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Culturally Competent Outreach Programs Increase Cervical Cancer Screening Among Chinese Women

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Re-Imagining, Not Reinventing the Wheel

By Thomas A. LaVeist, PhD
Director, Hopkins Center for Health Disparities Solutions
Johns Hopkins Bloomberg School of Public Health
Former Member, Innovations Exchange Editorial Board

In their 2001 release, “When It All Goes South,” the venerable country music band “Alabama” dispensed health prevention wisdom that has stood the test of time. The seventh cut on that album (or should I say CD for the “age challenged”) titled “Reinvent the Wheel” said it in that characteristically folksy “Alabamaistic” way:

“… in a world that’s mostly imitation it’s hard to recognize the real, it takes a brave heart to resist temptation to take the easy way and reinvent the wheel.“

Researchers at the Fred Hutchinson Cancer Research Center, equal to “Alabama” in venerability, wisdom, and creativity, took a vexing problem and fashioned a variation on the wheel.

It has been well-documented that Chinese American women have significantly lower utilization rates for cervical cancer screening compared to all other American ethnic groups. How to narrow that disparity has vexed cancer control and prevention experts for some time.

The Chinese Women’s Health Project uses videos and lay health workers as peer health educators and patient navigators to provide women with health education and practical logistical supports that encourage cervical cancer screening. Lay health workers and patient navigators are not particularly original; nor is the use of video dramatizations, which have been widely used in Hispanic populations via novellas, but what the Chinese Women’s Health Project lacks in originality, it makes up for in results.

The primary innovation was the effective use of cultural tailoring—again not original—but in this case cultural tailoring was deployed more effectively than in previous applications I have seen. The lay health workers were not just language translators for the women; they were also cultural translators who bridged the cultural divide between the patients and the health care system.

While I like this program quite a lot, I have some questions about sustainability and cost effectiveness. The cost of $73.06 per patient in the high intensity intervention and $48.54 for the low intensity intervention is hard to evaluate without more information about the number of cervical cancer cases detected by the intervention. What is the relative cost savings associated with earlier detection relative to the costs of treating cervical cancer in this population? And, what is the cost-to-benefit ratio of the low intensity intervention relative to the high intensity version? Broad adoption will likely depend on the results of this analysis.

In terms of making a significant dent in a significant problem, however, there is no doubt that the Chinese Women’s Health Project is a promising innovation deserving of serious consideration for adaptation.

Disclosure Statement: Dr. LaVeist has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this commentary.

Original publication: October 13, 2008.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: June 18, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: June 06, 2014.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.