Evaluation of the Intervention at the Community Level
The premise for this evaluation is based on the effects of
the intervention having an impact not only on women who
directly participate but also on the general population. This
has been observed in studies conducted in different contexts
[33], including the Mexican context [34]. To this end,
free-lists [29] were administered before and after the
intervention to women in intervention group and control
group. Free listing is an elicitation technique used in social
sciences to identify items of a cultural domain and to
calculate each item’s relative cultural salience [35]. This
technique is based on a direct relationship between the
order of occurrence of restrictive associative responses and
the frequency of occurrence of responses of a group, when
considering individuals with similar cultural backgrounds
[36]. Free listings are obtained as part of a semi-structured
interview; respondents are asked to write down all the
items they can think about a previous selected topic [29].
When free-lists are administered to individuals in a community,
it is possible to identify items in the cultural
domain and calculate their relative importance or prominence
[35, 37]. This method was used to inquire about the
usefulness of the Papanicolaou test and the barriers and
facilitator factors for accessing this service in this community;
it was useful because it helped to focus topics
during the intervention taking into account the context of
this group of women. The questions were: Why should a
woman get a Papanicolaou test done? (Free-list 1) What
prevents women from having a Papanicolaou? (Free-list 2)
What things facilitate women to get a Papanicolaou? (Freelist
3) How is getting a Papanicolaou useful to women?
(Free-list 4) What do women not like about having a
Papanicolaou done? (Free-list 5) The women were asked to
make a list of all the possible responses that they knew
women in their community could give for each case. In this
way, the responses were not personalized and information
was obtained about the cultural domain of all the women in
the community.
Smith’s salience indices were calculated based on the
responses given by the participants. This salience was
selected because it is the most frequently used to analyze
free lists, and its results are similar to those obtained with
Suthrop’s salience according to empirical studies [37]. For
pre and post comparisons, when a response was not mentioned
in either of the two measurements, its value was
taken to be zero. The comparison between pre and post
intervention results were summarized with histograms of
the difference between these two moments (the only
domains charted were those for which the pre and post
difference between Smith’s index of relevance were over
±0.05). Thus, negative values corresponded to lesser
importance and positive values to greater importance.
Smith’s relevance index (S) is defined as S = [(L Rj ? 1)/
L]/N, where L is the length of each list, Rj is the rank of
item j in the list and N is the number of lists in the sample
[38]. These calculations were conducted with Visual Anthropac
1.0.