Cervical Cancer Risk Reduction for Lesbian, Bisexual and Transgender Individuals: A Community Engaged Approach

Cervical Cancer Risk Reduction for Lesbian, Bisexual and Transgender Individuals: A Community Engaged Approach Abstract: 450 words Purpose: The burden of cervical cancer is highest among vulnerable populations, including lesbian and bisexual women, and transgender individuals with a cervix (LBT). The aims of this project, informed by the Socio-Ecological Model, are to: (1) describe personal, sociocultural, and health system barriers and motivators to reducing cervical cancer risk (engaging in tobacco treatment, human papillomavirus (HPV) vaccination and cervical cancer screening); (2) describe strategies identified by the LBT community and health care providers to address the identified barriers. This team of research and clinical experts in cervical cancer prevention and LBT health is uniquely poised to address this pressing social justice issue. Significance: Cervical cancer is almost entirely preventable, yet the American Cancer Society projects that there will be 13,000 new cases of invasive cervical cancer and 4,000 related deaths in 2016. LBT individuals have a higher incidence of cervical cancer than their cisgender, heterosexual counterparts. This is likely due to the high rates of smoking and low prevalence of HPV vaccination and cervical cancer screening among LBT individuals. Culturally appropriate strategies are needed to reduce cervical cancer risk. Methods: Design. A community engaged, cross-sectional, descriptive design will be used. Setting/Sample/Procedures. For Aim 1, we will conduct semi-structured interviews with 30 LBT individuals at high risk for cervical cancer (currently smoke, have not completed the HPV vaccine series, and/or are not up to-date on cervical cancer screening) to discuss personal, sociocultural and health system barriers and facilitators to cervical cancer risk reduction. Participants will be recruited through flyers in community venues and events (e.g, LGBT bars and Pride festival), LGBT organizations, and snowball sampling. To account for potential subgroup differences, we will recruit 10 lesbian identified individuals, 10 bisexual identified individuals, and 10 female to male transgender individuals. For Aim 2, we will conduct five focus groups (n=6 in each, N=30 total) with leaders in the LBT community as well as health care providers (e.g, physicians and nurses working in primary care, tobacco treatment specialists). Data from the interviews in Aim 1 will be analyzed to inform focus groups. Focus group participants will be asked to: (1) develop strategies to address identified barriers; (2) design dissemination strategies to raise awareness about cervical cancer risk in this patient population Instruments. Semi-structured interview and focus group guides will be developed based on the Social-Ecological Model. Analysis plan. Interviews and focus groups will be professionally transcribed and analyzed using content analysis in MAXQDA software. A codebook will be developed inductively, the transcripts will be coded, and the codes will be examined to identify themes, patterns, and relationships. Nursing Implications: This community engaged study will lead to the development of an intervention to reduce disproportionate cervical cancer risk in this vulnerable patient population. Key words: sexual and gender minority health, LBT health, tobacco cessation, HPV vaccination, cervical cancer screening, cervical cancer risk reduction Lay abstract (3-4 sentences) Cervical cancer is a pressing social justice issue, as it is almost entirely preventable and concentrated in disadvantaged populations, including sexual and gender minorities. To understand barriers and motivators for cervical cancer risk reduction (tobacco cessation, human papillomavirus vaccination, and cervical cancer screening), we will conduct interviews will 30 sexual and gender minorities (lesbian and bisexual women, and transgender individuals with a cervix). Next, we will convene 5 focus groups of leaders in the lesbian, bisexual, and transgender community as well as healthcare providers to develop strategies to promote cervical cancer risk reduction. The overall goal of this program of research is to promote health equity by reducing cervical cancer risk in this vulnerable patient population.