Table 1.

Summary Regarding the 11 Articles Included in the Review.

Abbreviated citation	Study aim	Study setting	Country of origin	Priority population	Study design	Position title	Sample size	Intervention summary	Outcome measures	Results (training outcome)
(Thompson, Carosso, Jhingan, Wang, & Holte, 2017)	The use of Promotora and video education to increase Cervical cancer Screening Among Rural Latinas	A rural agricultural region where approximately 67% of the population are of Latino	USA (Yakima Valley of Washington State)	Being out of adherence with current recommendations for Pap test screening, 21 to 64 years old, and having no a prior Hysterectomy	3-arm randomized controlled trial	Promotora	Control (usual care) (n = 147), low intensity (video) intervention arm (n = 150) and high intensity (video + promotora) intervention arm (n = 146)	Promotora were trained for 3 days on procedures for approaching households and delivering the intervention, cervical cancer screening facts and tracking and documentation procedures. Women in the high-intensity arm received a promotora-led educational session in their home. The educational session included watching the video with the promotora followed by discussion. A local resource sheet listing means for overcoming barriers to care such as financial aid, transportation, and childcare was provided.	The primary outcome was completion of a Pap test within the 7 months after randomization. Secondary outcomes included changes in knowledge level.	We see that significantly more women underwent Pap test within 7 months of randomization in the high-intensity arm (n = 578 [53.4%]). We found significant increases in the knowledge factors overall for all the variables in all arms.
(Han et al, 2017)	To assess the impact of CHW intervention focused on building health literacy skills among Korean American women.	Community churches	USA, Baltimore, Maryland—Washington, DC	Women aged 21 to 65 years, had not had a Pap test within the past 24 months, and were able to read and write Korean or English	A cluster-randomized wait list control design	Community health workers (CHW)	560 women agreed to participate: (intervention: n = 278; control: n = 282)	CHWs had at least a high school level of education. CHWs received 16 hours of training over 3 days, CHWs learned key medical terminology in cervical cancer screening and screening of relevant medical instructions. Initially, the intervention group received brochure tailored individual risk factors for cervical cancer, followed by CHWs delivered a health literacy skills training in 1 ½ to 2-hour-long group meeting. At the end of session, participants received DVD and picture guidebook. CHWs made monthly telephone calls provide navigation assistance over a 6-month period.	Outcome measure were participants characteristics, Pap test use in 6 months, and changes in cancer knowledge	At 6 months, 54.5% of those in the intervention group received Pap test. The mean increase in health literacy was 7.0 points (95% CI = 4.9, 9.0) higher on average in women in the intervention group than women in the control group
(Rosser, Njoroge, & Huchko, 2015)	To find out whether the health talk provided by CHWs promote changes in knowledge level and screening rates	Rural health facilities	Kenya, East Africa	Non-pregnant women aged 23 years old, had not previously screened, could speak native or English language, willing to provide informed consent	2-Arm Randomized Controlled Trial (RCT)	Community health worker (CHW)	Intervention (N = 207) and control (N = 212) arm	CHWs attended 1-day training learned and practiced teaching materials. Participants in the intervention arm participated in the group health talk delivered by CHWs. The intervention consisted of a 30-minute interactive talk about cervical cancer, risk factors, how screening is performed, what screening results mean, and treatment options. The flipchart was used.	The primary outcome was change in knowledge level. Secondary outcome was perception of personal cervical cancer risk. The follow up was 3-months.	Knowledge scores in the intervention arm increased 26.4% (8.7 to 11.0 points) compared to only a 17.6% increase (8.5 to 10.0 points) in the control arm. Over half of all participants in the intervention arm (N = 122/207; 58.9%) underwent screening
(Mojica, Morales-campos, Carmona, & Ouyang, 2015)	Latinas attending the education-plus-navigation intervention would increase their knowledge of cervical cancer and would report receipt of Pap test	Community-based organizations	West and south sides of San Antonio, Texas. USA	Women aged 18 to 65 years and had never had a Pap test or not had 1 in the past 3	A single-arm, nonrandomized, pre–post design	Community Health Worker (CHW)	691 participants were recruited into the study, while 535 attended the education	2-week of CHWs training to discuss study protocols on data collection procedure, cervical cancer risks, screening tests and guidelines by project coordinator. CHWs provided 1 group session education to the community about cervical cancer risks, screening guidelines, and benefit of early detection in convenient places using English or Spanish in 90 minutes. Bilingual flip charts, with visual content such as culturally relevant pictures and graphics to establish a connection between the information. After session, CHWs provided health informational sheets on cervical cancer and cervical cancer screening. CHWs provided navigation service; scheduled appointment, help women to identify low or free cost screening service, reminder, follow-up calls before and after clinic appointments.	The primary outcome was receipt of Pap test. Secondary outcomes were knowledge of screening guidelines, knowledge of the benefits of early detection, and beliefs on early detection.	158 (72%) participants at pretest and 176 (80%) at posttest correctly answered questions (P = 0.03) and 25% (n = 174) of eligible participants reported having screened for cervical cancer
(Schuster et al, 2015)	To evaluate the screening adherence within 6 months aforementioned health literacy-focused intervention delivered by CHWs	Community churches	USA Johns Hopkins University School of Nursing	Women aged 21 to 65 years old, had not had Pap test within the last 24 months, able to read and write Korean or English, and willing to provide written consent	Cluster-randomized controlled trial	Community health workers (CHWs)	Participants in the intervention group (n = 245) and participants in the control group (n = 43)	CHWs in received 3-day training from CHWs coordinator regarding predisposing, enabling, and reinforcing factors consistently found to affect cancer-screening behaviors. Intervention group received a brochure containing specific health messages and information tailored to individual risk factors. Thereafter, CHWs delivered a 2-hour education to participants on English medical terminology in the context of cervical cancer screening. At the end of the education session, participants received a DVD and a picture guidebook that detailed the health literacy content covered in the class. Navigational assistance included making a screening appointment, providing transportation and translation services, and/or completing paperwork.	Participants were required to complete screening within 6 months but the follow up were 3-monthly after the education	Out of 276 participants in the interventional group received brochure and CHW health literacy program, 85% participants were screened against 15% in the control group
(Dunn et al, 2017)	To assess the impact of Cancer Awareness: Ready for Education and Screening (CARES) on cervical screening facilitated by community-based peer leaders and CARES program staff.	Community-based intervention	Toronto, Canada	Women aged 21-69 years old	Cohort study	Peer leaders or lay health educators	331 participated in the CARES cohort	42 peer leaders or lay health educators, attended a 3-day training session delivered by research stuff that included orientation of their roles, content about cervical cancer, cancer screening, adult learning principles, communication skills, group facilitation skills, woman centered decision-making, cross-cultural sensitivity, time management, challenging situations, and research documentation. Even after the training, research stuff kept providing on-going mentorship either face-to-face or through telephone Peer leaders shared the content orally in the language of the group regarding information about cervical cancer screening. Educational materials consisted of a simple PowerPoint presentation with Slides contained visual imagery. Linguistic, childcare, transportation, and guiding women to access screening were navigation services	The primary outcome was the participation in the screening program in the 8 months.	26% had screened against 9% in the control group
(Wong, Choi, Law, Chan, & So, 2019)	To examine whether CHW-led intervention can enhance cancer knowledge and screening intention among South Asian ethnic minorities in these communities	Non-governmental organizations	Hong Kong, China	Women aged 25 or above, with previous sexual activity, no previous cervical cancer screening in the past 5 years, no previous cancer diagnosis, and no educational intervention on cervical cancer screening in the past year.	Randomized wait-list controlled trial	Community Health Worker (CHW)	42 participants allocated to either the CHW-led intervention (n = 21) or wait-list control arm (n = 21).	Two nurses and 1 psychologist delivered CHW training about the disease (risk factors, signs and symptoms, and associated myths and misconceptions, and measures for early detection). Topics included currently available screening tests, consequences of delaying cancer detection, barriers against the uptake of screening services, and possible strategies to overcome these barriers, as well as influencing their community peers to engage in cancer prevention practices. Short lectures and teaching strategies were Group games, group discussion, real-life video, role play and demonstrations. CHWs delivered 30 minutes intervention using a structured PowerPoint slide with a video clip. Information booklet was provided to each participant to recap what they had learned A monthly telephone follow-up and the provision of navigation assistance	The primary outcome was cervical screening uptake in 3 months, and secondary outcome were, Readiness to Undergo Screening, Screening Beliefs, Socio-demographic information	The use of the multimedia approach would enable a more effective education of individuals with lower literacy levels. Participants (100% in the control arm and 95.2% in the intervention arm) indicating that they would undergo a Pap test within the next month.
(Fleming et al, 2018)	To assess the Promotora-Led Charla Intervention in promoting cervical cancer screening, knowledge, and beliefs	Community-based facilities (eg, FSH youth center, church, etc.).	USA	Women aged 21-70 years, able to speak and read Spanish or English, and able to provide written informed consent	single-arm study used a pretest-posttest design	Promotora, community health educator (CHE)	60 women	Promotora were selected from the community through community leaders. Promotoras received training through 3 educational sessions on role and function of promotoras, significance of health disparities in their community, cervical cancer screening guidelines, HPV transmission, HPV vaccines, cervical cancer causation, and local Pap testing resources. Role-plays were used. Charlas are small tailored group discussions (chats) on targeted health topics. Promotora conducted a total of 6 charlas (sessions) lasting about 75 minutes each. The navigation service provided was scheduling appointments	Uptake of pap test in 3 months, cervical cancer/HPV knowledge, socio demographic characteristics	20 participants had received a Pap test (65%). Repeated measures ANOVAs revealed a significant increase in HPV knowledge and Pap test self-efficacy (F [1,59] >22.7, Ps < .0001) following participation in the charla.
(Molokwu, Penaranda, Flores, & Shokar, 2015)	To evaluate the effect of a promotora-led educational program on HPV and cervical cancer	Clinical setting	USA	Women aged 30 to 65 years old, had a uterus, had no history of cervical cancer, without hysterectomy, or pregnant.	Quasi-experimental study	Promotora	A total of 347 women were approached, and 31.7 % met the inclusion criteria and agreed to participate in the study	Promotora were trained in 3 initial sessions followed by continued review and supervision during the study period. Promotora were trained on cause of cervical cancer, risk factors, basic Pathophysiology, as well as disease progression and communication skills. CHWs delivered a 1 hour educational session covered information on important basic cervical cancer facts: what is cervical cancer, who gets cervical cancer, how do women get cervical cancer, causes of cervical cancer, role of HPV in causing cervical cancer, symptoms of cervical cancer, risk factors for cervical cancer, screening guidelines for cervical cancer, and prevention of HPV. Educational sessions were carried out on an individual or small group basis. Sessions were also held in English or Spanish based on participants identified preferred language.	Participant’s knowledge level and social demographic characteristics	Participants showed an improvement of knowledge level on cervical cancer and HPV infection from a mean score of 10.8 (SD 3.43) out of a possible score of 18 to a mean score of 16.0 (SD1.51) (P < 0.001).
(Ayla Bayık Temel, Şafak Dağhan, Şenay Kaymakçı, Renginar Öztürk Dönmez, & Zeynep Arabacı, 2017)	To encourage teachers to teach and share the knowledge with the women who attend their classes and courses in public training centers, and also to evaluate the diffuseness of the teachers’ training efforts on the students’ Pap smear test (PST) behaviors. Screening knowledge and to evaluate the uptake of screening service	Public training centers	Turkey	Females studying at the public training centers	Quasi-experimental with pre-intervention and post-intervention	Female teachers	64 volunteering students	Teachers attended a training session that took 60 minutes covered content about anatomy, physiology of reproductive system, cervical cancer symptoms, risk factors, early detection, prevention, treatment methods, and PST. The training session was carried out in the form of lectures and group discussions. CD, documents, brochure, and magnet with a message (Don’t be afraid of cancer, learn how to prevent and share your knowledge) were given out to the participants for self-learning and to reinforce their memories. At the end of the training program, the teachers transferred the knowledge to their volunteer students (n = 64) through the lecture method.	To evaluate the effect of a structured teaching program on cervical cancer screening on the knowledge and practice of teachers after t the 6 months	The mean score of knowledge of the teachers in terms of cervical cancer risk factors and its early diagnosis was 7.75 ± 5.60 (Min = 1, Max = 18) before the training and 17.68 ± 3.79 (Min = 12, Max = 25) after the training. After the knowledge transferred to students, 67% of all the students had undergone PST and had positive behavior change on PST
(Mbachu, Dim, & Ezeoke, 2017)	To examine the effectiveness of peer health education on perception, willingness to screen and uptake of cervical cancer screening by women	Community churches	Enugu state, Nigeria.	Women aged 21 years old or more; currently sexually active or have been in the past; and never been diagnosed with any cancer	Community-based randomized, A before and after intervention study	Peer health educators	283 participants	The peer health educators completed secondary school. Education, role models and well respected in the community. An 18-hour peer educators’ training workshop was provided over a 3-day period covered basic information of cervical cancer; burden of cervical cancer, risks, prevention, screening tests and guidelines, existing myths. After the training, the peer health educators provided Group session consisted of 45-60 min on what the cervix is and how it can be kept healthy; definition of cervical cancer; burden of cervical cancer in Nigeria relative to other settings; risk factors, symptoms and signs of cervical cancer; prevention and treatment options for cervical cancer; and healthy living with cervical cancer	Outcome measures were perception of individual risk for cervical cancer and benefits of screening, willingness to screen, actual practice of screening, preferred method, frequency of screening and reasons for screening	The proportion of participants who screened for cervical cancer increased from 30 (10.5%) before the intervention to 49 (17.3%) after the intervention. Higher proportions of participants 219 (77.4%) perceived cervical cancer to be as serious as other cancers (P < 0.001); and felt themselves at risk of developing cervical cancer 113 (40%) (P = 0.01). Majority who reported that screening for the disease would be highly beneficial increased significantly from 145 (50.9%) to 195 (68.9%) after the intervention (P = 0.01).