Community Outreach Boosts Pap Tests Among Vietnamese-American Women

Newswise — A broad-based outreach program that included everything from Vietnamese-language television commercials to a weekly neighborhood clinic increased the rate of Pap tests in a California community of Vietnamese-American women, according to a new study.

The Pap test checks for abnormal changes in the cervix that could lead to cervical cancer. Vietnamese-American women have the highest incidence of cervical cancer among all ethnic groups in the United States, but they lag behind other women in getting regular Pap tests, said lead researcher Tung Nguyen M.D., of the University of California, San Francisco.

The five-year program increased the rate of women receiving the Pap test from 77 percent to 84 percent. The outreach program is the likely cause of this increase, since Pap test rates stayed the same in a similar Texas community — the control group — that did not participate in the program, say Tung and colleagues.

Nguyen said the study, one of the first to show a significant community-wide change in behavior, uses a "participatory research approach, in which community member work with researchers to address health problems."

The study will be published in the July issue of the American Journal of Preventive Medicine.

The research began with 1,566 Vietnamese-American women ages 18 and older living in Santa Clara County, Calif., and Harris County, Texas. By study's end, a total of 2,009 women had participated.

Nguyen and his colleagues teamed up with other academics and community leaders in the Vietnamese REACH for Health Initiative Coalition in designing a multifaceted approach that combined a media blitz with more opportunities for Pap testing.

Vietnamese-American women in the California community saw television and print ads encouraging them to get tested, while community health workers fanned out through the neighborhoods to talk about the tests and physicians sent out thousands of reminders for repeat Pap tests to their patients.

The coalition also created a weekly, bilingual clinic to give Pap tests at discount rates and convinced state officials and legislators to restore funding for free screenings for low-income women.

Nguyen said that such an intensive program requires a lot of manpower and resources, but it "is inherently valued by the communities suffering from disparities."

"The change in behavior went beyond the number of women participating in the surveys and applied to all Vietnamese women living in the California community," Nguyen said. "In addition, system changes such as the restoration of free screenings helped all low-income women regardless of their ethnicity in the same community."

Other factors beyond the program also influence whether a Vietnamese-American woman is likely to get a Pap test, the researchers found. Women who had lived longer in the United States and had health insurance and a regular place of care were more likely than others in their community to get the test.

University of Houston researcher Jenny Yi, who studies Asian-American community health, agrees that overall "differences in access and availability of health services in California and Texas for Vietnamese women" probably played an important part in the likelihood of screening in both communities.

Women who got the Pap test appeared to value having a female physician and "respectful" physicians more than having a Vietnamese physician, Nguyen and colleagues found. This may mean that, at least for the Pap test, these women can get effective preventive care in areas of the country with few practicing Vietnamese doctors, they say.

Certain cultural barriers to getting a Pap test, such as deferring to a doctor's expertise and not requesting a test, remained intact even after the five-year program. However, the program's overall success "suggests that culturally appropriate interventions can succeed in changing health behaviors even if they are not successful in changing cultural barriers," Nguyen says.

The study was funded by the Centers for Disease Control and Prevention and the Asian American Network for Cancer Awareness, Research and Training.

Nguyen TT, et al. Pap testing among Vietnamese Americans: results of a multifaceted intervention. Am Prev Med 31(1), 2006.