Latinas have 70% higher incidence and double the mortality rate of cervical cancer than non-Latinas in the U.S., primarily due to low rates of screening and COLPOscopy, the recommended follow-up for abnormalPapanicolou (Pap) tests. Factors related to low rates include access to health care, anxiety, fear of pain andcancer, low educational and low health literacy levels. While the Affordable Care Act will increase access, itmay decrease health care provider (HCP) time to provide complex education needed to address other factors.Patient education challenges for Latinas with low health literacy can be further complicated by languagedifferences and by low basic literacy - an inadequate ability to read. Low literacy is not limited to Latinos butaffects many who have had little opportunity for formal schooling. Due to high rates of low basic literacy, lowhealth literacy, and increasing pressures on HCPs, we propose a paradigmatic shift in health education. Thepurpose of this Phase I SBIR proposal is to establish technical/scientific merit and feasibility of using aninteractive computer-based education (ICBE) approach to educate and prepare Spanish speaking Latinas, withlow educational and health literacy levels, for a colposcopy. This proposal is significant in its focus on thehealth disparity of cervical cancer in Latinas and on the need for quality health education in a changing healthcare environment. ICBE programs can greatly augment health education by providing time, basic healthknowledge, repetition, language and attentiveness to personal and cultural barriers that vulnerable populationsneed, but that clinical settings realistically cannot provide. Specific aims for this Phase I study are to developCOLPO PRIMER-S (Spanish) and to pilot the product in a clinical setting. The long term goal is to create,evaluate and market the 'PRIMER series' (Patient Ready Interactive Multi-media Educational Resources) - aline of health educational products appropriate for all literacy levels. Methods: COLPO PRIMER-S will bemodeled after an English language version, but informed by a different literature for its content. It will be pilotedat a health department in the Midwest U.S. with 20 women, half with low to marginal health literacy. Surveydata assessing knowledge and preparedness, anxiety related to abnormal Pap and colposcopy, technology-related anxiety, learner pathway through COLPO PRIMER-S, acceptability and satisfaction with the program,and actual follow-up with the procedure will be collected through the touch screen and recorded automatically ,before and after viewing and after colposcopy. HCP interviews will evaluate the amount of teaching needed forparticipants to begin using the program, difficulties encountered, user engagement with HCP following viewing,the impact on staff time and feasibility within the organization. While educational resources explainingcolposcopy procedures do exist for Latina populations, none identified are theory and evidence-based ICBE,Spanish language programs that address literacy, knowledge and psychosocial barriers. Findings will guideparadigm shifts in health education and marketing of ICBE products and service.
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