Effectiveness of health education to increase screening for cervical cancer among Eastern-Band Cherokee Indian women in North Carolina
Effectiveness of health education to increase screening for cervical cancer among Eastern-Band Cherokee Indian women in North Carolina
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DOI：
10.1093/jnci/88.22.1670
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发表时间：
1996-11-20
期刊：
影响因子：
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通讯作者：
McQuellon, RP
中科院分区：
文献类型：
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作者：
Dignan, M;Michielutte, R;McQuellon, RP
背景资料：北卡罗来纳州美国原住民宫颈癌预防项目是一项为期5年、由国家癌症研究所资助的健康教育试验，旨在增加北卡罗来纳州美国原住民妇女的宫颈癌筛查。目的：本研究旨在评估这一教育计划在东部切罗基目标人群中的有效性。研究方法：绘制了切罗基部落土地的地图，列出了所有家庭（N = 2 223），以确保最大限度地覆盖合格人口（18岁及以上的妇女，她们是登记的部落成员）。合格的妇女是通过使用一个简短的问卷调查管理的成年家庭成员。在1 279户有合格妇女的家庭中，1 020户（79.8%）同意参加。干预是由女性切罗基滞后健康教育者提供的个性化健康教育计划。参与者被随机分配接受或不接受干预（即，分别为程序组和对照组）。在参与者家中进行的面对面访谈中收集了数据。在最终入选的996名妇女中，540名被随机分配接受预测试（干预前）访谈，其中包括96项问卷调查，旨在收集与宫颈癌相关的知识，意图和行为数据;在这540名妇女中，263名被随机分配接受教育计划。其余456名妇女没有接受预测试，但218名被随机分配接受教育计划。在接受教育计划六个月后，所有四组中的女性都接受了与前测相同的后测。Logistic回归分析被用来评估预测试和教育计划的影响。所有P值均来自双侧统计检验。结果：81.8%（8115）的996名参与者完成了测试后的采访。其余181名失访的女性均匀分布在四个研究组中。在后测试中，385名接受教育计划的妇女中有282名（73.2%）报告在干预后进行了巴氏涂片检查，而430名对照组中有275名（64%）。与对照组相比，接受教育计划的妇女更有可能在后测中正确回答所有知识项目（比值比[OR] = 2.18，95%置信区间[CI] = 1.08-4.39），并报告在过去一年中获得了巴氏涂片（OR = 2.06，95% CI = 1.14-3.72）。结论：接受教育方案的妇女对宫颈癌预防有更多的了解，并且比没有接受该方案的妇女更有可能报告在过去一年中进行了巴氏涂片检查。
Background: The North Carolina Native American Cervical Cancer Prevention Project was a 5-year, National Cancer Institute-funded trial of health education designed to increase screening for cervical cancer among Native-American women in North Carolina. Purpose: This study was conducted to evaluate the effectiveness of this education program in the Eastern-Band Cherokee target population. Methods: Cherokee tribal lands were mapped and all households (N = 2223) were listed to ensure maximum coverage of the eligible population (women, aged 18 years and older, who were enrolled tribal members). Eligible women were identified by the use of a brief questionnaire administered to an adult member of the household. Of the 1279 households with eligible women, 1020 (79.8%) agreed to participate. The intervention was an individualized health education program delivered by female Cherokee lag health educators. The participants were randomly assigned to receive or not to receive the intervention (i.e., to program and control groups, respectively) by use of the Solomon Four-Group design. Data were collected in face-to-face interviews conducted in the participant's home. Of the 996 women who were ultimately enrolled, 540 were randomly assigned to receive a pretest (preintervention) interview that involved administration of a 96-item questionnaire designed to collect data on knowledge, intentions, and behaviors related to cervical cancer; of these 540 women, 263 were randomly assigned to receive the education program. The remaining 456 women did not receive the pretest, but 218 were randomly assigned to receive the education program. Six months after receiving the education program, the women in all four groups were administered a post-test that was identical to the pretest. Logistic regression was used to assess the effects of the pretest and the educational program. All P values resulted from two-sided statistical tests. Results: Eight hundred and fifteen (81.8%) of the 996 participants completed the post-test interview. The remaining 181 women who were lost to follow-up were evenly distributed among the four study groups. At the post-test, 282 (73.2%) of the 385 women who received the education program reported having had a Pap smear following the intervention, compared with 275 (64%) of the 430 control subjects. Women who received the education program were more likely to answer all knowledge items correctly on the post-test (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.08-4.39) and to report having obtained a Pap smear in the past year (OR = 2.06, 95% CI = 1.14-3.72) than women in the control groups. Conclusion: Women who received the education program exhibited a greater knowledge about cervical cancer prevention and were more likely to have reported having had a Pap smear within the past year than women who did not receive the program.