Analysis and Refinement of a Women’s Reproductive Health (WRH) Curriculum in San Martin, Guatemala

In Guatemala, cervical cancer is the leading cause of cancer-related deaths and the most common cancer among women, despite being preventable and treatable. In the last 50 years the successful implementation of early screening programs in developed countries has led to a large decline in incidence and mortality of cervical cancer. In Guatemala, only an estimated 40% of women have ever been screened for this preventable cancer. Culturally appropriate education has proved to be an effective way to increase screening among Hispanic women. This research has identified a huge need for education in women’s health, especially concerning cervical cancer causes and prevention. This culturally sensitive pilot course was developed through feedback from community members as a response to these needs. An 8-week pilot course was taught by community health worker to 13 indigenous women from San Martin. After every class, individual home interviews served to evaluate learning, answer questions and gather real time course feedback. There was a large impact on health knowledge, attitudes, and behaviors: Participants reported learning information they’d never before learned, and appreciation for the dynamic and visual teaching methods.Participants shared what they learned with husbands, daughters, and in-laws, and hoped the course would continue to be offered so that more women, especially young women could benefit. In the first interview, only 3 of the 13 participants desired a Pap test. By the end, that number increased to 13. When looking at logistics and sustainability, we found that there were obstacles to class attendance included family emergencies, household work, child care, and personal health issues. Transportation, a culture of machismo and lack of family support, however, were not identified as barriers. Possible adaptations include having longer classes, combining weeks 4-5 into one class, and adding additional classes on topics such as contraceptives, breast cancer, or domestic violence. Teachers of this course should be female, experienced on WRH topics, fluent in Spanish and the local indigenous language, and chiefly, trusted by community members. Remaining obstacles to screening include the current lack of accessible resources (e.g. Pap tests, cervical cancer treatment) in the local health system. In conclusion, this course proved an effective way to bridge knowledge gaps, and improve attitudes concerning WRH care in San Martin, however this research found that many participants were still unable to seek care due to the current lack of accessible resources. So while education is an effective way to address issues in WRH, it should be combined with strategies to reduce barriers to screening and treatment. Finally, in order to be effective, both educators and health care providers in this population must be perceived as trustworthy.This research has highlighted the need for advocacy and community partnerships to improve WRH resources in the area. Future research should focus on refining this curriculum for use in other SLAB communities, offering a similar course for young women, and exploring the possibility of a mini course for men. Finally, future iterations of this course in other SLAB communities must adapt curriculum to the nuances of each community.

Co-authors: Kristen Zwicklbauer, Darrah Dickerson, Andrea Valdez, Briana Williams