Improving Routine Asymptomatic Cancer Screening among Federally Qualified Health Center Users in Florida: Application of a Health Literacy Framework

改善佛罗里达州联邦合格健康中心用户的常规无症状癌症筛查：健康素养框架的应用

• 批准号: 10377506
• 负责人: Alicia Lynette Best
• 金额: $ 15.46万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10377506
• 关键词: Active Learning; Acute; Address; Adherence; Age; Award; Behavioral Research; Breast Cancer Detection; Cancer Burden; Chronic; Clinic; Collaborations; Colorectal Cancer; Communication; Communication Research; Competence; Complex; Consultations; Decision Analysis; Decision Making; Decision Trees; Development Plans; Diabetes Mellitus; Diagnosis; Disease; Educational workshop; Ethnography; Evaluation; Federally Qualified Health Center; Fees; Florida; Foundations; Future; General Population; Goals; HCV screening; Health; Health Promotion; Health Status; Healthy People 2020; Hepatitis C Vaccination; Home; Human Papilloma Virus Vaccination; Incidence; Individual; Injury; Intervention; Intervention Studies; Interview; Knowledge; Level of Evidence; Location; Low Income Population; Low income; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Medical; Medically Underserved Area; Mentors; Mentorship; Mission; Modeling; Motivation; Not Hispanic or Latino; Patients; Persons; Phase; Physicians; Population; Preventive care; Primary Health Care; Process; Production; Provider; Public Health; Recommendation; Research; Research Personnel; Research Project Grants; Resources; Risk; Role; Screening for cancer; Services; Slide; Socioeconomic Status; Structure; Surveys; System; Testing; Time; Training; Translating; Uninsured; Vulnerable Populations; base; cancer health disparity; cancer prevention; career; career development; colorectal cancer screening; design; disparity reduction; eHealth; ethnic minority; evidence base; experience; health communication; health equity; health literacy; improved; innovation; literacy; low socioeconomic status; malignant breast neoplasm; medically underserved; mortality; mortality disparity; operation; pilot test; professor; racial and ethnic; research to practice; routine screening; screening; service delivery; skills; social; socioeconomics; tenure track; therapy design; tool

ABSTRACT As a recently appointed tenure-track Assistant Professor of Public Health, my long-term career goal is to make a meaningful contribution to the elimination of cancer disparities. In doing this, I wish to establish myself as a nationally-recognized independent investigator with expertise in the use of health communication to address cancer disparities. I have substantial training in behavioral research, primarily focused on understanding the role of various social and cultural factors on cancer disparities. Building on this foundation, I require additional training to fill gaps related to the design, implementation, and evaluation of health communication interventions. My Mentorship Team and I have prepared a comprehensive career development plan that consists of mentorship, coursework, expert consultations, workshops, experiential learning, and an innovative research project. My proposed research plan aligns with my overarching career goal in seeking to improve routine cancer screening within federally qualified health centers (FQHCs), where the burden of cancer is greater compared to the general population, but screening rates are much lower than national averages. Despite the significant contribution of routine screening in the reduction of breast, cervical, and colorectal cancer (CRC) incidence and mortality, disparities persist among racial/ethnic minority and low socioeconomic (SES) populations who continue to underutilize screening. FQHCs can be invaluable partners in reducing these disparities due to their sliding-fee pay structure and location in medically underserved areas. The goal of the proposed K01 research project is to understand how current FQHC users perceive routine asymptomatic cancer screening, and develop and pre- test an eHealth tool that promotes screening among FQHC users. The specific aims are to: (1) Conduct formative research with FQHC users to understand how they perceive and make decisions about routine asymptomatic cancer screening; (2) Design and pre-test an eHealth tool that addresses each domain of the health literacy framework, and incorporates key decision criteria of asymptomatic cancer screening among FQHC users; and (3) Pilot test an eHealth intervention within an FQHC setting aimed at delivering literacy appropriate, “decision- relevant” information about routine asymptomatic cancer screening to FQHC users. This Mentored Research Award would provide the necessary protected time to achieve the following training goals: (1) Develop expertise in the application of decision analysis to health communication, within a health literacy framework; (2) Become familiar with clinic operations, user profiles, and service delivery within FQHCs, along with successful research collaboration with FQHCs; (3) Build competence in health communication intervention design, implementation, and evaluation; and (4) Develop the necessary skills to translate communication research into practice, specifically within an FQHC setting. This research would set the stage for a larger R01-level health communication intervention study. Findings might inform not only cancer screening, but also other health promotion interventions in FQHCs, which are increasingly becoming medical homes for low SES populations.

摘要 作为最近被任命为终身教职的公共卫生助理教授，我的长期职业目标是使 对消除癌症差异做出了有意义的贡献。在这样做的过程中，我希望确立自己作为一个 国家公认的独立调查员，具有利用健康传播的专业知识来解决 癌症差异。我在行为研究方面接受过大量的培训，主要专注于理解 各种社会和文化因素对癌症差异的影响。在此基础上，我需要额外的培训 填补与健康传播干预措施的设计、实施和评估相关的空白。我的 导师团队和我已经准备了一份全面的职业发展计划，其中包括导师， 课程、专家咨询、研讨会、体验式学习和创新研究项目。我的 拟议的研究计划与我寻求改善常规癌症筛查的首要职业目标一致 在联邦合格的健康中心(FQHC)内，癌症的负担比普通患者更重 但筛查率远低于全国平均水平。尽管做出了重大贡献， 在降低乳腺癌、宫颈癌和结直肠癌(CRC)发病率和死亡率方面的常规筛查， 种族/少数民族和低社会经济(SES)人口之间的差距仍然存在，他们继续 未充分利用筛查。由于费用不断下滑，FQHC在缩小这些差距方面可以成为宝贵的合作伙伴 医疗服务不足地区的薪酬结构和地点。拟议的K01研究项目的目标是 了解当前的FQHC用户如何看待常规的无症状癌症筛查，并制定和实施 测试一个在FQHC用户中促进筛查的电子健康工具。具体目标是：(1)进行形成性 与FQHC用户进行研究，了解他们对常规无症状的认知和决策方式 癌症筛查；(2)设计和预先测试电子健康工具，解决健康素养的各个领域 框架，并纳入了在FQHC用户中进行无症状癌症筛查的关键决策标准；以及 (3)在FQHC环境中试点测试旨在提供适当识字的电子健康干预措施，“决定-- 向FQHC用户提供有关常规无症状癌症筛查的相关信息。这项指导性研究 奖励将提供必要的保护时间，以实现以下培训目标：(1)发展专门知识 在健康素养框架内，将决策分析应用于健康传播；(2)成为 熟悉FQHC内的诊所运营、用户概况和服务交付，并有成功的研究 (3)培养健康沟通干预措施的设计、实施、 和评估；以及(4)培养必要的技能，将传播研究转化为实践， 特别是在FQHC设置内。这项研究将为更大的R01级健康奠定基础 沟通干预研究。这些发现不仅可能为癌症筛查提供信息，还可能为其他健康提供信息 FQHC的宣传干预措施，这些医院正越来越多地成为低SES人群的医疗之家。