A Workplace-Based Intervention to Improve Awareness, Knowledge, and Utilization of Breast, Cervical, and Colorectal Cancer Screenings Among Latino Service and Manual Labor Employees in Utah
In the United States, Latinos are more likely to be uninsured and diagnosed with later stage cancer than non-Hispanic whites. Promotoras (lay health educators) help improve cancer knowledge and facilitate access to cancer screenings. We tested a promotora led workplace-based intervention to improve knowledge of and adherence to breast, cervical, and colorectal cancer screening among Latino employees in service or manual labor jobs. Latinos 18 and older from Salt Lake County, Utah were enrolled from January 2015 to February 2016. N = 265 completed pre- and post-intervention surveys that measured knowledge of and adherence to breast, cervical, and colorectal cancer screenings. Demographic, economic, and cancer factors of participants who completed the intervention were compared to those who were incomplete. Changes in knowledge and adherence were calculated using McNemar’s tests. Logistic regression compared outcomes by select demographic, economic and cancer factors. More participants were older, spoke Non-English languages, were single/widow(er)s, worked part-time, and had an immediate family member with cancer compared to those who did not complete the study (all p < 0.05). Knowledge of the age to begin cancer screenings increased significantly from baseline to follow-up for cervical (65.1–77.7%), breast (67.2–81.7%), and colorectal cancer (49.8–80.7%), all p ≤ 0.001. Knowledge of the frequency of cervical (34.0–46.5%) and colorectal (72.1–84.5%) screening increased from baseline to follow-up, both p < 0.001. Adherence to fecal immunochemical tests (FIT) for colorectal cancer increased from baseline to follow-up (13.8–56.9%, p < 0.001). Promotora led workplace-based interventions can strengthen community capacity for educating and supporting Latino employees in preventing breast, cervical, and colorectal cancer.
KeywordsHealth education Intervention Community-based participatory research Cancer prevention Latino
We would like to acknowledge the work of our community based partners, Alliance Community Services and Comunidades Unidas. We recognize the vital importance of the promotoras who took part in this research and thank them for their contributions, as well as the Utah Partners for Health, and St. Marks Hospital. This work was supported by the Beaumont Foundation, the University of Utah College of Nursing Research Committee, Cancer Control and Population Sciences at Huntsman Cancer Institute, and the Huntsman Cancer Foundation. The funding organizations had no role in the design and conduct of the study, collection or interpretation of the data, nor in preparation, review, or approval of the manuscript.
Compliance with Ethical Standards
Conflict of interest
Dr. Kirchhoff has an immediate family member who has stock or other ownership in Medtronic. The authors declare that they have no other conflicts of interest.
- 1.American Cancer Society. (2015). Cancer facts & figures for Hispanics/Latinos 2015–2017. Atlanta, GA: American Cancer Society.Google Scholar
- 2.Gonzales, M., Qeadan, F., Mishra, S. I., Rajput, A., & Hoffman, R. M. (2017). Racial-ethnic disparities in late-stage colorectal cancer among Hispanics and Non-Hispanic Whites of New Mexico. Hispanic Health Care International, 15(4), 180–188. https://doi.org/10.1177/1540415317746317.CrossRefPubMedGoogle Scholar
- 4.Department of Workforce Services. (2016). Equal employer opportunity (EEO) data. Salt Lake City: Department of Workforce Services.Google Scholar
- 6.Koskan, A., Friedman, D. B., Messias, D. K., Brandt, H. M., & Walsemann, K. (2013). Sustainability of promotora initiatives: Program planners’ perspectives. Journal of Public Health Management and Practice, 19(5), E1–E9. https://doi.org/10.1097/PHH.0b013e318280012a.CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Beach, M. L., Flood, A. B., Robinson, C. M., Cassells, A. N., Tobin, J. N., Greene, M. A., & Dietrich, A. J. (2007). Can language-concordant prevention care managers improve cancer screening rates? Cancer Epidemiology, Biomarkers & Prevention, 16(10), 2058–2064. https://doi.org/10.1158/1055-9965.epi-07-0373.CrossRefGoogle Scholar
- 9.Warner, E. L., Bodson, J., Mooney, R., Lai, D., Samadder, N. J., & Kepka, D. (2017). Latinas’ colorectal cancer screening knowledge, barriers to receipt, and feasibility of home-based fecal immunochemical Ttesting. Journal of Immigrant and Minority Health. https://doi.org/10.1007/s10903-017-0615-3.CrossRefPubMedGoogle Scholar
- 10.StataCorp. (2015). Stata statistical software: Release 14. College Station: StataCorp LP.Google Scholar
- 13.Sabatino, S. A., Thompson, T. D., Miller, J. W., Breen, N., White, M. C., Breslau, E., & Shoemaker, M. L. (2018). Prevalence of out-of-pocket payments for mammography screening among recently screened women. Journal of Women's Health. https://doi.org/10.1089/jwh.2018.6973.CrossRefPubMedGoogle Scholar
- 14.Cowburn, S., Carlson, M. J., Lapidus, J. A., & DeVoe, J. E. (2013). The association between insurance status and cervical cancer screening in community health centers: Exploring the potential of electronic health records for population-level surveillance, 2008–2010. Preventing Chronic Disease, 10, E173. https://doi.org/10.5888/pcd10.130034.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Luque, J. S., Logan, A., Soulen, G., Armeson, K. E., Garrett, D. M., Davila, C. B., & Ford, M. E. (2018). Systematic review of mammography screening educational interventions for Hispanic women in the United States. Journal of Cancer Education. https://doi.org/10.1007/s13187-018-1321-0.CrossRefPubMedGoogle Scholar
- 19.Molokwu, J., Penaranda, E., Flores, S., & Shokar, N. K. (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. Journal of Cancer Education, 31(4), 742–748. https://doi.org/10.1007/s13187-015-0938-5.CrossRefPubMedGoogle Scholar
- 21.Watson-Johnson, L. C., Bhagatwala, J., Reyes-Garcia, C., Hinojosa, A., Mason, M., Meade, C. D., & Luque, J. S. (2012). Refinement of an educational toolkit to promote cervical cancer screening among Hispanic immigrant women in rural South Georgia. Journal of Health Care for the Poor and Underserved, 23(4), 1704–1711. https://doi.org/10.1353/hpu.2012.0150.CrossRefPubMedPubMedCentralGoogle Scholar