Cancer Causes & Control

, Volume 30, Issue 4, pp 375–384 | Cite as

Educating Latinas about cervical cancer and HPV: a pilot randomized study

  • Beti ThompsonEmail author
  • Wendy E. Barrington
  • Katherine J. Briant
  • Erin Kupay
  • Elizabeth Carosso
  • Nora E. Gonzalez
  • Virginia J. Gonzalez
Original Paper



The purpose of this study was to assess effects of three different educational intervention arms on knowledge of and intention to receive Pap testing and HPV co-testing.


Three active educational intervention arms were developed: a fotonovela, a radionovela, and a digital story. A pilot randomized controlled trial of 160 Latinas was conducted to assess the effectiveness of the intervention arms in increasing knowledge of cervical cancer and HPV and intention to be screened for cervical cancer compared to an attention control group (flu vaccination).


Women in all three treatment arms significantly increased knowledge about cervical cancer compared to control arm (p = 0.02). Knowledge about cervical cancer screening also increased in the active arms compared to control (p = 0.0003). Knowledge of HPV risk also increased relative to the control (p = 0.0001). There were no significant differences between the intervention arms in increased knowledge of cervical cancer or cervical cancer screening (p = 0.57 and 0.16, respectively).


This study supported the use of small media interventions in narrative education form as effective in increasing knowledge and intention to be screened for cervical cancer. The three culturally relevant interventions, built on qualitative data, were all successful in increasing knowledge.


Cervical cancer HPV Latinas Fotonovela Radionovela Digital story Education 



We are grateful to all the providers and community women who participated in this research project. We would also like to thank all the staff at the Center for Community Health Promotion. This project was supported by Grant Numbers 3U54CA153502, 3U54CA153502-05S1, U54 CA132381, and U54 CA132383 from the National Cancer Institute (NCI) and the Institute of Translational Health Science Grant (UL1 RR025014) from the National Center for Research Resources (NCRR) at the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCI, NCRR, or the NIH.

Author contributions

BT was responsible for the overall conceptualization, funding acquisition, methodology, and writing of the manuscript. WEB contributed to the formal analysis, supervision, and writing of the manuscript. KJB contributed to conceptualization, funding acquisition, methodology, and writing of the manuscript. EK contributed to the formal analysis, the visualization, and the writing of the manuscript. EC contributed to the conceptualization, methodology, project administration, and supervision of the manuscript. NEG and VJG involved with conceptualization, data curation, validation, and investigation of the manuscript.


  1. 1.
    National Cancer Institute Surveillance Epidermiology and End Results (SEER) Program (2016) Cancer statistics facts: cervix uteri cancerGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention (CDC) (2015) Cancer screening test use. Morbidity and mortality weekly report, pp. 464–468Google Scholar
  3. 3.
    National Cancer Institute (2016) NCI dictionary of cancer termsGoogle Scholar
  4. 4.
    United States Preventive Services Task Force (2016) Final update summary: cervical cancer screeningGoogle Scholar
  5. 5.
    American Cancer Society (2017) HPV and HPV testing: human papilloma virus (HPV)Google Scholar
  6. 6.
    Harper DM et al (2004) Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. The Lancet 364(9447):1757–1765Google Scholar
  7. 7.
    Brown ML et al (2014) Peer reviewed: challenges in meeting healthy people 2020 objectives for cancer-related preventive services. National Health Interview Survey, 2008 and 2010. Prevent Chronic Dis 11:E29Google Scholar
  8. 8.
    CDC (2014) Behavioral risk factor surveillance system survey data. CDC, AtlantaGoogle Scholar
  9. 9.
    Goel MS et al (2003) Racial and ethnic disparities in cancer screening. J Gen Intern Med 18(12):1028–1035Google Scholar
  10. 10.
    Singh GK, Hiatt RA (2006) Trends and disparities in socioeconomic and behavioural characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979–2003. Int J Epidemiol 35(4):903–919Google Scholar
  11. 11.
    Froment M-A et al (2014) Impact of socioeconomic status and ethnic enclave on cervical cancer incidence among Hispanics and Asians in California. Gynecol Oncol 133(3):409–415Google Scholar
  12. 12.
    Vanslyke JG et al (2008) HPV and cervical cancer testing and prevention: knowledge, beliefs, and attitudes among Hispanic women. Qual Health Res 18(5):584–596Google Scholar
  13. 13.
    Fernandez-Esquer ME et al (2003) A su salud: a quasi-experimental study among Mexican American women. Am J Health Behav 27(5):536–545Google Scholar
  14. 14.
    Baezconde-Garbanati L et al (2013) Reducing the excess burden of cervical cancer among latinas: translating science into health promotion initiatives. Calif J Health Promot 11(1):45–57Google Scholar
  15. 15.
    Fernandez ME et al (2014) Cervical cancer control for Hispanic women in Texas: strategies from research and practice. Gynecol Oncol 132(Suppl 1):S26–S32Google Scholar
  16. 16.
    Mann L et al (2015) Increasing cervical cancer screening among US hispanics/latinas: a qualitative systematic review. J Cancer Educ 30(2):374–387Google Scholar
  17. 17.
    Chen NN et al (2018) Understanding cervical cancer screening among latinas through the lens of structure, culture, psychology and communication. J Health Commun 23:1–9Google Scholar
  18. 18.
    Guide to Community Preventive Services (2005) Cancer screening: small media targeting clients—cervical cancer. (cited 2019 Jan 7, 2019)
  19. 19.
    Jandorf L et al (2008) Breast and cervical cancer screening among Latinas attending culturally specific educational programs. Prog Community Health Partnersh 2(3):195–204Google Scholar
  20. 20.
    Fernández ME et al (2009) Effectiveness of Cultivando La Salud: a breast and cervical cancer screening promotion program for low-income hispanic women. Am J Public Health 99(5):936–943Google Scholar
  21. 21.
    O’Brien MJ et al (2010) Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med 25(11):1186–1192Google Scholar
  22. 22.
    Luque JS et al (2011) Salud es vida: development of a cervical cancer education curriculum for promotora outreach with Latina farmworkers in rural Southern Georgia. Am J Public Health 101(12):2233–2235Google Scholar
  23. 23.
    Saad-Harfouche FG et al (2011) Esperanza y Vida: training Lay health advisors and cancer survivors to promote breast and cervical cancer screening in latinas. J Community Health 36(2):219–227Google Scholar
  24. 24.
    Thompson B et al (2014) Increasing cervical cancer screening in the United States-Mexico border region. J Rural Health 30(2):196–205Google Scholar
  25. 25.
    Molokwu J et al (2016) Evaluation of the effect of a promotora-led educational intervention on cervical cancer and human papillomavirus knowledge among predominantly hispanic primary care patients on the US-mexico border. J Cancer Educ 31(4):742–748Google Scholar
  26. 26.
    Thompson B et al (2017) Results of a randomized controlled trial to increase cervical cancer screening among rural latinas. Cancer 123(4):666–674Google Scholar
  27. 27.
    Fleming K et al (2018) Educating hispanic women about cervical cancer prevention: feasibility of a promotora-led charla intervention in a farmworker community. Ethn Dis 28(3):169–176Google Scholar
  28. 28.
    Nuno T et al (2011) A Promotora-administered group education intervention to promote breast and cervical cancer screening in a rural community along the U.S.-Mexico border: a randomized controlled trial. Cancer Causes Control 22(3):367–374Google Scholar
  29. 29.
    Cheun ASA, Loomis J (2018) A culturally sensitive approach to cervical cancer prevention in the latina population using the promotora model. Nurs Womens Health 22(4):338–345Google Scholar
  30. 30.
    Sabatino SA et al (2012) Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. Am J Prev Med 43(1):97–118Google Scholar
  31. 31.
    Task Force on Community Preventive Services (2008) Recommendations for client-and provider-directed interventions to increase breast, cervical, and colorectal cancer screening. Am J Prev Med 35(1 Suppl):S21Google Scholar
  32. 32.
    Byrd TL et al (2013) AMIGAS: a multicity, multicomponent cervical cancer prevention trial among Mexican American women. Cancer 119(7):1365–1372Google Scholar
  33. 33.
    American FactFinder Community Facts (2017) Poverty status in the past 12 months; Yakima County 2013–2017 American community survey 5-year estimates. U.S. Census Bureau, Washington, DCGoogle Scholar
  34. 34.
    American FactFinder Community Facts (2017) Language spoken at home; Yakima County 2013–2017 American community survey 5-year estimates. U.S. Census Bureau, Washington, DCGoogle Scholar
  35. 35.
    Washington State Department of Health (2017) Chronic disease profiles by county. Washington State Department of Health, OlympiaGoogle Scholar
  36. 36.
    Truven Health Analytics (2018) Community need index methodology and source notes, p. 2Google Scholar
  37. 37.
    Hinojosa MS et al (2010) Salud de la mujer: using fotonovelas to increase health literacy among Latinas. Prog Commun Health Partnersh 4(1):25–30Google Scholar
  38. 38.
    Houston C (2012) Fotonovelas and historietas. Library services for multicultural patrons: strategies to encourage library use, p 149Google Scholar
  39. 39.
    Clayman ML et al (2010) Providing health messages to Hispanics/Latinos: understanding the importance of language, trust in health information sources, and media use. J Health Commun 15(sup3):252–263Google Scholar
  40. 40.
    Ramirez AS et al (2015) Seeking Information on behalf of others: an analysis of calls to a Spanish-language radio health program. Health Promot Pract 16(4):501–509Google Scholar
  41. 41.
    Briant KJ et al (2016) The power of digital storytelling as a culturally relevant health promotion tool. Health Promot Pract 17(6):793–801Google Scholar
  42. 42.
    Kepka D et al (2011) Evaluation of a radionovela to promote HPV vaccine awareness and knowledge among Hispanic parents. J Community Health 36(6):957–965Google Scholar
  43. 43.
    Kepka DL et al (2012) Development of a radionovela to promote HPV vaccine awareness and knowledge among latino parents. Public Health Rep 127(1):130–138Google Scholar
  44. 44.
    Centers for Disease Control and Prevention (2016) Seasonal influenza. Centers for Disease Control and Prevention, AtlantaGoogle Scholar
  45. 45.
    Robinson D (2012) Becoming a translator: an introduction to the theory and practice of translation. Routledge, LondonGoogle Scholar
  46. 46.
    Harris PA et al (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381Google Scholar
  47. 47.
    Sabogal F et al (1996) Printed health education materials for diverse communities: suggestions learned from the field. Health Educ Q 23(1_suppl):123–141Google Scholar
  48. 48.
    Dixon-Gray LA et al (2013) Amor y Salud (love and health): a preconception health campaign for second-generation Latinas in Oregon. Am J Health Promot 27(3_suppl):S74–S76Google Scholar
  49. 49.
    Murphy ST et al (2013) Narrative versus nonnarrative: the role of identification, transportation, and emotion in reducing health disparities. J Commun 63(1):116–137Google Scholar
  50. 50.
    Moran MB et al (2016) A pilot test of the acceptability and efficacy of narrative and non-narrative health education materials in a low health literacy population. J Commun Healthc 9(1):40–48Google Scholar
  51. 51.
    Hinyard LJ, Kreuter MW (2007) Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview. Health Educ Behav 34(5):777–792Google Scholar
  52. 52.
    Kilanowski JF (2013) Anticipatory guidance preferences of Latina migrant farmworker mothers. J Pediatr Health Care 27(3):164–171Google Scholar
  53. 53.
    Kochhar R (2000) The occupational status and mobility of Hispanics. Pew Hispanic Center, Washington, p. 7Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Beti Thompson
    • 1
    Email author
  • Wendy E. Barrington
    • 1
    • 2
  • Katherine J. Briant
    • 1
  • Erin Kupay
    • 1
    • 3
  • Elizabeth Carosso
    • 1
  • Nora E. Gonzalez
    • 4
  • Virginia J. Gonzalez
    • 4
  1. 1.Fred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Department of Psychosocial & Community HealthUniversity of Washington School of NursingSeattleUSA
  3. 3.New Mexico State UniversityLas CrucesUSA
  4. 4.Center for Community Health PromotionFred Hutchinson Cancer Research CenterSunnysideUSA

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