JMIR Publications

ABSTRACT

Background:

Women with limited English proficiency (LEP) continue experiencing an unequal cancer burden. Non-White immigrant women present with more advanced breast and cervical cancer than non-Hispanic Whites, attributed to significant cultural barriers as well as low health literacy in attempting to navigate the United States healthcare system for cancer screening. CHECC-uP—Community-based Health litEracy-focused intervention for breast and cervical Cancer Control—was an in-person, community health worker-led intervention, addressing both cultural and health literacy barriers through health literacy education and follow-up counseling with navigation assistance. The in-person program was tested in a large cluster-randomized trial and yielded high efficacy in promoting mammogram and Pap test screening in Korean-speaking women. With over 90% of Americans now having online access, the in-person program was adapted to web-based delivery.

Objective:

The objective of this study was to evaluate the feasibility, acceptability, and preliminary efficacy of the web-version of the intervention—e-CHECC-uP.

Methods:

We conducted a randomized pilot trial. A total of 40 women were enrolled and randomized (20 per arm). The study intervention consisted of web-based health literacy education followed by phone counseling with navigation assistance. Study assessments were done at baseline, 3 months, and 6 months. The study’s primary outcomes were cancer screening behaviors verified by medical record review. Upon completion of final study assessments, intervention participants were invited to join post-intervention interviews.

Results:

Thirty-four women (intervention n=15 and control n=19) completed the assessment at 6 months, yielding a retention rate of 85%. The intervention participants were highly satisfied with e-CHECC-uP with a median rating of 8 on a 10-point scale. Between-group differences in screening rates were 34.6%, 47.9%, and 37.5%, respectively, for completion of mammogram, Pap test, and both at 6 months.

Conclusions:

We were able to achieve a high retention rate with high satisfaction ratings. e-CHECC-uP resulted in large group differences across all cancer screening outcomes in the pilot sample. Online technology can help address multiple logistical barriers associated with in-person intervention delivery. Our findings suggest that web-based delivery of CHECC-uP may be used to promote cancer screening among immigrant women with LEP, as a promising avenue to ultimately reduce health disparities faced by the underserved communities. Clinical Trial: Clinicaltrials.gov NCT03726619