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Abstract:
Using community-based participatory research methods, a community-research coalition in Santa Clara County, California (SCC) conducted a quasi-experimental, controlled trial to increase Pap test receipt and to build community capacity among Vietnamese-American women. From 1999 to 2004, the Coalition planned and implemented an Action Plan with six components: multimedia campaign, lay health worker outreach, Vietnamese Pap clinic with patient navigation, registry and reminder system, continuing medical education for Vietnamese physicians, and restoring a Breast and Cervical Cancer Control Program site. Components were evaluated individually. Community-wide, cross-sectional telephone surveys of Vietnamese women in SCC (intervention community) and Harris County, Texas (comparison community) measured overall project impact. Receipt and currency of Pap tests increased significantly in the intervention compared with the comparison community. Community involvement, system changes, community and research capacity building, dissemination of results, and program sustainability were also demonstrated. Community-based participatory research is feasible and effective in Vietnamese-American communities.
Key words: Vietnamese, Asian, cervical cancer, screening, Pap test, community-based participatory research.
Traditional health promotion research often undervalues community leadership and involvement.1 Community-based participatory research (CBPR) includes the community from project conception to result dissemination and beyond.2 This approach addresses health disparities in a manner that is culturally appropriate, makes use of local expertise, and leads to community ownership.2"4 Proponents argue that, by focusing on community-based solutions, CBPR can reduce health disparities.5 However, in 2004, the Agency for Healthcare Research and Quality (AHRQ) found that, out of 60 papers describing CBPR projects, only 8 reported system change and only 2 reported improved outcomes.6 Thus, there is a need to conduct and report systematic studies of CBPR to document its effectiveness.
Cervical cancer disparities are indicative of problems with access to care.7 The Papanicolaou (Pap) test has been the most important advance in the prevention of cervical cancer. Vietnamese-American women have the highest rate of cervical cancer among all ethnic groups8"9 and low rates of Pap test receipt.10"14 Their Pap test receipt is associated with sociodemographic characteristics, beliefs, access, and physician characteristics.12'13·15 Previous community-oriented research found that media and lay health worker approaches led to increased Pap test receipt but that access barriers remained difficult to address. 12>16~17 This paper reports processes and results of a controlled trial using CBPR methods to increase Pap test receipt...