CAPRELA (Cancer Prevention for Latinas): findings of a pilot study in Winston-Salem, Forsyth County.

OBJECTIVE: To evaluate knowledge and attitudes that affect cervical and breast cancer screening among uninsured Hispanic women.

STUDY DESIGN: Cross-sectional, descriptive study of uninsured Latino women in Forsyth County, North Carolina.

DATA SOURCES/STUDY SETTING: A convenience sample of Hispanic women who immigrated to the United States within the last ten years, primarily from Mexico (N = 70).

DATA COLLECTION METHODS: Two trained lay health advisors (promotoras) administered in-person, structured surveys to 70 women in the community. All interviews were conducted in Spanish. Additionally two focus groups were conducted in Spanish to elucidate cultural beliefs and barriers to cancer screening not otherwise captured in the standardized surveys. Quantitative data were analyzed using logistic regression analysis. Qualitative data were transcribed and analyzed using a multi-step framework approach to identify and validate themes.

PRINCIPAL FINDINGS: Of 70 women, 42 (60%) reported a Pap smear within the last year; 26 (37%) reported two exams within the past three years. Among women aged 40 and older, 10 of 18 (56%) reported ever having a mammogram. Being married (OR = 4.05, CI 1.07-15.25) and having the same healthcare provider (OR 5.64, CI 1.04-30.56) predicted better Pap smear screening in multivariate analyses. Limited knowledge about breast cancer and needing an interpreter to communicate reduced the likelihood that women received a mammogram. Qualitative results indicated that women had poor prior experiences with Pap smears, held several misconceptions about cancer etiology and risk factors, and expressed distinct gender roles for Latina women and men that may affect healthcare utilization.

CONCLUSIONS: Screening rates for cervical and breast cancer are low among uninsured Latina women. Therefore, community and clinic-based interventions are needed to improve underutilization of and satisfaction with cancer screening practices among uninsured Latina women.