Improved access to women's health services for Alaska natives through community health aide training.

This project demonstrates the effect of increasing the skills of Community Health Aides (CHAs) on the use of specific preventive health services by women in remote Alaska villages. Eight CHAs were trained in specimen collection for Pap and sexually transmitted disease testing, and in clinical breast examination. Skill competency was monitored. Computerized medical records of all women between the ages of 18 and 75 in the four villages with trained CHAs and in four comparison villages (n = 1093) were checked for Pap status prior to CHA training and again 12 months later. All eight CHAs achieved competency and provided services in their village clinics with telephone support from an experienced clinician. The post-training year Pap test rate of women who were overdue for a Pap test was 0.44 in the villages with trained CHAs; the rate among the women in the comparison villages was 0.32 (p = .079).

Cervical cancer screening on the Yukon-Kuskokwim Delta, Southwest Alaska. A population-based study.

BACKGROUND: Alaska Native women suffer excess morbidity and mortality due to cervical cancer. This population-based study analyzed data from a regional Pap smear registry to describe the 2-year prevalence of cervical cancer screening for the women who live in remotely located villages in the Yukon-Kuskokwim Delta region. METHODS: All women older than 18 years of age who lived in one of the villages of the Yukon-Kuskokwim Delta were included (n = 6916). A 2-year Pap prevalence rate for each village was estimated by counting the number of women who had at least one Pap smear between September 1, 1992, and August 31, 1994, using the computer-based Pap registry located at the regional medical center in Bethel, Alaska. Population estimates for each village were obtained from a database maintained by the local office of the State of Alaska's Public Health Nurses. RESULTS: The overall 2-year Pap prevalence rate for the population was 62%. By age group, 2-year prevalence rates were as follows: women 18 to 44 years, 64%; women 45 to 64 years, 58%; and women 65 years and older, 52%. CONCLUSION: This study demonstrated that there is a significant need to improve access to and use of cervical cancer screening in this region to achieve national and state objectives. Village-based clinic staff are underutilized for cancer prevention service delivery; with additional training and supervision, staff members may serve as a means to improve this preventive health care service.