Focus group findings indicated that the women of all our targeted ethnic groups responded well to trusted others who are like themselves and that there were many barriers that could be addressed in one-to-one or small group interactions. Because the focal point of the outreach intervention was the social and cultural connection between the outreach workers and women in the community, seven Community Educators (their self-selected name) were recruited to represent the major targeted race/ethnic groups, African American, Chinese, Hispanic, and white. These women had varying levels of experience and education but were all hired as staff, paid a salary, and intensively trained in very basic breast and cervical cancer biology, screening, and treatment, as well as in the health systems and screening services available in the intervention neighborhoods. Emphasis was placed on repeated contacts with women to create a bond and thus the motivation to have their first screening test and/or to establish the practice of routine, repeat screening. We adapted and simplified the adoption stages for screening from the Transtheoretical Model [64–67] to four stages: precontemplation (never heard of a specific test), contemplation (heard of the test but never had it), action (had the test at least once but not according to guidelines), and maintenance (three tests in the past 5 years). These classifications were taught to the CEs for use in delivering stage-based outreach and education and to measure incremental changes that were evidence of the impact of the intervention [68]. CEs in both counties encouraged, directed, and in many cases accompanied women to Women’s Health Days or to clinics and practitioners to receive mammograms, clinical breast examinations, and Pap smears. Messages and materials were delivered in English, Chinese (low-income women of
Chinese descent in the Bay Area are overwhelmingly Cantonese speakers), and Spanish. A more detailed account of the outreach intervention is under preparation [68].