simply by using concepts of community-based participatory research 58 and intervention mapping, a systematic approach for intervention preparation and execution. 14,59 We opted lay health workers to supply the intervention system due to their unique capability to achieve, through individual contact in the neighborhood, ladies who hardly ever or never ever access health care. Lay health workers had been anticipated not just to teach ladies and motivate them to have assessment but additionally to provide assistance that is practical would facilitate the ladies’s use of assessment services.

This program materials contained an application manual, an exercise curriculum, and a couple of training tools for the health that is lay (“tool box”). This program manual had been built to increase use associated with the scheduled system and also to offer directions for system execution and sustainability. It included a description for the scheduled system, proof of its effectiveness, and information regarding just how to develop and manage a lay wellness worker system. Working out curriculum consisted of class plans, learning tasks, and artistic helps for lay health worker training by hospital staff. The “tool box” included bilingual breast and cervical cancer tumors academic materials including a movie, flipchart, breast models, pamphlets, and a training guide. The lay health workers utilized these materials to supply assessment information to feamales in the city. 60 A pilot research conducted in 2 farmworker communities in south Texas (Brownsville and Pharr) supplied home elevators the appropriateness and acceptability of this materials that are educational the feasibility of applying this system. 14,61


This research had been sustained by an agreement that is cooperative the Centers for infection Control and Prevention, A nationwide Cancer Institute Preventive Oncology Academic Award, a nationwide Cancer Institute research grant tion analysis Center Special Interest Project ). This book ended up being additionally authorized by the nationwide Cancer Institute .

We gratefully acknowledge the help regarding the farmworker females and lay wellness workers whom took part in this task while the known people in the nationwide Center for Farmworker wellness nationwide Cancer Coalition. We additionally acknowledge Vincent Chen and Patricia Dolan Mullen for help in the analysis and Edward W. Fernandez and Karyn Popham for editorial assistance.