AMIGAS Administrator’s Guide

If Hispanic women and Latinas are not taking advantage of cervical cancer screening resources in your community, AMIGAS is a proven program that can help you.

AMIGAS is a bilingual educational outreach program. It is proven to be effective in promoting cervical cancer screening among Hispanic women and Latinas ages 21 to 65. AMIGAS stands for “Ayudando a las Mujeres con Información, Guía y Amor para su Salud.” In English, this means “Helping Women with Information, Guidance, and Love for their Health.” AMIGAS is designed to help community health workers or other lay health educators to increase cervical cancer screening among women who have rarely or never been screened.

Why a Cervical Cancer Screening Education Program for Latinas Is Needed

• Latinas have the highest incidence of cervical cancer. In 2019, Latinas had the highest cervical cancer incidence rate compared to women from other racial and ethnic groups in the United States.¹
• Latinas are less likely to be screened than non-Hispanic women. In 2019, cervical cancer screening among Latinas was more than 20% below national targets.²
• Latinas have specific needs for health information. Latinas often face language, cultural, and educational barriers to accessing information and services.³ Especially if they are new to their communities, Latinas may not be aware of services that are offered.
• Latinas respond to culturally relevant messages. Taking care of the health of family members and the community is very important in the cultural belief systems of many Latinas.⁴ Latinas may be more likely to respond to a message that talks about the health and well-being of their family or community.

Why AMIGAS Is Successful

AMIGAS is a proven health education model that—

• Provides a best practice you can use to increase cervical cancer screening.
• Is delivered by women in the community who have been identified as natural helpers—health educators, consejeras, promotoras, or community health workers.
• Stresses how the information and skills in the program will help women, their families, and their communities stay healthy.
• Provides bilingual information that is culturally appropriate.
• Uses naturally occurring social networks to recruit women into the program.

Community Health Workers

One key to the success of AMIGAS is that it uses community health workers. A community health worker is a person who helps to educate community members about a particular health problem—in this case, cervical cancer. Community health workers are women who live in the community they represent. They serve as the cultural bridge between community-based organizations, health care agencies, and their respective communities. Community health workers usually share the same language and culture with the women they serve, and they understand the women’s concerns and beliefs. Community health workers may be paid workers or unpaid volunteers.

Development and Testing

AMIGAS was developed by and tested with the women it is designed to help. Latinas in El Paso and Houston, Texas; San Diego and Fresno, California; and Yakima, Washington shared their beliefs and experiences. Skilled community health workers and program administrators working in a variety of settings provided expert advice and review. A rigorous community trial showed that AMIGAS works in a one-on-one setting. AMIGAS increased screening by as much as 33% in the communities where it was tested. Community health worker workshops provided valuable feedback on the program’s use in group settings.

Flexibility

Each organization and community health worker program is unique and has its own way of operating within the community. For this reason, AMIGAS is designed to be flexible.

• Individual or group sessions. Individual sessions are better for discussing each woman’s experiences and concerns. Women often like having someone come to their home, but many women also like the company of their friends or family. If you prefer group sessions, the tool box contains interactive games designed for groups.
• Length of sessions. We recommend that you plan one hour for individual sessions and 1½ to 2 hours for group sessions. This will allow time to understand why a woman has not been screened recently (or ever), discuss her concerns, and make an action plan. If you have less time available, the lesson plans tell you how to make the best use of the time you have.
• Tools. The community trial results showed us that AMIGAS can be successful even if you choose not to use all of the tools provided. As long as you have a well-trained community health worker with the correct tools, it is not essential that every tool be used.

How AMIGAS Can Benefit Your Organization

AMIGAS can help you achieve your screening goals while building goodwill in the community. By adopting AMIGAS, you can—

• Increase the number of Latinas who get screened for cervical cancer.
• Build the capacity of your existing community health worker program.
• Remove cultural and language barriers.

By adopting AMIGAS, you may also—

• Increase reimbursement for covered services.
• Gain more funding to support your community health worker program.
• Promote the visibility of your programs, community health workers, or clinic in the community.
• Increase communication between the community and the providers.
• Strengthen existing community partnerships or build new ones.

Research on AMIGAS

Researchers have published several articles about their work on AMIGAS.

• Lairson DR, Chang YC, Byrd TL, Lee Smith J, Fernandez ME, Wilson KM. AMIGAS: a cost-effectiveness analysis. American Journal of Preventive Medicine 2014;46(6):617–623.
• Smith JL, Wilson KM, Orians CE, Byrd TL. AMIGAS: Building a cervical cancer screening intervention for public health practice. Journal of Women’s Health 2013;22(9):718–723.
• Byrd TL, Wilson KM, Smith JL, Coronado GD, Vernon SW, Fernandez-Esquer ME, Thompson B, Ortiz M, Lairson D, Fernandez ME. AMIGAS: A multi-city, multi-component cervical cancer prevention trial among Mexican-American women. Cancer 2013;119(7):1365–1372.
• Byrd TL, Wilson KM, Smith JL, Heckert A, Orians CE, Vernon SW, Fernandez-Esquer ME, Fernandez ME. Using intervention mapping as a participatory strategy: development of a cervical cancer screening intervention for Hispanic women. Health Education and Behavior 2012;39(5):603–611.
• Byrd TL, Chavez R, Wilson KM. Barriers and facilitators of cervical cancer screening among Hispanic women. Ethnicity and Disease 2007;17(1):129–134.
• Wilson KM, Orians CE. Considerations in recruiting underscreened women to focus groups on screening for cervical cancer. Health Promotion Practice 2005;6(4):379–384.
• Byrd TL, Peterson SK, Chavez R, Heckert A. Cervical cancer screening beliefs among young Hispanic women. Preventive Medicine 2004;38(2):92–197.

References

¹U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2021 submission data (1999–2019): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; www.cdc.gov/cancer/dataviz, released in November 2022.

²Sabatino SA, Thompson TD, White MC, Shapiro JA, Clarke TC, Croswell JM, Richardson LC. Cancer screening test use—U.S., 2019. American Journal of Preventive Medicine 2022;63(3):431–439.

³Byrd TL, Chavez R, Wilson KM. Barriers and facilitators of cervical cancer screening among Hispanic women. Ethnicity and Disease 2007;17(1):129–134.

⁴Valle CG, Padilla P, Gellin M, Manning M, Reuland DS, Rios P, Lane G, Lewis V, Rosenstein DL. Ahora que?: Cultural adaptation of a cancer survivorship intervention for Latino/a cancer survivors. Psychooncology 2019;28(9):1854–1861.