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JNCI Journal of the National Cancer Institute 2002 94(9):670-677; doi:10.1093/jnci/94.9.670
© 2002 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 94, No. 9, 670-677, May 1, 2002
© 2002 Oxford University Press

ARTICLE

A Randomized Controlled Trial of Interventions to Promote Cervical Cancer Screening Among Chinese Women in North America

Victoria M. Taylor, T. Gregory Hislop, J. Carey Jackson, Shin-Ping Tu, Yutaka Yasui, Stephen M. Schwartz, Chong Teh, Alan Kuniyuki, Elizabeth Acorda, Ann Marchand, Beti Thompson

Affiliations of authors: V. M. Taylor, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Health Services, University of Washington, Seattle; T. G. Hislop, Cancer Control Research, British Columbia Cancer Agency, Vancouver; J. C. Jackson, S.-P. Tu, Department of Medicine, University of Washington, and International Medicine Clinic, Harborview Medical Center, Seattle; Y. Yasui, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center; S. M. Schwartz, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington; C. Teh, Cancer Control Research, British Columbia Cancer Agency; A. Kuniyuki, E. Acorda, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center; A. Marchand, Department of Medicine, University of Washington; B. Thompson, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Health Services, University of Washington.

Correspondence to: Victoria M. Taylor, M.D., M.P.H., Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. North (MP-702), Seattle, WA 98105 (e-mail vtaylor{at}fhcrc.org).

Background: North American Chinese women have lower levels of Papanicolaou (Pap) testing than other population subgroups. We conducted a randomized controlled trial to evaluate the effectiveness of two alternative cervical cancer screening interventions for Chinese women living in North America. Methods: Four hundred and eighty-two Pap testing underutilizers were identified from community-based surveys of Chinese women conducted in Seattle, Washington, and Vancouver, British Columbia. These women were randomly assigned to one of two experimental arms or control status. Several Chinese-language materials were used in both experimental arms: an education-entertainment video, a motivational pamphlet, an educational brochure, and a fact sheet. Women in the first experimental group (outreach worker intervention) received the materials, as well as tailored counseling and logistic assistance, during home visits by trilingual, bicultural outreach workers. Those in the second experimental group (direct mail intervention) received the materials by mail. The control group received usual care. Follow-up surveys were completed 6 months after randomization to ascertain participants' Pap testing behavior. All statistical tests were two-sided. Results: A total of 402 women responded to the follow-up survey (83% response rate). Of these women, 50 (39%) of the 129 women in the outreach group, 35 (25%) of the 139 women in the direct mail group, and 20 (15%) of the 134 women in the control group reported Pap testing in the interval between randomization and follow-up data collection (P<.001 for outreach worker versus control, P = .03 for direct mail versus control, and P = .02 for outreach worker versus direct mail). Intervention effects were greater in Vancouver than in Seattle. Conclusion: Culturally and linguistically appropriate interventions may improve Pap testing levels among Chinese women in North America.


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