Project Summary Our overarching goal is to increase the rates of cervical cancer (CC) screening among Indigenous women in the U.S. This population experiences disproportionately high rates of cervical cancer morbidity and mortality. They are twice as likely to develop and to die from CC compared to non-Hispanic White women. They are often diagnosed at a later stage, which makes successful treatment and survival more challenging. Early detection through regular CC screening saves lives and significantly reduces human papillomavirus (HPV)- related infections, subsequent health risks, and CC mortality by up to 80%. However, approximately 45% of Indigenous women remain unscreened. To address this issue and improve CC screening rates, we aim to develop and test the efficacy and feasibility of a theory-driven, culturally-tailored, multilevel, multimedia mobile web app intervention (called wPap), specifically targeting Indigenous women in the Yankton Sioux Tribe (YST) Reservation in South Dakota. We will conduct a 2-arm randomized controlled trial using community-based participatory research and multiple methodologies over a 4-year period. We will recruit 120 YST women aged 25 to 65 years and randomly assign them to either the waitlist control group (n=60, receiving printed educational materials on CC and screening guidelines), or the wPap intervention group (n=60, receiving culturally-tailored and personalized multilevel, multimedia messages through a mobile web app). The wPap interventions will be administered for 7 days. We will conduct assessments at baseline, 1-week post- intervention, and 6-month follow-up surveys and focus groups. Aim 1 will identify individual, sociocultural, and structural determinants of CC and CC screening through qualitative assessment. The information gathered will guide developing the wPap intervention. Aim 2 will develop the multilevel, multimedia wPap intervention to promote CC screening for Indigenous women. Aim 3 will evaluate the feasibility and efficacy of the wPap intervention for increasing CC screening rates among Indigenous women. Evaluation criteria will include the intervention’s feasibility (i.e., acceptability and satisfaction) and efficacy (i.e., receipt of CC screening, changes in knowledge and attitudes/beliefs about screening, self-efficacy, and intent to undergo CC screening). By addressing barriers to screening, the wPap intervention has the potential to increase accessibility and sustainability of evidence-based preventive care, ultimately reducing health disparities in Indian Country. The results will have wide applicability, serving as a model for improving cancer-related health outcomes and early intervention for other types of cancer for Indigenous women across geographical regions and tribal communities.

Project Narrative This project aims to improve cervical cancer (CC) screening rates for Indigenous women by using an innovative mobile web app intervention called wPap. Specifically targeting Indigenous women living on the Yankton Sioux Tribe Reservation in South Dakota, the project will develop and evaluate the efficacy and feasibility of the theory-driven, culturally-tailored, multilevel, and multimedia wPap intervention. By offering a low-cost and easily replicable alternative to existing interventions, the project seeks to increase CC screening rates, reduce cancer-related health disparities, and enhance health outcomes for underserved Indigenous women at both local and national levels.