TABLE 2.

Proposed Intervention: Objectives and Strategies as They Relate to the PEN-3 and Health Belief Model

Theoretical Constructs	Intervention Objectives	Strategies—Group Sessions	Strategies—Individual Sessions
Perceptions (PEN-3)	Reinforce the knowledge, attitudes, and beliefs that lead to engaging in healthy behaviors Promote knowledge about HPV (infection and testing), cervical cancer, and screening Recognize the importance of taking care of themselves in order to be healthy, including seeking care	Provision of education and knowledge Cognitive restructuring Challenge stoic attitude toward health and illness Increased perceived behavioral control over their health Emphasize ethnic and gender pride	Personalize the education (e.g., reinforcement of personal motivators to be healthy) Review homework—“pie” Correct misinformation Promote awareness
Enablers (PEN-3)/Perceived Barriers (HBM)a	Reinforce the trust in church-based organizations and churches and promote trust in providers and interpreters Decrease structural barriers to screening Decrease or eliminate fear about learning Pap smear results Promote knowledge regarding the health care system in the United States and where to obtain screening	Education, including education about medical and social services (including faith-based) available in the communityb Problem solving Counter the negative barriers of seeking screening Communication skills with providers and clinic personnel	Review of homework—problem-solving skills Identify and reduce individual barriers (e.g., make provisions for travel and child care) Facilitate obtaining and scheduling appointments, reminders by lay health educators
Nurturers (PEN-3)	Provide tools and skills to seek social support Reinforce the importance of reliance on each other Reinforce cultural norms to be monogamous Improve communication with sexual partners: refusal skills, assertiveness, talking with partners about their sexual history	Exchange of phone numbers and contact information among participants (if willing to do so) Training and guidance Role-playing Graded exposure Coping cards Cognitive rehearsal Use progressive goal setting Verbal reinforcement	Identify and address specific areas of difficulty and strengths in obtaining (and maintaining) social support for screening Individualized positive reinforcement of successful attempts to engage in the learned strategies (e.g., communication with partners)
Perceived susceptibility (HBM)	Provide information on HPV infection risk factors as well as information that every sexually active woman is at risk Provide information on the importance of preventive care with concrete examples and testimonials	Education—verbal and written culturally relevant materials Discuss the role of family history and sexual behavior Reinforce that all sexually active women are at risk for HPV infection	Identify individual risk levels Link sexual practices and risks based on personal sexual history, current sexual practices, as well as environmental and partner factors
Perceived severity (HBM)	Provide information that although cervical cancer is a serious condition, it can be cured if detected early	Education—verbal and written culturally relevant materials Testimonials of survivors New approaches available for early detection	Review of cognitive distortions and early detection Specify consequences of sexual risk behaviors and cervical cancer
Perceived benefits (HBM)	Increase the perceived advantages associated with open communication with sexual partners Emphasize the advantages of early detection and treatment	Decision making (list of pros and cons) Group discussion of the pros of sexual communication with partners Group discussion of perceived advantages of early detection	Cognitive restructuring based on the list of pros and cons
Self-efficacy (HBM)	Increase self-efficacy for engaging in both primary and secondary prevention of cervical cancer Promote self-responsibility and personal control	Role-playing Empower women to take personal control over their reproductive health Increase confidence in initiating safer-sex conversations, negotiating safer sex, and refusing unwanted or unsafe sexual encounters Acknowledge success at group level Ask for assistance from the group	Positive reinforcement Anxiety reduction Identify and address specific sexual situations in which participant may have low self-confidence to protect her health Reinforce personal success

NOTE: HBM = Health Belief Model; HPV = human papilloma virus.

^a.Structural perceived barriers overlap with negative enablers. Therefore, they were grouped in the same category for intervention purposes.

^b.Participants received a “directory”, including medical and social services available in the community. This directory provides hours, costs, availability of interpreters, services, etc.