DESCRIPTION (provided by applicant): Since 1975, more than 3 million refugees have been resettled in the United States. Currently, about one-half of all newly admitted refugees are from Bhutan or Burma. Regular cervical cancer screening is recommended for all women ages 21-65. Refugee groups have very high cervical cancer incidence rates and very low cervical cancer screening rates. Centers for Disease Control and Prevention guidelines specify that refugee women should be offered cervical cancer screening early in their resettlement period. Multiple organizations provide services to newly and recently arrived refugees; these organizations include voluntary resettlement agencies, mutual assistance associations, ethnic community organizations, local health departments, and health care facilities that serve vulnerable groups. Our long-term goal is to evaluate a contextually relevant cervical cancer control program targeting refugee women during their resettlement. The program would involve use of culturally tailored videos, as well as logistic assistance accessing screening services (i.e. navigation). Refugee resettlement organization personnel would implement the intervention components. This developmental application has the following objectives: (1) Through focus group research, identify and describe cervical cancer screening barriers and facilitators among refugee women; (2) Develop culturally tailored educational and motivational cervical cancer screening videos (that could be used in multiple resettlement settings); (3) Pilot test the intervention program (video use and logistic assistance), and conduct an exploratory evaluation of the program; and (4) Through key informant interviews with representatives from refugee resettlement organizations, assess refugee organizations readiness to implement our intervention program during the resettlement process. The investigator group has extensive experience working with refugee communities and resettlement organizations, as well as conducting cervical cancer control research in vulnerable populations. Our research will be conducted in Washington State. This developmental research will focus on refugee women from Bhutan and Burma (who are particularly unfamiliar with western health systems, as well as concepts of cancer and preventive care). However, our intervention program could be adapted for use with other refugee groups in the future. We will collaborate with a community advisory group (that includes representatives from refugee resettlement organizations) throughout the project. The Behavioral Model for Vulnerable Populations will guide all aspects of our research with refugee women. Weiner's Theory of Organizational Readiness will guide our key informant interviews with representatives from refugee resettlement organizations. Our exploratory evaluation will include assessments of the videos' potential effect on intermediate outcomes (e.g. knowledge and screening intentions), the videos' acceptability (i.e. women's satisfaction with the videos), and demand for logistic assistance (i.e. women's uptake of logistic assistance).
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