Expanding the Impact of the Evidence-Based Salud En Mis Manos (SEMM) Intervention: Evaluation of the Telephone-Based SEMM Education Component
Introduction
Hispanic women have lower breast and cervical (B&C) cancer screening and HPV vaccination completion rates compared with non-Hispanic Black and White women in Texas. We developed Salud en Mis Manos (SEMM), a community-based community health worker (CHW)-delivered behavioral intervention (education in-person or by telephone followed by navigation support) to help women overcome complex barriers to cancer screening and HPV vaccination services. In a previous randomized trial, the program was proven to effectively increase B&C cancer screening among medically underserved Latinas. To reach women with barriers to participating in the in-person education session, we developed and evaluated telephone-based education delivery. The purpose of this project was to evaluate the new education delivery strategy’s effect and reach among medically underserved Latinas.
Methods
From 2016 to 2019, CHWs completed B&C cancer screening and HPV vaccination needs assessments among Latinas (21-74 years) and enrolled women identified as overdue for a mammogram, cervical screening, and/or HPV vaccination. A subgroup consented to participate in a one-group pretest-post-test embedded study to examine the increase in mammogram, cervical screening, and HPV vaccination at nine months follow-up. We also compared reach and proportion screened among women who participated in the CHW-delivered in-person education compared with telephone-based education.
Results
CHWs assessed 8,138 women to determine B&C screening and/or HPV vaccination needs and delivered the SEMM education to 2,506 women in-person and to 1,466 women by telephone. Among 1,439 women included in the embedded study, 522 (36%) participated in SEMM in-person education and 81% continued with telephone navigation. Among women who had barriers to in-person participation, 602 (42%) were offered and received the education by telephone, and 88% of this group continued with navigation support. 315 (22%) women enrolled in the embedded study did not continue to participate in the SEMM program. Among women receiving in-person versus telephone-based education, respectively, 41% and 32% completed a mammogram, 49% and 38% completed a Pap screening, and 30% and 17% initiated HPV vaccination. Additionally, 22% of women enrolled in the embedded study did not participate in SEMM. Among non-participants, 14% received a mammogram, 16% completed a Pap screening, and 2% completed an HPV vaccine at follow-up.
Conclusion
Providing the telephone-based education alternative method for women with barriers to attending the in-person SEMM education increased program reach. While screening and vaccination rates were slightly lower among those receiving the education by telephone, providing telephone-based education increased the overall program impact. Current work is focused on strengthening the effect and reach of telephone-based education to further improve program impact.