Journal of General Internal Medicine

, Volume 25, Issue 11, pp 1186–1192

Community Health Worker Intervention to Decrease Cervical Cancer Disparities in Hispanic Women

  • Matthew J. O’Brien
  • Chanita Hughes Halbert
  • Rebecca Bixby
  • Susana Pimentel
  • Judy A. Shea
Original Research

DOI: 10.1007/s11606-010-1434-6

Cite this article as:
O’Brien, M.J., Halbert, C.H., Bixby, R. et al. J GEN INTERN MED (2010) 25: 1186. doi:10.1007/s11606-010-1434-6



U.S. Hispanic women suffer a disproportionate burden of cervical cancer, with incidence and mortality rates almost twice that of whites. Community health workers, or promotoras, are considered a potential strategy for eliminating such racial and ethnic health disparities. The current study is a randomized trial of a promotora-led educational intervention focused on cervical cancer in a local Hispanic community.


Four promotoras led a series of two workshops with community members covering content related to cervical cancer. Sociodemographic characteristics, cervical cancer risk, previous screening history, cervical cancer knowledge, and self-efficacy were measured by a pre-intervention questionnaire. The post-intervention questionnaire measured the following outcomes: cervical cancer knowledge (on a 0–6 scale), self-efficacy (on a 0–5 scale), and receipt of Pap smear screening during the previous 6 months (dichotomous). Univariate analyses were performed using chi square, t-test, and the Mann–Whitney test. Multivariate logistic regression was used to model the association between explanatory variables and receipt of Pap smear screening.


There were no statistically significant differences between the two experimental groups at baseline. Follow-up data revealed significant improvements in all outcome measures: Pap smear screening (65% vs. 36%, p-value 0.02), cervical cancer knowledge (5.4 vs. 3.5, p-value < 0.001), and self-efficacy (4.7 vs. 4.0, p-value 0.002). In multivariate analysis, cervical cancer knowledge (OR 1.68, 95% CI 1.10-2.81) and intervention group assignment (OR 6.74, 95% CI 1.77-25.66) were associated with receiving a Pap smear during the follow-up period.


Our randomized trial of a promotora-led educational intervention demonstrated improved Pap screening rates, in addition to increased knowledge about cervical cancer and self-efficacy. The observed association between cervical cancer knowledge and Pap smear receipt underscores the importance of educating vulnerable populations about the diseases that disproportionately affect them. Future research should evaluate such programs on a larger scale, and identify novel targets for intervention.


cervical cancerhealth disparitiescommunity health workerpromotora

Supplementary material

11606_2010_1434_MOESM1_ESM.doc (366 kb)
ESM 1(DOC 366 kb)

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Matthew J. O’Brien
    • 1
    • 4
  • Chanita Hughes Halbert
    • 3
  • Rebecca Bixby
    • 4
  • Susana Pimentel
    • 4
  • Judy A. Shea
    • 2
  1. 1.Division of General Internal MedicineTemple University School of MedicinePhiladelphiaUSA
  2. 2.Department of Medicine, Division of General Internal MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Puentes de Salud Health CenterPhiladelphiaUSA