Cervical cancer is a major public health problem in the developing world, including Latin
America and the Caribbean. Most countries in this region lack organized programs of screening
for cervical cancer, despite the proven survival benefits associated with the Pap test. The
purposes of this mixed-methods study are to explore the barriers that prevent women in Tobago
from obtaining Pap smears and implement and evaluate an intervention designed to affect
knowledge, attitude, and Pap smear receipt. Two focus groups (N= 6 and 7) were conducted
using a semi-structured interview guide. The proceedings were audio-taped, transcribed
verbatim, and coded to generate themes using the constant comparative approach. The main
barriers identified by all participants were availability and accessibility of quality services,
facilities that lack comfort and privacy, courtesy of providers, knowledge, gender of providers,
cancer fatalism, and embarrassment. Phase Two of the four-month pilot study recruited and
trained eight hairstylists from seven beauty salons, to deliver cervical cancer messages to women
in Tobago. Stylists attended a 5-hr training session to develop skills for delivering messages
designed to increase knowledge and Pap test receipt. The intervention consisted of hairstylists
delivering the health chat to their clients, in addition to the placement of pamphlets in the salons. Participants (N= 133) completed a questionnaire at the start of the intervention and a telephone
follow-up four months later. At baseline, 27% of eligible women had never had a Pap test, while
only 37% had obtained one in the last year. Pap test receipt increased at the end of the
intervention. Twenty-six percent of the women in the intervention reported that their hairstylists
had spoken to them about cervical cancer and Pap smear receipt. Knowledge of the human
papillomavirus as the cause of cervical cancer did not increase post-intervention. This pilot
study suggests that there is a continuing need for intervention programs that will raise awareness
and increase cervical cancer knowledge and behavior in communities. This study further
suggests that hairstylists are willing to use their skills to educate and encourage their customers
to engage in informed decision-making. Physicians should also be targeted to increase
recommendations from providers for cervical cancer screening.