Building relationships and cultivating trust and respect: A multi-level comparison of cultural tailoring processes by community health workers addressing breast and cervical cancer screening needs in a Cambodian and a Laotian community in California

Although randomized controlled trials have demonstrated that cancer screening exams effectively reduce breast and cervical cancer-related mortality, Asian American and Pacific Islander (AAPI) women, in particular, have the lowest screening rates for cancer compared to all other ethnic groups (American Cancer Society, 1998). Unfortunately, few programs have specifically targeted AAPI women to promote and sustain screening practices.; In recent years, there has been an increasing emphasis on the importance of community-driven programs employing community health workers (CHWs) or lay health advisors in promoting and applying concepts such as collaboration, responsiveness, inclusiveness, and empowerment, in the design, implementation, and evaluation of cancer screening and health promotion programs.; This study compared the culturally-tailored work of CHWs in a Cambodian and a Laotian community in California to increase breast and cervical cancer screening practices for community women. Using an ecological perspective and concepts from the social support and social networks literature, both quantitative and qualitative methods were used to investigate the study research questions. A community-based survey was used to quantitatively explore and describe the cancer screening knowledge, attitudes, and behaviors of 180 women from each of these two communities. Qualitative interviews and observations were conducted with two Cambodian and three Laotian CHWs to learn about their perspectives on the individual, interpersonal, and community-level factors that affected cancer screening in their communities. Qualitative outreach logs and activities reports were also analyzed to learn about the processes and strategies used by these CHWs to link community women with the mainstream health care system.; Study findings showed that the Cambodian and Laotian communities had similar as well as unique needs and resources for breast and cervical cancer screening. The CHWs were effective in recruiting women for screening exams because they applied culturally appropriate messages through their interpersonal skills for building trust and mutual respect with the members in their communities.; The study's findings have important implications for health education theory, health education practice, and future studies on cancer in underserved communities employing community health workers.