EFFECTIVENESS OF HEALTH-EDUCATION TO INCREASE SCREENING FOR CERVICAL-CANCER AMONG EASTERN-BAND CHEROKEE INDIAN WOMEN IN NORTH-CAROLINA

Background: The North Carolina Native American Cervical Cancer Prevent ion Project was a 5-year, National Cancer Institute-funded trial of he alth education designed to increase screening for cervical cancer amon g Native-American women in North Carolina. Purpose: This study was con ducted to evaluate the effectiveness of this education program in the Eastern-Band Cherokee target population. Methods: Cherokee tribal land s were mapped and all households (N = 2223) were listed to ensure maxi mum coverage of the eligible population (women, aged 18 years and olde r, who were enrolled tribal members). Eligible women were identified b y the use of a brief questionnaire administered to an adult member of the household. Of the 1279 households with eligible women, 1020 (79.8% ) agreed to participate. The intervention was an individualized health education program delivered by female Cherokee lag health educators. The participants were randomly assigned to receive or not to receive t he intervention (i.e., to program and control groups, respectively) by use of the Solomon Four-Group design. Data were collected in face-to- face interviews conducted in the participant's home. Of the 996 women who were ultimately enrolled, 540 were randomly assigned to receive a pretest (preintervention) interview that involved administration of a 96-item questionnaire designed to collect data on knowledge, intention s, and behaviors related to cervical cancer; of these 540 women, 263 w ere randomly assigned to receive the education program. The remaining 456 women did not receive the pretest, but 218 were randomly assigned to receive the education program. Six months after receiving the educa tion program, the women in all four groups were administered a post-te st that was identical to the pretest. Logistic regression was used to assess the effects of the pretest and the educational program. All P v alues resulted from two-sided statistical tests. Results: Eight hundre d and fifteen (81.8%) of the 996 participants completed the post-test interview. The remaining 181 women who were lost to follow-up were eve nly distributed among the four study groups. At the post-test, 282 (73 .2%) of the 385 women who received the education program reported havi ng had a Pap smear following the intervention, compared with 275 (64%) of the 430 control subjects. Women who received the education program were more likely to answer all knowledge items correctly on the post- test (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.08-4.39 ) and to report having obtained a Pap smear in the past year (OR = 2.0 6, 95% CI = 1.14-3.72) than women in the control groups. Conclusion: W omen who received the education program exhibited a greater knowledge about cervical cancer prevention and were more likely to have reported having had a Pap smear within the past year than women who did not re ceive the program.