SAN FRANCISCO-A culturally tailored intervention empowered low-income Asian American women to improve human papillomavirus (HPV) screening and significantly increased their awareness and willingness to conduct a self-sampling test.
Uptake of HPV vaccination has been lower in Asian American and African American young women than in white young women, leading some experts to predict that there will be increased inequality in HPV-attributable cancer incidence between ethnic minorities in terms of absolute numbers. This difference in cervical screening uptake needs to be addressed to protect those who go unvaccinated.
"Asian American women are disproportionally affected by HPV and cervical cancer, and screening rates are particularly low among first-generation immigrants who are socioeconomically disadvantaged and have limited English proficiency," said lead author Lin Zhu, PhD, postdoctoral research fellow in the Center for Asian Health at the Lewis Katz School of Medicine at Temple University in Philadelphia. Zhu presented the study's results at the 12th AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.
Self-sampling is a viable approach to improve cervical cancer screening rates by providing convenience and minimal financial burden, said senior author Grace Ma, PhD, Associate Dean for Health Disparities and Director of the Center for Asian Health at the Lewis Katz School of Medicine. "We wanted to assess how a culturally tailored intervention could impact HPV screening through self-sampling among this underserved cohort," said Ma.
The researchers recruited 156 female Asian Americans from community-based organizations in the greater Philadelphia metropolitan area. The participants spanned three ethnic groups (56 Chinese women, 50 Korean women, and 50 Vietnamese women). Among them, 62.3 percent had an annual household income of less than $20,000 and 61.3 percent did not have a college degree.
The culturally tailored intervention included education pertaining to symptoms of HPV infection, transmission, and screening through workshops and group discussions in Chinese, Korean, and Vietnamese. The researchers included handouts, lectures, and a demonstration on conducting an HPV self-sampling test. Participants were also given self-sampling kits.
The researchers conducted surveys before and after the intervention about the following: knowledge on HPV, social support, and self-efficacy and confidence in conducting an HPV self-sampling test. They found significant increases in scores in all four categories compared to baseline assessment.
In addition, 100 percent of the participants completed the HPV self-sampling test and returned the kits, and all the kits were viable for laboratory analysis. The results of the laboratory analysis were communicated to the participants in their native language, and those with abnormal results were referred to a collaborating physician for follow-up care. The researchers conducted a follow-up call with the participants to verify that they had contacted their doctor for necessary care.
The main limitation of the study, said Zhu, was that it did not include a control group, which will be considered in their future studies.
"To the best of our knowledge, this is the first intervention study evaluating HPV self-sampling in Asian American populations," said Zhu. "Our study provides evidence for effectiveness of a culturally tailored intervention in improving HPV screening rates among Asian ethnic groups and emphasizes appropriate messaging and hands-on demonstrations to foster a sense of empowerment among study participants."
Conference Chair Laura Fejerman, PhD, Associate Professor in the Department Of Medicine at UCSF, stated: "There are a lot of new initiatives in cancer prevention, and screening and early detection; however, awareness and access are huge barriers. A lot of research is addressing these barriers in addition to efforts around outreach and access to quality treatment.
"My personal opinion is that we have some systemic problems. I think the way the health care system works in the United States exacerbates disparities. We also have larger, societal issues, such as lack of access to quality education for children from underserved populations, large income gaps, and large groups of people living in poor neighborhoods, which ultimately translate into disparities in health," she noted. "It is harder to make a huge difference in these areas that we all want to see. Hopefully we will have more data on underserved populations in the future and we will know more about the nature and causes of their disease.
"We will know a lot more about cancer health disparities in 10 years, and I hope that the knowledge gained will translate into real health equity through dialogue and by bringing all stakeholders to the table," Fejerman concluded.
Mark L. Fuerst is a contributing writer.