Web-Based Delivery of an Effective Church-Based Intervention Program to Promote Cancer Screening (Community-based Health litEracy-focused intervention for breast and cervical Cancer Control) Among Korean Immigrant Women in the United States: Randomized Controlled Trial.

Background: Women with limited English proficiency continue experiencing an unequal cancer burden. Non-White immigrant women present with more advanced breast and cervical cancer than non-Hispanic Whites, attributed to significant cultural barriers as well as low health literacy in attempting to navigate the United States health care system for cancer screening. Community-based Health litEracy-focused intervention for breast and cervical Cancer Control (CHECC-uP) was an in-person, community health worker-led intervention, addressing both cultural and health literacy barriers through health literacy education and follow-up counseling with navigation assistance. The in-person program was tested in a large cluster-randomized trial and yielded high efficacy in promoting mammogram and Papanicolaou test screening in Korean-speaking women. With over 90% of Americans now having online access, the in-person program was adapted to web-based delivery. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of the web version of the intervention-e-CHECC-uP. Methods: A randomized pilot trial was conducted. A total of 40 women were enrolled and randomized (20 per arm). The study intervention consisted of web-based health literacy education followed by phone counseling with navigation assistance. Study assessments were done at baseline, 3 months, and 6 months. The study's primary outcomes were cancer screening behaviors verified by medical record review. Upon completion of final study assessments, intervention participants were invited to join postintervention interviews. Results: In total, 34 women (intervention: n=15; control: n=19) completed the assessment at 6 months, yielding a retention rate of 85%. The intervention participants were highly satisfied with e-CHECC-uP with a median rating of 8 on a 10-point scale. Between-group differences in screening rates were 34.6%, 47.9%, and 37.5%, respectively, for completion of the mammogram, Papanicolaou test, and both at 6 months. Conclusions: We achieved a high retention rate and high participant satisfaction. Although the study was not powered for significance testing, the e-CHECC-uP intervention resulted in large group differences across all cancer screening outcomes in the pilot sample. Online technology can help address multiple logistical barriers associated with in-person intervention delivery. Our findings suggest that web-based delivery of CHECC-uP may be used to promote cancer screening among immigrant women with limited English proficiency, as a promising avenue to ultimately reduce health disparities in underserved communities.