A Systematic Review of the Effectiveness of Cervical Cancer Screening and Prevention Interventions Targeting African American Women: Implications for Addressing Health Disparities

Background: African American women are third in incidence for cervical cancer, but first in mortality in comparison to all racial/ethnic groups. The five-year survivorship rate for African American women is 56% in comparison to the national trend of 67%. African American women, when accounting for hysterectomies, have a 10.1 mortality rate compared to the 4.7 rate of Caucasian women. One of the reasons why African American women, have such poor survivorship outcomes is they are often diagnosed at later stages of the disease. Interventions to improve survivorship and screening for African American women should center around health equity solutions. The purpose of this review is to critically evaluate cervical cancer screening and prevention interventions that target African American women on their effectiveness and commitment to health equity.

Methods: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we conducted a systematic review of the literature. Our proposal is registered here: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=210691. To be included in this review articles must 1) focus on screening and prevention for African American women, 2) English speaking, 3) having a quasi-experimental or randomized control trial design, and 4) target population were women over the age of 18. Using Medical Subject Headings (MeSH) terms we searched Pubmed, Cinhal, Embase and Scopus for appropriate articles from inception to January 2021. To critically assess the articles' commitment to health equity, we used the CONSORT-Equity 2017 guide to evaluate articles from theoretical framework to implementation and rationale. In addition, we used Quality Assessment Tool for Reviewing Studies with Diverse Designs (QATSDD) to assess the quality of included articles.

Results: 1950 titles and abstracts were initially screened by both reviewers using the systematic review web-based tool Rayyan, this was done before Rayyan incorporated their AI capabilities. After having removed 45 duplicates, 1849 titles were excluded for not meeting the criteria, and 20 articles were included in the review. Common intervention strategies of the included studies, focused on health education either through tailored or culturally relevant material, health education via a licensed health professional or a lay health worker, patient navigation services and the education and use of self-sampling kits. Of the included studies, QATSDD helped the reviewers to rate six of the studies as of good quality. Findings showed improvement in knowledge about cervical cancer screening and prevention, and an increase in screening behaviors when compared with control groups.

Conclusion: Cervical cancer screening and prevention interventions are needed to reduce health disparities for African American women. Interventions that focused on cultural relevancy and addressing health equity saw success in improving both knowledge and behavior. Social worker researchers and practitioners can help further reduce cervical cancer disparities by adopting a health equity focused approach that tailors' intervention development and implementation towards the target population.