Do community health worker interventions improve rates of screening mammography in the United States? A systematic review.
Do community health worker interventions improve rates of screening mammography in the United States? A systematic review.
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社区卫生工作者的干预措施是否可以提高美国筛查乳房X线摄影的率？系统评价。
DOI：
10.1158/1055-9965.epi-11-0276
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发表时间：
2011-08
期刊：
影响因子：
--
通讯作者：
Kumar A
中科院分区：
文献类型：
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作者：
Wells KJ;Luque JS;Miladinovic B;Vargas N;Asvat Y;Roetzheim RG;Kumar A
社区卫生工作者（CHW）是受过培训的非专业人员，他们是社区成员与医疗保健提供者和服务之间的联络人。进行了一项系统综述，以综合来自所有前瞻性对照研究的证据，这些研究涉及CHW计划在提高筛查乳腺X线摄影率方面的有效性。纳入以英语报告并在美国进行的研究，如果它们：（1）评价CHW干预措施，旨在增加40岁或40岁以上无乳腺癌病史的女性的筛查乳腺X射线摄影率;（2）是随机对照试验（RCT）、病例对照研究或准实验研究;（3）评价医院外的CHW干预措施。参与CHW干预与接受筛查性乳腺X线摄影的统计学显著性增加相关[风险比（RR）：1.06（支持干预）; 95%置信区间（CI：1.02，1.11），p=0.003]。荟萃分析中仅纳入随机对照试验的汇总数据时，该效应仍然存在（RR：1.07，95%CI：1.03，1.12，p =0.0005），但仅纳入准实验研究的汇总数据时，该效应不存在（RR：1.03，95%CI：0.89，1.18，p =0.71）。在随机对照试验中，从医疗机构招募的参与者（RR：1.41，95%CI：1.09，1.82，p =0.008），在城市环境中进行的项目（RR：1.23，95%CI：1.09，1.39，p =0.001），以及CHW与干预参与者在种族或民族上匹配的项目（RR：1.58，95%CI：1.29，1.93，p =0.0001）对提高乳腺X线摄影筛查率表现出更强的效果。CHW干预措施对于在某些环境和人群中增加筛查性乳房X光检查是有效的。CHW干预措施尤其与医疗环境、城市环境以及与CHW种族或民族一致的参与者中乳腺X射线摄影筛查率的提高相关。
Community health workers (CHWs) are lay individuals who are trained to serve as liaisons between members of their communities and healthcare providers and services. A systematic review was conducted to synthesize evidence from all prospective controlled studies on effectiveness of CHW programs in improving screening mammography rates. Studies reported in English and conducted in the United States were included if they: (1) evaluated a CHW intervention designed to increase screening mammography rates in women 40 years of age or older without a history of breast cancer; (2) were a randomized controlled trial (RCT), case-controlled study, or quasi-experimental study; and (3) evaluated a CHW intervention outside of a hospital setting. Participation in a CHW intervention was associated with a statistically significant increase in receipt of screening mammography [Risk Ratio (RR):1.06 (favoring intervention); 95% Confidence Interval (CI:1.02, 1.11),p=0.003]. The effect remained when pooled data from only RCTs were included in meta-analysis (RR:1.07,95% CI:1.03,1.12,p=0.0005), but was not present using pooled data from only quasi-experimental studies (RR:1.03,95% CI:0.89,1.18,p=0.71). In RCTs, participants recruited from medical settings (RR:1.41,95% CI:1.09,1.82,p=0.008), programs conducted in urban settings (RR:1.23,95% CI:1.09,1.39,p=0.001), and programs where CHWs were matched to intervention participants on race or ethnicity (RR:1.58, 95%CI:1.29,1.93,p=0.0001) demonstrated stronger effects on increasing mammography screening rates. CHW interventions are effective for increasing screening mammography in certain settings and populations. CHW interventions are especially associated with improvements in rate of screening mammography in medical settings, urban settings, and in participants who are racially or ethnically concordant with the CHW.