Development of an Acute Pain Assessment Tool for Patients in Post-anesthesia Care Units.

BACKGROUND: Post-operative pain is a common form of acute pain. Objective pain assessment in post-anesthesia care units after surgery is useful regardless of the patient's condition. AIMS: This study aimed to develop and evaluate an acute pain assessment tool for patients in post-anesthesia care units. DESIGN: This was a cross-sectional observational study comprising two stages: scale development and psychometric evaluation. SETTINGS:  . PARTICIPANTS/SUBJECTS:  . METHODS: Scale items were developed based on a literature review and content validity by experts. The validity and interrater reliability of the pain scale were evaluated using data from 218 patients admitted to the post-anesthesia care unit at a university hospital. A receiver operating characteristic curve was used to identify the sensitivity and specificity for determining the cutoff point for acute pain. RESULTS: We developed an objective acute pain scale, called the APA5, which ranges from 0-10 and comprises behavioral (facial and verbal expressions and body movement) and physiological (changes in heart rate and blood pressure) responses. The APA5 is valid and reliable for assessing acute pain in the recovery room. Sensitivity and specificity were acceptable when the cutoff was 2 out of 10 points. CONCLUSIONS: The APA5 is an easy and simple tool for measuring pain in patients in post-anesthesia care units who have difficulties with self-reporting.

Related Factors for Impaired Fasting Glucose in Korean Adults: A Population Based Study.

BACKGROUND: Individuals with impaired fasting glucose (IFG) who have poor health behaviors are at a greater risk for various health outcomes. This study compared the health behaviors and health literacy between individuals with non-IFG and IFG; factors that were associated with IFG were identified by sex. METHODS: This study was an observational study with a cross-sectional design based on data from the Korea National Health and Nutrition Examination Survey (KNHANES) that used a stratified, multi-stage, cluster-sampling design to obtain a nationally representative sample. This study analyzed the KNHANES Health Examination Survey and Health Behavior Survey from 2016 to 2018 (N=9919). Multiple logistic regression analysis was employed to compute the odds ratios of health behaviors and health literacy to identify the risk factors for IFG. RESULTS: The prevalence of IFG among the total was 29.0% (weighted n=2826, 95% CI 27.8-30.2). In the IFG group, 63.6% were male and 36.4% were female (X2=320.57, p<.001). In multiple logistic regression by sex, the factors associated with IFG in male were as follows: age (50s; OR=2.36, 95% CI 1.79-3.13), high BMI (OR=2.27, 95% CI 1.78-2.90), frequent drinking (OR=1.83, 95% CI 1.23-2.72), and using nutrition fact labels (OR=1.35, 95% CI 1.05-1.75). Low economic status (OR=4.18, 95% CI 1.57-11.15) and high BMI (OR=2.35, 95% CI 1.29-4.28) were the affecting factors in female. On the other hand, employment status, perceived stress, and job type were not related to IFG in both male and female. CONCLUSIONS: Strategies should be targeted to improve health behaviors and health literacy for those in their 40s and 60s, male in shift work, those who frequently dine out, overweight male, female with low economic statuses, and frequent drinkers. Moreover, healthcare providers should understand the barriers to health behaviors and literacy to effectively deliver healthcare service.

Distorted body weight perception and its gender differences in middle-aged adults: population based study.

BACKGROUND: Increasing interest in appearance and the growing preference for a beautiful body can lead to physical and psychological problems due to an inappropriate body image perception. As such, there is a need to identify what factors may contribute to an inappropriate body image. The purpose of this study was to examine the presence of distorted body weight perception among middle-aged Koreans and identify gender differences and other factors that contribute to a distorted body image regarding body weight. METHODS: Data on 8363 middle-aged adults (aged 45-64 years) from the Korea National Health and Nutrition Examination Survey were analyzed using complex samples analysis considering weight, stratification variables, and cluster variables. The difference between perceived body image regarding body weight and actual body mass index was used to assess distorted body weight perception. Socioeconomic status, health behaviors, daily energy consumption, and psychological status (depression and stress) were assessed for their relationship to distorted body weight perception. RESULTS: Results showed that a distorted body image regarding body weight was more prevalent among middle-aged men (45.3%) than women (25.7%). Age, income, perceived health status, and health behaviors were significantly associated with distorted body weight perception in middle-aged men, whereas psychological factors were associated with distorted body weight perception in middle-aged women. CONCLUSIONS: Further research on distorted body weight perception is needed to gain understanding of the gender differences between middle-aged men and women in Korea. Furthermore, to the results of the study can be used as a basis for developing various education, health mediation, and public health promotion interventions and programs to address body weight perception in middle-aged adults.

Self-stigma among Korean patients with diabetes: A concept analysis.

AIMS AND OBJECTIVES: To conduct a concept analysis of self-stigma among patients with diabetes and introduce an operational definition of self-stigma. BACKGROUND: Due to fears of being monitored, patients with diabetes often conceal their disease and/or withdraw from social relationships. These behaviours negatively affect patients' self-care and socialisation. DESIGN: A concept analysis was conducted using a three-phase (theoretical phase, fieldwork phase and final analysis phase) hybrid method by Schwartz-Barcott and Kim (Nursing research methodology: Issues and implementations, 1986, Rockville, MD: Aspen). METHODS: During the theoretical phase, a literature search was conducted using PubMed and CINAHL. Using COREQ guidelines, in the fieldwork phase, in-depth interviews were conducted with nine participants with diabetes. The recorded data were analysed using a grounded theory approach. Results from both were included in the analytic phase. RESULTS: In the fieldwork phase, nine patients with diabetes (four men and five women; mean age = 57.00 ± 21.93 years) participated in the interview. The mean duration of diabetes was 21.44 ± 12.39 years. The self-stigma concept included three categories with nine attributes: affective (negative feelings and feeling sorry for others who have concerns about me), cognitive (low self-esteem and self-efficacy, perceived weakness, low expectations for the future, worry for children and disease burden) and behavioural factors (social withdrawal and avoiding disease disclosure). The nine attributes included 23 indicators. CONCLUSIONS: Self-stigma among patients with diabetes is defined as a state in which patients develop negative self-feelings as they deal with the disease. This can cause diminished self-esteem and self-efficacy, as well as a tendency to avoid disclosing the illness along with social withdrawal. RELEVANCE TO CLINICAL PRACTICE: Based on this self-stigma concept analysis, we clarified the attributes of diabetes self-stigma and distinguished it from social stigma in nurse professionals during patient education and clinical assessment.

Effect of 24-Hour Bed Rest versus Early Ambulation on Headache after Spinal Anesthesia: Systematic Review and Meta-analysis.

OBJECTIVES: We performed a systematic review of the evidence for the effectiveness of bed rest after dural puncture to update current evidence on the topic. DESIGN: The design was a systematic review and meta-analysis. DATA SOURCES: We searched 10 electronic databases in English (Medline, CINAHL, EMBASE, and the Cochrane Controlled Trial Register) and Korean (KISS, KMBASE, NDSL, and RISS) using the terms "post-dural puncture headache," "spinal anesthesia," "epidural anesthesia," and "bed rest" to identify reports discussing the effectiveness of bed rest in preventing post-dural puncture headache (PDPH) after spinal anesthesia from 1980 to 2014. Review/Analysis Methods: Original studies such as randomized and nonrandomized controlled trials, where participants were allocated to an intervention or control group, were included. A total of eight studies that met the inclusion criteria were independently reviewed and encoded by two review authors. To ensure the quality of the eight studies, levels of risk of bias were assessed by two different researchers. The main outcome was the prevalence of PDPH. RESULTS: The included studies indicated that PDPH prevalence did not differ between the group assigned to 24 hours of bed rest and the group assigned to early ambulation. In subgroup analysis, the effect size of clinical factors (severity of headache, day of onset, and needle gauge) and the study characteristics (language and sample size) did not differ between groups. CONCLUSION: This meta-analysis of studies suggested that long-term bed rest after spinal anesthesia may not be effective in preventing PDPH.

Breast and Cervical Cancer Screening Literacy Among Korean American Women: A Community Health Worker-Led Intervention.

OBJECTIVES: To test a community health worker (CHW)-led health literacy intervention on mammogram and Papanicolaou test screening among Korean American women. METHODS: We conducted a cluster-randomized trial at 23 ethnic churches in the Baltimore, Maryland-Washington, DC, metropolitan area between 2010 and 2014. Trained CHWs enrolled 560 women. The intervention group received an individually tailored cancer-screening brochure followed by CHW-led health literacy training and monthly telephone counseling with navigation assistance. Study outcomes included receipt of an age-appropriate cancer screening test, health literacy, cancer knowledge, and perceptions about cancer screening at 6 months. RESULTS: The odds of having received a mammogram were 18.5 (95% confidence interval [CI] = 9.2, 37.4) times higher in the intervention than in the control group, adjusting for covariates. The odds of receiving a Papanicolaou test were 13.3 (95% CI = 7.9, 22.3) times higher; the odds of receiving both tests were 17.4 (95% CI = 7.5, 40.3) times higher. Intervention effects also included increases in health literacy and positive perceptions about cancer screening. CONCLUSIONS: A health literacy-focused CHW intervention successfully promoted cancer-screening behaviors and related cognitive and attitudinal outcomes in Korean American women.

Community Health Worker Perspectives on Recruitment and Retention of Recent Immigrant Women in a Randomized Clinical Trial.

This study explores the recruitment and retention strategies used by community health workers who enrolled Korean Americans in a church-based, randomized trial to promote mammogram and Papanicolaou tests and retained them for 6 months. We conducted 4 focus groups with 23 community health workers. Data were analyzed using a thematic analysis. Themes were identified in relation to recruitment: personal networks, formal networks at churches, building on trust and respect, and facilitating a nonthreatening environment. Themes were identified for retention: trust and peer support. Qualified, well-trained community health workers can recruit and retain hard-to-reach immigrant women in a randomized trial by using multiple culturally sensitive strategies.

The Methodological Quality of Systematic Reviews and Meta-Analyses on the Effectiveness of Non-pharmacological Cancer Pain Management.

This study used the Assessment of Multiple Systematic Reviews (AMSTAR) to determine how the quality of methodologies in systematic reviews (SRs) and meta-analyses (MAs) impacts the effectiveness of nonpharmacological cancer pain management. The authors searched 11 electronic databases for published and unpublished studies (in English and Korean) on SRs and MAs relating to "cancer" and "pain management" that were released prior to May 7, 2014. The findings from 17 SRs and MAs were scored for quality using AMSTAR and coded by management type and value of effect size. Only one article was deemed high quality; five were considered to be of low quality. The mean score was 5.47 (SD = 2.03), indicating moderate quality. Among the items we tested via AMSTAR, zero studies stated whether they have a conflict of interest in their covered studies, but every study established the research question and inclusion criteria before constructing the review. Rigorous assessment of nonpharmacological cancer pain management using AMSTAR might contribute to healthcare providers making more informed clinical decisions when it comes to handling pain. Based on the finding, researchers should abide by reporting guidelines for SRs and MAs to ensure that research is more rigorously synthesized.

Mediating role of critical thinking disposition in the relationship between perceived barriers to research use and evidence-based practice.

BACKGROUND: Despite the importance of critical thinking in clinical and educational settings, little is known about its role in evidence-based practice (EBP). AIM: This study examined whether critical thinking disposition (CTD) mediates the relationship between perceived barriers to research use and EBP in clinical nurses (N=409). METHODS/DESIGN: A path diagram using structural equation modeling was used to estimate the direct and indirect effects of perceived barriers to research use on EBP, controlling for CTD as a mediator. RESULTS: CTD partially mediated the relationship between perceived barriers to research use and EBP. Furthermore, the hypothesized mediation model demonstrated an appropriate fit to the data. CONCLUSIONS: Individual and organizational efforts are needed to help nurses further improve their critical thinking skills. CTD is important as research barriers to engage effectively in EBP. Without the skills to evaluate evidence carefully, research utilization may be compromised.

A psychometric evaluation of the Korean version of the evidence-based practice questionnaire for nurses.

BACKGROUND: Measurement of evidence-based practice (EBP) competence is a challenge in the health care setting. AIM: The purpose of this study was to evaluate the psychometric properties of the Korean version of the Evidence-Based Practice Questionnaire (EBPQ). METHODS/DESIGN: Data were collected from Korean clinical nurses (N = 801) who worked in acute care settings. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to assess its construct validity. Concurrent validity and internal consistence were also assessed. RESULTS: Findings identified that EFA revealed a three-factor solution with 64.4% of total variance explained. The factor loadings ranged from 0.431 to 0.900 for the 24 items. The instrument showed good reliability and concurrent validity with the Critical Thinking Disposition scale. CFA revealed that the Korean version of the EBPQ was acceptable. CONCLUSION: The Korean version of the EBPQ is a valid and reliable evaluation measure of EBP competencies of nurses in South Korea.

Physical Leisure Activities in Adolescents with Disabilities: Data from National Survey of Disabled Persons.

The impact of activities of daily living (ADLs) on the life satisfaction of adolescents with disabilities and the potential role of physical leisure activities as a moderator in this context have received attention. However, little is known about the influence of physical leisure activities on the relationship between ADLs and life satisfaction in adolescents with disabilities. This cross-sectional study aimed to investigate the moderating effect of physical leisure activities on the relationship between ADLs and life satisfaction among adolescents with disabilities. Secondary data analysis was conducted by extracting data from 5364 adolescents aged 12-18 years with disabilities from the 2020 National Survey of Disabled Persons of Korea. The potential moderating effect of physical leisure activities on the relationship between ADLs and life satisfaction was investigated using Pearson's correlation analysis and hierarchical multiple regression. Significant positive correlations were found for living, life satisfaction, and physical leisure activities. Physical leisure activities were found to play a moderating role in the relationship between ADLs and life satisfaction. This study concluded that increasing physical leisure activities, even with dependent ADLs, promotes life satisfaction, especially if ADLs are low, highlighting the necessity of increasing leisure activities in adolescents with disabilities.

Health equilibrium in Korean adults with type 2 diabetes mellitus: A hybrid concept analysis.

AIM: The aim of the study was to provide a concept analysis of health equilibrium among patients with diabetes and introduced its operational definition. DESIGN: A concept analysis was conducted using a hybrid model of Schwartz-Barcott and Kim (Nursing research methodology: issues and implementations, Aspen, 1986). METHODS: Using consolidated criteria for reporting qualitative research guidelines, 10 participants with diabetes mellitus were interviewed. Each participant conducted at least two interviews, with each interview session lasting approximately 20-60 min at home or in a quiet place with some privacy. Data were analysed using a grounded theory approach. RESULTS: The health equilibrium concept included four categories with 12 attributes: cognitive (commitment to health, willingness to make life adjustments, balanced awareness, maintaining control), social (social role performance, holding a social support system, participation in social relationships), behavioural (leading a balanced life, making efforts to maintain health, modulating overreaction diabetes) and psychological (hopefulness for a healthy life psychological stability) factors. Thus, health equilibrium was defined as a state in which remain committed to health, while maintaining a stable daily life, social relationships and psychological stability despite prejudices against the disease and self-care experiences. CONCLUSION: Health equilibrium for diabetes patients was defined as maintaining cognitive, social, behavioural and psychological equilibrium as a process of willingly adjusting to life with diabetes. This can help people with diabetes improve self-care and maintain social roles.

High-Tech Home-Based Rehabilitation after Stroke: A Systematic Review and Meta-Analysis.

(1) Background: To improve existing rehabilitation technologies, we conducted a systematic review and meta-analysis to identify the effect size of home-based rehabilitation using robotic, virtual reality, and game devices on physical function for stroke survivors. (2) Methods: Embase, PubMed, Cochrane Library, ProQuest, and CINAHL were used to search the randomized controlled trials that applied technologies via home-based rehabilitation, such as virtual reality, robot-assisted devices, and games. The effect size (Hedges's g) of technology type and affected limb on physical function were calculated. (3) Results: Ten studies were included. The effect size of home-based rehabilitation in virtual reality had the greatest value (Hedges's g, 0.850; 95% CI, 0.314-1.385), followed by robot-assisted devices (Hedges's g, 0.120; 95% CI, 0.003-0.017) and games (Hedges's g, -0.162; 95% CI, -0.036 to -0.534). The effect size was larger in the upper limbs (Hedges's g, 0.287; 95% CI, 0.128-0.447) than in the lower limbs (Hedges's g, -0.113; 95% CI, -0.547 to 0.321). (4) Conclusions: Virtual reality home rehabilitation was highly effective for physical function compared to other rehabilitation technologies. Interventions that consisted of a pre-structured and tailored program applied to the upper limbs were effective for physical function and psychological outcomes.

Suggestion for item allocation to 8 nursing activity categories of the Korean Nursing Licensing Examination: a survey-based descriptive study.

PURPOSE: This study aims to suggest the number of test items in each of 8 nursing activity categories of the Korean Nursing Licensing Examination, which comprises 134 activity statements including 275 items. The examination will be able to evaluate the minimum ability that nursing graduates must have to perform their duties. METHODS: Two opinion surveys involving the members of 7 academic societies were conducted from March 19 to May 14, 2021. The survey results were reviewed by members of 4 expert associations from May 21 to June 4, 2021. The results for revised numbers of items in each category were compared with those reported by Tak and his colleagues and the National Council License Examination for Registered Nurses of the United States. RESULTS: Based on 2 opinion surveys and previous studies, the suggestions for item allocation to 8 nursing activity categories of the Korean Nursing Licensing Examination in this study are as follows: 50 items for management of care and improvement of professionalism, 33 items for safety and infection control, 40 items for management of potential risk, 28 items for basic care, 47 items for physiological integrity and maintenance, 33 items for pharmacological and parenteral therapies, 24 items for psychosocial integrity and maintenance, and 20 items for health promotion and maintenance. Twenty other items related to health and medical laws were not included due to their mandatory status. CONCLUSION: These suggestions for the number of test items for each activity category will be helpful in developing new items for the Korean Nursing Licensing Examination.

Factors associated with health-related quality of life in elderly Korean patients with heart failure.

BACKGROUND: Heart failure (HF) is a debilitating chronic disease with incidence and prevalence increasing worldwide. People with HF experience deteriorating functional status, severe fatigue, dyspnea, and repeated hospital admissions, which negatively affect health-related quality of life (HRQoL). Therefore, 1 of the primary goals of HF management is to improve HRQoL. OBJECTIVE: The purpose of this study was to describe the relationship among sociodemographics, clinical factors, functional status, depression, and HRQoL in elderly Korean patients with HF. METHODS: A descriptive, cross-sectional study design was used. We enrolled 134 HF patients from outpatient cardiology clinics at an academic-affiliated hospital and a tertiary care academic referral medical center in Cheonan, South Korea. We obtained sociodemographic and psychosocial variables from face-to-face interviews and obtained clinical variables from medical record reviews. We used the Minnesota Living With Heart Failure Questionnaire to measure HRQoL. RESULTS: Using hierarchical multiple regression analysis and after controlling for sociodemographic and clinical factors, we determined that HRQoL was independently influenced by depression (ß = .443, P < .001), New York Heart Association classification (ß = .148, P < .05), and functional status (ß = -.403, P < .001). Depression and functional status explained about 26% of the variance in HRQoL. CONCLUSIONS: Depression and functional status were significantly associated with HRQoL in elderly patients with HF. Our findings emphasize the need for careful clinical screening of both depression and functional status in older patients with HF. More research needs to be conducted to develop effective intervention strategies to improve HRQoL and, in turn, HF outcomes.

Multimodal Diabetes Empowerment for Older Adults with Diabetes.

Systematically improving empowerment is not easy when operating a diabetes program for older adults. This study aimed to develop and test the feasibility of the diabetes empowerment (Dia-Empower) program for older adults with type 2 diabetes. A non-randomized controlled study with a matched sampling design was conducted. Community-dwelling older adults with diabetes were allocated to either the Dia-Empower program group or a control group. Changes in the primary (diabetes self-care and empowerment) and secondary outcomes (body composition and physical function) were compared between the groups. The scores for diabetes self-care and empowerment were significantly higher in the experimental group than in the control group. Changes in skeletal muscle mass and body fat ratio were significantly different between the groups. Handgrip strength and shoulder flexibility positively changed in the experimental group. The Dia-Empower program was feasible for older adults with diabetes in the community. In the future, it is necessary to study the long-term effects of the program and its effects on blood sugar control.

Fact Sheet of Amputee 10-Year Trends in Korea: From 2011 to 2020.

This fact sheet was used to analyze the trends in the number of amputees within the population and changes in their health-related behaviors since 2011. Data from the National Survey of Disabled Persons in Korea from 2011 to 2020 were used in this study. The cases of amputation among people with disabilities have increased. Although there were more upper extremity amputations than lower extremity amputations, as amputations below the wrist account for a greater proportion in South Korea than in other countries, the number of upper extremity amputations decreased and lower extremity amputations increased. The most common cause of amputation is accidents, followed by diseases and congenital anomalies. The majority of the amputees were male; however, the number of females showed a gradual increase, and the average age also increased. The proportion of amputated patients with chronic diseases, such as diabetes and hypertension, is increasing, and medical services are relatively limited. In this review study, through the 10-year trend change in the prevalence of amputee, it was possible to infer the impact of personal, social, and environmental changes. Based on these amputee statistics, it is expected that they can be used to plan health and medical policies for the disabled.

Do Adults Who Practice Aerobic Physical Activities Have Different Influencing Factors for Depression: A Secondary Data Analysis.

Practice in aerobic activities can positively impact depression. This study aimed to identify differences between adults who do and do not practice aerobic activities in terms of general, physical, and psychological factors that influence depression. This study comprised a secondary analysis of data from the 6th (year 2) and 7th (years 1, 3) editions of the Korea National Health and Nutrition Examination Survey. Data from 12,891 adults were analyzed, of whom 7148 reported no practice in aerobic physical activities and 5743 reported practicing such activities. Data were analyzed using SPSS 25. Among those who did not perform aerobic activities, gender, family income, marital status, obesity, frequency of drinking, subjective health, subjective body weight, and stress were found to influence the level of depression. For those who practiced aerobic activities, gender, age, family income, education level, marital status, blood pressure, hypercholesterolemia status, frequency of drinking, subjective health, subjective body weight, and stress influenced the level of depression. This study found that the factors affecting depressive symptoms differ depending on whether individuals practice aerobic activities. Thus, to reduce depressive symptoms among adults, it is necessary to consider their level of physical activity and target the influencing factors associated with this level.

Adaptive behavior in stroke survivors: A concept analysis.

PURPOSE: This study aims to explore a clear and evidence-based definition of adaptive behavior in stroke survivors and establish the antecedents, attributes, consequences, and empirical referents of the concept. METHODS: The concept analysis was performed using the Walker and Avant methods as a framework. Data from 90 publications were collected using various databases (PubMed, EMBASE, CINAHL, RISS, and KISS) and applied in the analysis. RESULTS: Adaptive behavior in stroke survivors was defined according to four attributes: realizing change, taking an optimistic view, restructuring daily activities to suit oneself, and carrying out one's own daily life. The conceptual structure of their adaptive behavior comprised stroke onset, functional changes, and emotional liability as antecedents and autonomy, family equilibrium, and quality of life as consequences. CONCLUSIONS: Clarifying the concept of adaptive behavior in stroke survivors provides an understanding of the underlying attributes of this concept. Furthermore, it will facilitate the development of scales to measure the concept and the application of a theory-based intervention program that can improve adaptive behavior.

Interventions that increase use of Pap tests among ethnic minority women: a meta-analysis.

OBJECTIVE: Although a variety of intervention methods have been used to promote Pap test screening among ethnic minority women in the US, the effectiveness of such interventions is unclear. We performed a meta-analysis to examine the overall effectiveness of these interventions in increasing Pap test use by ethnic minority women in the US. METHODS: A search of databases (MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Science Citation Index-Expanded) and review articles for articles published between 1984 and April 2009 identified 18 randomized and non-randomized controlled trials. The primary study outcome was the difference in the proportion of Pap tests between the treatment and comparison groups. RESULTS: The pooled mean weighted effect size (d) for the 18 studies was 0.158 (95% confidence interval [CI]=0.100, 0.215), indicating that the interventions were effective in improving Pap test use among ethnic minority women. Among the intervention types, access enhancement yielded the largest effect size (0.253 [95% CI=0.110, 0.397]), followed by community education (0.167 [95% CI=0.057, 0.278]) and individual counseling or letters (0.132 [95% CI=0.069, 0.195]). Combined intervention effects were significant for studies targeting Asian (0.177 [95% CI=0.098, 0.256]) and African American women (0.146 [95% CI=0.028, 0.265]), but not Hispanic women (0.116 [95% CI=-0.008, 0.240]). CONCLUSIONS: Pap test use among ethnic minority women is most likely to increase when access-enhancing strategies are combined. Further research is needed to determine whether more tightly controlled trials of such interventions might reveal an improved rate of cervical cancer screening in Hispanic women as well.