A Randomized Control Trial of Two Interventions Compared with Usual Care for Increasing Cervical Cancer Screening among Women Living in the Rural Midwest.

Abstract

Background: Lower cervical cancer screening rates are associated with higher cervical cancer mortality among women living in rural compared with urban areas (defined by rural-urban community codes). The study purpose was to examine the effectiveness of a mailed digital video disc (DVD) versus DVD plus patient navigation (PN) versus usual care (UC) on increasing the percentage of rural women up to date (UTD) with cervical cancer screening guidelines.

Methods: Rural women (ages 50-74 years) who were not UTD for cervical cancer screening (n = 553) were consented and randomized 2:2:1 (DVD, DVD + PN, and UC, respectively). Baseline and 12-month surveys included sociodemographic characteristics, history of previous cervical cancer screening, and cervical cancer screening knowledge and beliefs. Screening status was assessed by medical record review at baseline and 12 months after randomization.

Results: The mean age of participants was 59.8 years. After controlling for covariates, women randomized to the DVD + PN group had greater odds [OR = 5.01; 95% confidence interval (CI), 2.38-11.50] of being UTD with cervical cancer screening compared with UC at 12 months after randomization. Other significant covariates in the model included having a college versus high school or lower education (OR = 2.36; 95% CI, 1.08-5.63), private (OR = 4.16; 95% CI, 1.28-19.1) or no insurance (OR = 8.74; 95% CI, 1.77-51.9) versus public insurance, normal (OR = 3.25; 95% CI, 1.46-7.24) or overweight (OR = 2.15; 95% CI, 1.05-4.42) versus obese body mass index, and positive screening intention in the next six months (OR = 2.59; 95% CI, 1.48-4.52).

Conclusions: A DVD + PN intervention increased the percentage of rural women UTD with cervical cancer screening compared with UC or DVD only.

Impact: Women who have a high school or lower education, were on public insurance, obese, and not planning to be screened need increased attention to become UTD with cervical cancer screening.