Empowering Low-Income Asian American Women to Conduct Human Papillomavirus Self-Sampling Test: A Community-Engaged and Culturally Tailored Intervention

Grace X Ma, Lin Zhu, Shumenghui Zhai, Timmy R Lin, Yin Tan, Cicely Johnson, Carolyn Y Fang, Jerome L Belinson, Min Qi Wang, Grace X Ma, Lin Zhu, Shumenghui Zhai, Timmy R Lin, Yin Tan, Cicely Johnson, Carolyn Y Fang, Jerome L Belinson, Min Qi Wang

Abstract

Background: Asian American women face disproportionate burden of cervical cancer (CC) than non-Hispanic white women in the U.S. The goal of this study was to assess the feasibility and impact of a culturally tailored intervention to promote Human papillomavirus (HPV) self-sampling test among hard-to-reach Asian American women.

Methods: We adopted the community-based participatory research (CBPR) approach to conduct this efficacy study. A total of 156 female participants (56 Chinese, 50 Korean, and 50 Vietnamese) were recruited from community-based organizations (CBOs) in the greater Philadelphia metropolitan area. The intervention components included HPV-related education, HPV self-sampling test kit and instructions, group discussions, and patient navigations, all available in Asian languages. We examined several outcomes, including the completion of HPV self-sampling, HPV-related knowledge, perceived social support, self-efficacy, and comfort with the self-sampling test at post-intervention assessment.

Results: The majority of Asian American women had low annual household income (62.3% earned less than $20,000) and low educational attainment (61.3% without a college degree). We found significant increase in participants' knowledge on HPV (baseline: 2.83, post: 4.89, P <.001), social support (baseline: 3.91, post: 4.09, P < .001), self-efficacy (baseline: 3.05, post: 3.59, P < .001), and comfortable with HPV self-sample test (baseline: 3.62, post: 4.06, P < .001).

Conclusion: To the best of our knowledge, this is the first intervention study that promoted HPV self-sampling test among Asian American women. Our findings showed that CBPR culturally tailored intervention of self-sampling was highly effective in empowering low-income Asian American women to conduct HPV self-sampling tests.

Keywords: Asian American women; cervical cancer prevention; community-based participatory research; human papilloma virus; human papillomavirus self-test; women’s health.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

    1. Centers for Disease Control and Prevention . Basic Information about HPV and Cancer| CDC. [Internet]. 2019. Available from: . (Accessed February 28, 2020).
    1. Centers for Disease Control and Prevention . STD Facts - Human Papillomavirus (HPV). [Internet], 2019. Available from: . (Accessed February 28, 2020).
    1. National Cancer Institute . Cancer of the Cervix Uteri - Cancer Stat Facts. [Internet], 2020. SEER. Available from: . (Accessed February 28, 2020).
    1. Torjesen I. HPV vaccine: High coverage could eradicate cervical cancer within decades, say researchers. BMJ. 2019;365:l4450.
    1. Petry KU. HPV and cervical cancer. Scand J Clin Lab Investig. 2014;74:59-62
    1. Basu P, Hutubessy R, Broutet N. Cervical Cancer: WHO Called for Elimination, Not Eradication. BMJ; [Internet]; 2019. Available from: . (Accessed February 28, 2020).
    1. Centers for Disease Control and Prevention . What Should I Know about Cervical Cancer Screening? [Internet]. 2019. Available from: . (Accessed February 28, 2020)
    1. Centers for Disease Control and Prevention . Inside Knowledge Campaign: Cervical Cancer. [Internet] 2019. Available from:
    1. Shi L, Lebrun LA, Zhu J, Tsai J. Cancer screening among racial/ethnic and insurance groups in the United States: A comparison of disparities in 2000 and 2008. J Health Care Poor Underserved. 2011;22:945-961
    1. Wang JH, Sheppard VB, Schwartz MD, Liang W, Mandelblatt JS. Disparities in cervical cancer screening between Asian American and Non-Hispanic white women. Cancer Epidemiol Biomark Prev. 2008;17:1968-1973
    1. American Cancer Society . Special Section: Cancer in Asian Americans, Native Hawaiians, and Pacific Islander. [Internet] 2016. Available from:
    1. Johnson CE, Mues KE, Mayne SL, Kiblawi AN. Cervical cancer screening among immigrants and ethnic minorities. J Low Genit Tract Dis. 2008;12:232-241
    1. Gor BJ, Chilton JA, Camingue PT, Hajek RA. Young Asian Americans’ knowledge and perceptions of cervical cancer and the human papillomavirus. J Immigr Minority Health. 2011;13:81-86
    1. Ma GX, Shive SE, Wang MQ, Tan Y. Cancer screening behaviors and barriers in Asian Americans. Am J Health Behav. 2009;33:650-660
    1. US Department of Health and Human Services . Healthy People 2020. Cancer: C-15 increase the proportion of women who receive a cervical cancer screening based on the most recent guidelines [Internet]. 2017. Available from: (Accessed December 5, 2017)
    1. Yoo GJ, Le MN, Vong S, Lagman R, Lam AG. Cervical cancer screening: Attitudes and behaviors of young Asian American women. J Cancer Educ. 2011;26:740-746
    1. Ho IK, Dinh KT. Cervical cancer screening among Southeast Asian American women. J Immigr Minority Health. 2011;13:49-60
    1. Lee J, Carvallo M. Socioecological perspectives on cervical cancer and cervical cancer screening among Asian American women. J Community Health. 2014;39:863-871
    1. Levinson KL, Abuelo C, Salmeron J, et al. The peru cervical cancer prevention study (PERCAPS): The technology to make screening accessible. Gynecol Oncol. 2013;129:318-323.
    1. Snijders PJF, Verhoef VMJ, Arbyn M, et al. High-risk HPV testing on self-sampledversusclinician-collected specimens: A review on the clinical accuracy and impact on population attendance in cervical cancer screening. Int J Cancer. 2013;132:2223-2236.
    1. Gupta S, Palmer C, Bik EM, et al. Self-Sampling for Human Papillomavirus Testing: Increased Cervical Cancer Screening Participation and Incorporation in International Screening Programs. Front Public Health; [Internet]; 2018. Available from: . (Accessed February 28, 2020)
    1. Pan American Health Organization . Integrating HPV Testing in Cervical Cancer Screening Program: A Manual for Program Managers. Section 10: HPV testing using self-sampling; [Internet]. Washington, DC; 2016. Available from:
    1. Madzima TR, Vahabi M, Lofters A. Emerging role of HPV self-sampling in cervical cancer screening for hard-to-reach women: Focused literature review. Can Fam Physician. 2017;63:597-601
    1. Kim HJ, Choi SY. Status of use of menstrual hygiene products and genital organ hygiene management in unmarried women. Korean J Women Health Nursing. 2018;24:265-275
    1. Ren L, Simon D, Wu J. Meaning in absence: The case of tampon use among Chinese women. Asian J Wom Stud. 2018;24:28-46
    1. Hanley SJ, Fujita H, Yokoyama S, et al. HPV self-sampling in Japanese women: A feasibility study in a population with limited experience of tampon use. J Med Screen. 2016;23:164-170.
    1. Beksinska ME, Smit J, Greener R, et al. Acceptability and performance of the menstrual cup in South Africa: A randomized crossover trial comparing the menstrual cup to tampons or sanitary pads. J Wom Health. 2015;24:151-158.
    1. Carrasquillo O, Seay J, Amofah A, et al. HPV self-sampling for cervical cancer screening among ethnic minority women in South Florida: A randomized trial. J Gen Intern Med. 2018;33:1077-1083.
    1. Racey CS, Withrow DR, Gesink D. Self-collected HPV testing improves participation in cervical cancer screening: A systematic review and meta-analysis. Can J Public Health. 2013;104:e159-e166
    1. Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Educ Q. 1988;15:175-183
    1. Gustavsson I, Lindell M, Wilander E, Strand A, Gyllensten U. Use of FTA card for dry collection, transportation and storage of cervical cell specimen to detect high-risk HPV. J Clin Virol. 2009;46:112-116
    1. IBM Corp . IBM SPSS Statistics for Windows. Version 25.0. NY: Armonk; 2017
    1. Mandigo M, Frett B, Laurent JR, et al. Pairing community health workers with HPV self-sampling for cervical cancer prevention in rural Haiti. Int J Gynecol Obstet. 2015;128:206-210.
    1. Lee HY, Koopmeiners JS, McHugh J, Raveis VH, Ahluwalia JS. mHealth pilot study: Text messaging intervention to promote HPV vaccination. Am J Health Behav. 2016;40:67-76
    1. Lu M, Moritz S, Lorenzetti D, Sykes L, Straus S, Quan H. A systematic review of interventions to increase breast and cervical cancer screening uptake among Asian women. BMC Publ Health. 2012;12:413
    1. Aswathy S, Quereshi MA, Kurian B, Leelamoni K. Cervical cancer screening: Current knowledge & practice among women in a rural population of Kerala, India. Indian J Med Res. 2012;136:205-210
    1. Leung S, Leung I. Cervical cancer screening: Knowledge, health perception and attendance rate among Hong Kong Chinese women. Int J Wom Health. 2010;2:221-228
    1. Zhu L, Zhai S, Siu PT, et al. Factors related to chinese parents’ HPV vaccination intention for children. Am J Health Behav. 2019;43:994-1005.
    1. Fang CY, Ma GX, Ma GX, Tan Y. Overcoming barriers to cervical cancer screening among Asian American women. N Am J Med Sci. 2011;4:77-83.
    1. Oranratanaphan S, Termrungruanglert W, Khemapech N. Acceptability of self-sampling HPV testing among Thai women for cervical cancer screening. Asian Pac J Cancer Prev APJCP. 2014;15:7437-7441
    1. Montealegre JR, Landgren RM, Anderson ML, et al. Acceptability of self-sample human papillomavirus testing among medically underserved women visiting the emergency department. Gynecol Oncol. 2015;138:317-322.
    1. Cadman L, Ashdown-Barr L, Waller J, Szarewski A. Attitudes towards cytology and human papillomavirus self-sample collection for cervical screening among Hindu women in London, UK: A mixed methods study. J Fam Plann Reprod Health Care. 2015;41:38-47.

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