North American Chinese women have higher cervical cancer incidence and lower levels of Papanicolaou (Pap) testing than other population subgroups. We conducted a four phase project aimed at increasing Pap testing among Chinese women living in North America. The project was conducted by a multidisciplinary investigator team and the study group included Chinese women residing in Seattle, Washington and Vancouver, British Columbia. In phase 1, we sought to better understand the concepts and practices regarding health, illness and Pap testing in Chinese women using qualitative methods (87 unstructured interviews and 9 focus groups). In phase 2, we identified barriers and facilitators to Pap testing using a community-based survey of 1,486 Chinese women. In phase 3, we developed several cervical cancer screening interventions using the cultural information obtained in phase 1 (including a video, motivational pamphlet and fact sheet, and outreach worker). In phase 4, we assessed the effectiveness and feasibility of these screening interventions in a three-arm randomized controlled trial involving 482 Chinese women. The PRECEDE model was used as the overarching conceptual framework, with community participation in all phases. Significant increases were found in Pap testing with the screening interventions following randomization (39% in the outreach worker intervention versus 15% in the control, p<0.001). The study design and summary of findings are presented.
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