Proposal for Replication of a Health Education Intervention

Thiel de Bocanegra et al. created an online cervical cancer educational program to increase women’s knowledge of the updated cervical cancer guidelines. Through their evaluation, the authors found that women exposed to the intervention demonstrated increased confidence in their knowledge of cervical cancer screening (Thiel de Bocanegra et al., 2022). This intervention was developed, piloted, and implemented in a group of women aged 21-29 who obtained free reproductive care with the California PACT program. Many other communities would benefit from the cervical cancer educational tool outside this specific priority population for whom it was developed. For instance, this intervention could be successfully adapted for low-income, uninsured women aged 21-29 years old accessing free reproductive care at clinics in New York state.

Identification of a Similar At-Risk Population

Uninsured women aged 21-29 years old in New York are an ideal target population for the online cervical cancer educational program for a few reasons. The rationale for selecting this population is that, like California, New York is a highly populated area with women of diverse backgrounds, so there is potential for a large scope of impact (U.S. Census Bureau, n.d.). New York and California also have similar percentages of patients without health insurance (4.9% compared with 6.5%), so there is a sizable population of women to deliver the intervention (Johnson et al., 2024; New York, NY, n.d.). Furthermore, there is a demonstrated need for a cervical cancer screening educational intervention in New York. While the majority of women in New York are up to date with the current guidelines, data shows that age between 21 and 29 years old and the lack of health insurance are both risk factors for noncompliance with the new USPSTF recommendations (The Behavioral Risk Factor Surveillance System (BRFSS) Brief, 2022).

This program has the potential for replication in New York because of the demographic characteristics that are shared with the initial priority population in California. For instance, 31% and 14% of New York’s population identify as White and Asian American and Pacific Islander, respectively, and California has 34% White and 15% Asian American and Pacific Islander (Johnson et al., 2024; New York, NY, n.d.). These states are also similar in that they both have programs that finance free reproductive care for those without insurance. Similar to the California PACT program that was targeted in the original implementation, New York has the Family Planning Benefit Program (FPBP). It would be logical and efficient to use the FPBP program to find members of the target population in New York, as the PACT program was used similarly in California.

Engaging Stakeholders to Identify Implementation Barriers

To assess for potential factors that may differ between young, uninsured women in New York compared to California, it would be best to engage community stakeholders. Engaging leaders of the local community and university hospitals would help identify unique characteristics of the New York population of women aged 21-29 that may necessitate modification of the program. For instance, since OBGYN physicians at New York clinics providing care to patients through the FPBP have experience educating and caring for the priority population, they would offer valuable insight into the best ways to adapt the program to their needs. These stakeholders can provide insight into any past or current efforts to increase cervical cancer education, which will help ensure that the implementation of this program is not redundant and adds value to the community. Additionally, the organizations for which these doctors work may also provide partnerships that can contribute to funding the adaptation of this program. Community partnership and engaging these stakeholders will also help ensure the program’s missions align with the priorities and address their concerns.

Additionally, it is essential to engage members of the priority population before implementing this intervention in New York. This could be done through focus groups of women in the target age demographic, as was done in the initial development of the educational tool. This group will provide insight into the current level of understanding of the New York population, which may differ from that of California. They can also help ensure that the specific needs of women in New York are met through this program. For instance, if perhaps New York women want to know more about the HPV vaccination, the program could be updated to address this concern. Another way to identify factors that would hinder the program’s success in this new population would be to start a pilot program before full implementation. A pilot program would allow us to obtain feedback from New York about the program and how the educational tool can be improved.

Potential Implementation Barriers and Program Modifications

Identifying implementation barriers through conversation with community stakeholders will allow modification of the program to suit New York women's needs best. One potential barrier to the successful implementation of the cervical cancer education program is the differences in the structure and function of clinics in the FPBP program in New York. Compared to those in the PACT program in California, these clinics likely have different organizational structures, staffing, and information technology abilities. Thus, orienting clinic staff to the program and clarifying their role in implementation is essential. Perhaps some clinics do not have computers or iPads for the patients to view the educational tool, and physical copies will be necessary. The New York clinics may require more research staff to administer the program at each location because they serve a higher volume of patients.

The educational program itself may also be adapted because the cultures of New York and California differ. For instance, New York has a higher percentage of residents identifying as Black (21%) compared to Hispanic (14%), while California has more Hispanic (40%) than Black (5%) residents (Johnson et al., 2024; New York, NY, n.d.). The educational tool may be revised to ensure that it contains content that appeals to the diverse population in New York. If the program is modified to ensure that it is culturally relevant to New York’s population, it will have greater success.

References

Johnson, H., Mejia, M. C., & McGhee, E. (2024, January 19). California’s population. Public Policy Institute of California. https://www.ppic.org/publication/californias-population/

New York, NY. (n.d.). Retrieved August 7, 2024, from https://datausa.io/profile/geo/new-york-ny

The Behavioral Risk Factor Surveillance System (BRFSS) Brief. (2022). NY State of Health. https://www.health.ny.gov/statistics/brfss/reports/docs/2022-01_brfss_cervical_cancer_screening.pdf

Thiel de Bocanegra, H., Dehlendorf, C., Kuppermann, M., Vangala, S. S., & Moscicki, A.-B. (2022). Impact of an educational tool on young women’s knowledge of cervical cancer screening recommendations. Cancer Causes & Control: CCC, 33(6), 813–821. https://doi.org/10.1007/s10552-022-01569-8

U.S. Census Bureau. (n.d.). Explore census data. Retrieved August 7, 2024, from https://data.census.gov/profile/California?g=040XX00US06