Breast and cervical cancer screenings can detect cancer at an early stage when treatment is more effective; decreasing the risk of developing invasive cancer and reducing the burden of breast and cervical cancer mortality (Miranda-Diaz, Betancourt, Ruiz-Candelaria & Hunter-Mellado, 2015). Hispanic women frequently present with advanced stage disease and experience higher rates of breast and cervical cancer related deaths as compared to non-Hispanic women (CDC, 2018). Breast cancer is not only the most commonly diagnosed cancer among women in the U.S., it is also the leading cause of cancer-related death in Hispanic women (Siegel et al., 2015). When compared to white women, minority women have both higher cervical cancer mortality rates and lower cervical screening rates (Nardi, Sandhu & Selix,2016). In the U.S., Hispanic women have the highest cervical cancer incidence rate, approximately 44% higher incidence than among non-Hispanic whites, representing one of the greatest health disparities facing the Hispanic community (Lairson et al., 2014; Luque et al., 2018; Siegel et al., 2015).
Hispanic women face numerous barriers in obtaining cancer screenings, resulting in lower breast & cervical cancer screening utilization in this patient population. The literature has identified many factors including: lack of knowledge about breast and cervical cancer screenings; lack of health insurance; financial and transportation issues; language barriers; low education level; lack of trust of healthcare providers; lack of provider recommendation; and fear of pain or embarrassment (Alexandraki & Mooradian, 2010; Curry, Byers & Hewitt, 2003; White et al., 2017). Additionally, undocumented immigrants experience fear of deportation, financial limitations and discrimination, impacting the type and amount of health care received as well as limiting health care access (Hacker, Anies, Folb & Zallman, 2015). Suboptimal screening practices, lack of provider recommendation, unequal access to care as well as a lack of access to screening contribute to cervical cancer morbidity and mortality (Brown & Moscicki, 2017; National Cancer Institute [n.d.]).
These barriers impact the ability for health promotion information to be shared, contributing to limited health literacy in this population. Defined as the ability to obtain, acquire and understand basic health information in order to make informed health decisions, there is a need for health literacy to be addressed in patient education (United States Department of Health & Human Services Office of Disease Prevention & Promotion [n.d.]). One such method is the use of multimedia education. A review of the literature has found significant increased knowledge & screening self-assessment efficacy with the use of multimedia delivery of patient education (Borrayo, Rosales & Gonzalez, 2016; Buki, Yee, Weiterschcan & Lehardy, 2016; Makoul, Cameron, Baker, Francis, Scholetens & Wolf, 2009; Valdez, Napoles, Stewart, Garza [2018]).
Using the 2018 evidence-based guidelines of the United States Preventive Services Task Force, this linguistic and culturally-appropriate interactive tool allows Hispanic women to participate in a self-assessment of their breast and cervical cancer screening needs. Designed for active participation and addressing the health literacy needs of this patient population, the tool focuses on health promotion and screening self-assessment efficacy. The assessment results can be used to guide provider decisions to schedule mammography and Pap smears as indicated, thus improving the numbers of Hispanic women who participate in breast and cervical cancer screenings.
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