Feasibility of In-Person vs Virtual Community Health Worker-Facilitated Group Education to Improve Cancer Screening Among Women with Limited Healthcare Access - Project Summary/Abstract Breast and cervical cancers are the leading causes of cancer-related deaths among women in the United States (US), accounting for 33% of new diagnoses and 16% of cancer deaths annually. Despite the proven effectiveness of cancer screening, refugee women resettled in the US, particularly those from Muslim-majority countries - who represent approximately 40% of new arrivals - experience significantly lower screening rates compared to US-born women and other immigrant groups. Barriers include limited English proficiency, low health literacy, unfamiliarity with cancer screening, and cultural and religious factors such as fatalism, modesty, and gender discordance. Community health workers (CHWs), as trusted culturally concordant lay advisors, have improved screening in underserved populations. Still, few interventions are tailored to Muslim refugee women, and the potential of virtual CHW-led education to overcome barriers such as transportation and childcare remains underexplored. This project will evaluate the acceptability, appropriateness, feasibility, fidelity, cost, and preliminary effectiveness of CHW-facilitated breast and cervical cancer education delivered in-person versus virtually. We will (1) adapt culturally and linguistically tailored educational modules through interviews with refugee women (N=20) and consultation with community partners, and train two CHWs in delivery and communication skills; (2) conduct a three-arm pragmatic pilot trial comparing in-person CHW-led education (90 minutes), virtual CHW-led education (90 minutes), and information-only with delayed education control (n=25 per arm) to assess implementation outcomes using validated measures, fidelity checklists, and micro-costing; and (3) evaluate changes in cancer knowledge, screening intent, and uptake at pre-, post-, and 6-month follow-up, while examining between-arm differences to inform an R01 factorial trial testing delivery mode and navigation intensity. Innovation lies in testing virtual versus in-person CHW group education for refugee women, integrating micro-costing to evaluate delivery efficiency, and generating first-of-its-kind data on implementation outcomes and preliminary screening effects. Findings will establish benchmarks for scalable, culturally responsive interventions and inform an R01 factorial design study examining delivery mode and navigation intensity. This project fills a critical gap in CHW research, aligns with the NCI’s mission to reduce cancer burdens in underserved communities, and reflects NIH’s new unified strategy by advancing solution-oriented approaches that actively test, adapt, and scale evidence-based interventions to reduce cancer disparities among underserved populations.
