Gotay 2000.

Methods	Study design: controlled before‐after study Sampling frame: women age 18 or older of Hawaiian or part‐Hawaiian ancestry with a working telephone Sampling method: select every nth number with last 2 digits reversed Collection method: telephone interview (n = 678) Description of the community coalition: The Wai'anae Cancer Research Project emerged from a research collaboration between the University of Hawaii and the Wai'anae Coast Comprehensive Health Center, a community health center serving the target population. The study was headed by the medical director of the WCCHC with a policy‐making steering committee comprising representatives from the WHCHC, the University, and the Native Hawaiian community. An advisory committee of community members was formed to participate in the project
Participants	Communities: Oahu neighborhoods with high proportion of Native Hawaiians Country: USA Ages included in assessment: 18+ Reasons provided for selection of intervention community: Native Hawaiian women had the highest mortality and lowest screening rates for breast and cervical cancer among all ethnic groups in Hawaii Intervention community (population size): Wai’anae Coast (45,000; 18,000 are Native Hawaiians) Comparison community (population size): other Oahu neighborhoods with similar proportion of Native Hawaiians (unknown)
Interventions	Name of intervention: Wai’anae Cancer Research Project Theory: not reported Aim: to test the effectiveness of a culturally appropriate, community‐driven intervention as a means of increasing breast and cervical cancer screening practices among Native Hawaiian women  Description of costs and resources: lay health educators hired, educational materials and health care vouchers provided to participants. Costs not reported Components of the intervention: 65 health‐activated support groups of 2 to 19 women; each delivered information and facilitated interaction and experience via traditional Native Hawaiian “talk story” format. Educational materials and vouchers for free mammograms and Pap tests distributed. Support group for cancer patients and a designated women’s clinic at the health center were also initiated in the intervention community during the project Start date: 1990 (funding initiated) Duration: Most support groups met twice over 2 weeks. Length of time between baseline and follow‐up survey: 3 years
Outcomes	Outcomes and measures: Pap screening experience. Measures: ever had a pap test (%) and compliant with guidelines (%) Breast self examination. Measures: perform at least sometimes (%) and compliant with guidelines (%) Clinical breast examination. Measures: ever had a clinical breast exam (%) and compliant with guidelines (%) Mammography experience. Measures: ever had a mammogram (%) and compliant with guidelines (%) Time points: baseline (before intervention implementation) and follow‐up (3 years later)
Notes	Lay health educators were trained to provide group support and education to family and community members via “Kokua Groups” Funding source: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Intervention not randomly assigned
Allocation concealment (selection bias)	High risk	No allocation concealment
Baseline outcome measurement similar	Low risk	Intervention and comparison communities displayed similar screening histories at baseline
Baseline characteristics similar	Low risk	Intervention community participants somewhat more likely to be married and less likely to have higher education, otherwise similar to comparison community on demographic characteristics
Blinding of outcome assessment (detection bias) All outcomes	High risk	No blinding
Incomplete outcome data (attrition bias) All outcomes	High risk	46% of women who participated in baseline survey were lost to follow‐up. Participants retained in the study tended to be older, better educated, employed, married, and in compliance with mammography screening recommendations at baseline
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding
Protection against contamination	High risk	Intervention and comparison communities located on same small island (Oahu); intervention involved encouragement to share information and screening vouchers with friends
Selective reporting (reporting bias)	Low risk	All relevant outcomes reported