A Multilevel Social Capital Approach to Address Cervical Cancer Screening and Follow Up Delays among Latinas in Safety-Net Settings

ABSTRACT Latinas have the highest cervical cancer incidence rates compared to other racial and ethnic groups, and disparities are greater among low-income and non-US-born Latinas. Routine cervical cancer screening and timely follow-up of abnormal results are key to reducing cervical cancer mortality, especially among low-income and non-US-born Latina patients in safety-net healthcare settings. Higher social capital (resources rooted in social networks), which can be measured at the individual and community level, is positively associated with cervical cancer screening among Latinas, but how this association operates by nativity status and how clinic- based social capital interventions can be implemented in safety-net settings to address cervical cancer disparities among this population has not been explored. The goal of this mixed-methods study is to investigate multilevel ways in which social capital supports cervical cancer screening rates and follow-up and identify important considerations for a clinic-based social capital intervention to improve cervical cancer prevention practices among Latinas. The proposed study will explore two aims in the mentored phase: (1) test the association between social capital (measured at the individual and population level) and healthcare treatment delay; and (2) investigate the processes in which social capital influences cervical cancer screening and follow- up among Latina patients and identify strategies for intervention design and implementation. In the R00 phase, I will: (1) use Delphi method in a clinic-community engaged process to establish consensus on important considerations of a clinic-based social capital intervention for Latina patients; and (2) develop and pilot test the feasibility and acceptability of a social capital intervention in a safety-net clinic. The unique strengths of this proposal include a) its focus on understanding of multilevel social capital and the established association using national All of Us data; b) a unique focus is studying differences between U.S.- and non-US-born Latinas; and c) using a multisectoral approach to better understand community (i.e., stakeholders) and clinic (i.e., patients, providers, clinic staff) perspectives to inform an intervention aimed at increasing social capital that support cervical cancer screening and follow-up. Finally, I will benefit from a strong team of mentors and scientific advisory committee with specialties in health services research, health disparities, Latino health, multilevel research design, implementation science, community research, cancer epidemiology, biostatistics, and social capital. The proposed study is innovative in its plan to understand how social capital can improve cervical cancer screening and follow-up among U.S.-born and non-US-born Latinas to reduce cervical cancer disparities. Results of this study will provide preliminary data for a R01 application using a randomized controlled trial to test the selected intervention among Latina patients in safety-net settings.