Table 1.

Summary of needs assessment findings and outreach strategies and approaches according to PEN-3 Model framework

	Column 1	Column 2
	Needs Assessment Findings	Outreach Strategies and Approaches
Perceptions	Positive ▪Aware of role of family history in breast cancer ▪Importance of preventive regular check-ups ▪Family and children are motivation to be healthy ▪Acknowledge responsibility for their own health ▪Receptiveness to information and health education Negative ▪Lack of knowledge regarding HPV and HPV infection, breast/cervical cancer, screening ▪Procrastination ▪Reluctant to perform breast self-examination and have health care professionals touch their breasts and pelvis ▪Stoic attitude toward health and illness ▪Believe preventive practices cannot change the outcome ▪Believe there is no treatment for breast and cervical cancer	▪Reinforce knowledge regarding the role of family history in breast cancer risk ▪Reinforce knowledge regarding the importance of Pap smears and clinical breast exams ▪Reinforce importance of engaging in preventive practices and motivation to be healthy for their family and work ▪Promote knowledge about other risk factors for breast and cervical cancer as well as treatment options ▪Instruct women to perform breast self-exams and identify lumps using breast models ▪Have breast cancer survivors as guest speakers to discuss their experiences and answer questions
Enablers	Positive ▪Get health information at clinics, from pamphlets, radio and neighborhoods they live in ▪Trust in community-based organizations (CBO’s) and churches ▪Trust in Lay Health Promoters (LHPs) ▪Trust doctors as a source of health information Negative ▪Lack of health insurance, lack of transportation, cost, language barriers, lack of knowledge on where to obtain pap smears, clinical breast exams, and mammograms ▪Lack of trust in interpreters ▪Difference in health care system from home country ▪Fear of going to the doctor because of legal status ▪Believe they do not have control over their health because of the ‘system’	▪Advertise the event using LHPs, Spanish-language radio, newspapers, flyers in churches ▪Reinforce trust in CBO’s and churches by conducting the event at these sites ▪Arrange for physicians to give the lecture and answer medical questions ▪Decrease structural barriers by providing screening at low- to no-cost, and follow-up on abnormal results and treatment if cancers found ▪Promote knowledge about where to obtain screening by scheduling appointments for Pap smears, breast exams and mammograms at the event ▪Education on the US health care system ▪Arrangements for participants to become regular patients of the clinics
Nurturers	Positive ▪Strong alliance to other Latinas ▪Strong desire to help each other ▪Motivation to keep their families healthy Negative ▪Perceived racial/ethnic discrimination at clinics	▪Provide education in group setting ▪Have breast cancer survivors as guest speakers to discuss their experiences ▪Presence of LHPs and outreach staff at clinics when participants attend their scheduled appointments ▪Presence of clinic staff at educational events