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

Abstract Background: Lower cervical cancer (CC) screening rates are associated with higher CC mortality among women living in rural compared to urban areas (defined by Rural-Urban Community Codes). The study purpose was to examine the effectiveness of mailed DVD vs. DVD plus patient navigation (PN) vs. Usual Care (UC) on increasing the percentage of rural women up to date (UTD) with CC screening guidelines. Methods: Rural women (aged 50–74) who were not UTD for CC screening (n=553) were consented and randomized 2:2:1 (DVD, DVD+PN, UC, respectively). Baseline and 12-month surveys included sociodemographic characteristics, history of previous CC screening, and CC screening knowledge and beliefs. Screening status was assessed by medical record review at baseline and 12-months post-randomization. Results: 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%CI =2.38,11.50) of being UTD with CC screening compared to UC at 12-months post-randomization. Other significant covariates in the model included having a college vs. 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) vs. public insurance; normal (OR=3.25; 95%CI=1.46,7.24) or overweight (OR=2.15; 95%CI=1.05, 4.42) vs. obese BMI; 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 CC screening compared to 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 CC screening.