DESCRIPTION (provided by applicant): Despite its nearly preventable status, 13,000 new cases of invasive cervical cancer are diagnosed each year, with 4,600 deaths. While nationally, women have experienced a 75% reduction in cervical cancer mortality in the past 5 decades, rural Appalachian women continue to sustain low rates of Pap testing and disproportionately high cervical cancer rates. To reduce this cervical cancer burden experienced by middle aged and older Appalachian women, we propose to undertake a community participatory, tailored, faith based intervention entitled "Faith Moves Mountains." While extensive literature has established the association between rural culture and religiosity, aside from programs involving African-American churches, surprisingly few scientifically based interventions have located disease prevention activities within the trusted, sustainable, rural religious institutions of rural Appalachia. To address this missed opportunity, this project will develop a random, stratified sample of 50 congregations with 600 participants to: (1) Examine the factors (both barriers and assets) that influence the use of Pap tests; (2) Administer a faith-based lay health advisor intervention that is community-participatory, theoretically informed, and culturally consistent; (3) Evaluate the efficacy of the intervention in a group-randomized experimental design. These 3 aims correspond to 3 phases, a developmental, ethnographically oriented phase; a community-participatory intervention phase; and a qualitative and quantitative evaluation phase. With a multidisciplinary team of social scientists, community leaders, physicians, and cancer control experts, the results from the proposed project will enable researchers and communities to better address the barriers that prevent rural women from receiving Pap tests and recommended follow-up care; draw on local community assets to promote the use of Pap tests; and establish a community-based model that can be extrapolated to other rural, underserved communities for cancer prevention.
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