Evaluating a church-based navigation model to increase breast cancer screening uptake: Results from a cluster randomized trial

Background: Breast cancer remains a leading cause of cancer mortality in the United States, yet screening rates are suboptimal among certain populations, particularly Korean Americans. Access-related barriers, language, and trust contribute to delayed diagnosis and persistent disparities in cancer outcomes. Faith-based organizations represent trusted, accessible settings for delivering health interventions. Through Community Outreach and Engagement (COE) partnerships, and guided by a community advisory sub-committee, we developed and adapted a culturally tailored intervention, Faith in Action!, which uses a train-the-trainer approach to prepare lay navigators and trusted church members to deliver the intervention and provide cancer education and screening navigation in faith-based settings. The objective of this study was to evaluate the efficacy of “ Faith in Action!” on cancer screening adherence. Methods: A cluster randomized trial with staggered roll-out (NCT05298605) was conducted in 24 faith-based organizations randomized to either a faith-based breast cancer screening intervention or a wait-list control group. The intervention incorporated health education, community health advisor engagement, and facilitated access to cancer screening. Eligible participants were aged 45-75 years, attending participating Los Angeles County Korean churches, without a breast cancer diagnosis and not up to date with breast cancer screening at baseline. The primary outcome was guideline-concordant breast cancer screening within 6 months post-intervention. Secondary outcomes included intention to screen at 6 months and one yer, 1-year breast cancer screening adherence, and knowledge, assessed through standardized questionnaires. Results: A total of 235 women (median age 58 years) were enrolled across 3 cohorts of 8 churches (total 24 churches). Forty-five lay navigators were trained through the intervention. At 6-month follow-up, screening completion was higher in the intervention group compared with wait-list control (60.8% vs. 22.4%, p<0.0001). After adjustment for baseline characteristics and clustering, intervention group participants had statistically significant higher odds of receiving breast cancer screening compared to wait-list control (OR: 9.27, 95% CI 3.3-26.3). Significant improvements were also observed in intention to screen among intervention participants at 6 months (OR: 9.8, 95% CI 3.4-28.7). Retention was high, with 97% follow-up achieved at the primary 6-month time point among intervention participants. Conclusions: These findings suggest that Faith in Action! can increase breast cancer screening uptake among women who are not up to date on screening. Faith-based settings may offer a scalable, culturally acceptable cancer screening promotion strategy to reduce screening disparities among Korean women. Future research will evaluate the program's long-term scalability, sustainability, and screening uptake in diverse faith settings and denominations and across other cancer types.