Chapter 3. Cervical cancer education for Native American women in North Carolina: The North Carolina Native American Cervical Cancer Prevention Project.

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Bell, Ronny A., Mark B. Dignan, Robert Michielutte, Penny Sharp, Karen Blinson, and John G. Spangler. “Chapter 3. Cervical cancer education for Native American women in North Carolina: The North Carolina Native American Cervical Cancer Prevention Project.” Native outreach: a report to American Indian, Alaska Native, and Native Hawaiian communities. NIH Publication 98-4341. Office of Special Populations Research, National Cancer Institute, National Institutes of Health, March 1999. Pages 33-43. HE20.3152: N 21/4


The authors begin with statistics demonstrating that Native American women have significantly higher mortality rates from cervical cancer than the overall rate for women in the United States. They go on to describe Wake Forest University School of Medicine’s North Carolina Native American Cervical Cancer Prevention Project—the first cervical cancer education program aimed at this target population in North Carolina. The program sought to reduce cervical cancer mortality among Lumbee and Cherokee women through community-based, individualized education which would increase the number of women getting annual Pap tests.

The research team first conducted three focus groups with each tribe to ascertain community views of cancer, its treatment and prevention, and satisfaction with local health care providers. They also talked with business leaders, teachers, skilled and unskilled workers, town officials, and tribal officials. The purpose and design of the project were presented to the Lumbee and Cherokee Tribal Councils for approval. Elements of the project’s design included self-efficacy, the health belief model, social learning theory, the Minority Health Communication Model (MHCM), and PRECEDE (Predisposing, Reinforcing, and Enabling Causes in Educational Diagnosis and Evaluation). The team then hired Native American women who were enrolled tribal members to work as “project guides”—interviewers and educators who were trained both at Wake Forest University school of Medicine and in the field.

The project intervention consisted of two home visitrs to 854 Lumbee and 815 Cherokee women by the same project guide. The content of the visits is described by the authors as follows:

“The first visit involved administering the health risk appraisal, showing the video, and reviewing the educational materials. The second visit involved reviewing the health risk appraisal, reinforcing the message of cervical cancer prevention, and answering questions pertaining to the women’s schedule for obtaining a Pap test or followup care for abnormal results of a recent Pap test” (p. 37).

The effectiveness of the project was assessed using the Solomon Four-Group Design, which involved giving some of the women a pretest and/or a posttest. Women were placed into one of four groups, receiving (1) pretest, intervention, and posttest; (2) pretest and posttest but no intervention;, (3) intervention and posttest but no pretest; and (4) posttest only.

The authors assessed the intervention's increases in self-reported screening for cervical cancer as “not dramatic”; still, they felt the project was “generally successful” in meeting its objectives. The three strengths of the project, according to the authors, are its use of local Native American women to do data collection and conduct the intervention (especially for Lumbee women); the cultural appropriateness of the health education materials; and the nature of the intervention (i.e., that it was individualized and employed social learning theory).

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