Uniting Trusted Community Messengers to Improve Access to Cervical Cancer Screening in Rural North Carolina

Outcomes in human papillomavirus (HPV)-associated cervical cancer are significantly worse in rural areas than in urban areas, with high-risk women living in rural areas being disproportionately affected. Complex, multifaceted access barriers in rural areas often result in delayed screening and late-stage diagnoses. HPV self-collection (HPVSC) can mitigate access barriers to cervical cancer screening among high-risk, rural women. However, barriers to using HPVSC kits remain. Intentional, coordinated efforts to engage trusted community messengers at both the individual (community health workers [CHWs]) and community levels (community-based organizations [CBOs]), may address access barriers to cervical cancer screening in rural communities. However, few studies have engaged both CHWs and CBOs synergistically as collaborators in interventions to address access barriers to cervical cancer screening in rural areas. The purpose of this study is to develop and test the feasibility and acceptability of a multi-level, community-engaged intervention that unities trusted CBOs (community-level) and CHWs (individual-level) to increase access to cervical cancer screening using HPVSC outreach among women living in a high-risk, rural county and improve navigation for follow-up screening. We aim to 1) Develop a community advisory board (CAB) to inform the development of a multi-level intervention designed to increase uptake of HPVSC kits and evaluate CAB capacity, function, and long-term sustainability; 2) Co-develop an intervention protocol with the CAB intended to reach rural women at high-risk for cervical cancer and improve completion of follow-up screening among women testing HPV-positive; and 3) Assess the feasibility and acceptability of the intervention protocol, and preliminary outcomes, HPVSC kit return and HPV positive screening rate, among high-risk, rural women. A one-group intervention evaluation design will be used to pilot test the feasibility and acceptability of the multi-level intervention and to assess the proportion of women who return HPVSC kits and screen HPV-positive. We will recruit 100 participants from a rural county in North Carolina. At the community-level, local CBOs will serve as HPVSC kit distribution sites. At the individual-level, trained CHWs will collaborate with CBOs to provide navigation throughout the HPVSC process: Specimen collection, kit return, result notification, and follow-up clinic-based screening for women testing HPV-positive. We will apply select domains from the RE-AIM framework to assess feasibility outcomes using predetermined parameters. Quantitative surveys will measure acceptability of intervention components and qualitative interviews will explore women’s and community partners’ experiences in the intervention. Findings from this study will provide insight on a novel multi-level, community-engaged intervention intended to increase access to cervical cancer screening using HPVSC kits and provide navigation to follow-up care in high-risk, rural communities.