Reducing cervical cancer screening disparities in Somali immigrant women through a primary care based HPV self-sampling intervention

通过基于初级保健的 HPV 自我采样干预措施减少索马里移民妇女的宫颈癌筛查差异

• 批准号: 10427151
• 负责人: Rebekah J. Pratt
• 金额: $ 63.08万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-15 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10427151
• 关键词: Address; Administrator; Advisory Committees; Appointment; Area; Awareness; Cervical; Cervical Cancer Screening; Clinic; Communities; Community Health Aides; Consolidated Framework for Implementation Research; Development; Diagnosis; Female; Focus Groups; Guidelines; HPV-High Risk; Health Care Costs; Health Personnel; Home; Human Papillomavirus; Hybrids; Immigrant; Incidence; Insurance Coverage; Intervention; Interview; Koreans; Latino; Lead; Lesion; Male Circumcision; Malignant neoplasm of cervix uteri; Medical; Methods; Minority Groups; Modality; Nurses; Pap smear; Patients; Physicians; Population; Positioning Attribute; Prevention; Preventive healthcare; Preventive service; Primary Health Care; Process; Provider; Reach Effectiveness Adoption Implementation and Maintenance; Religious Belief; Research; Sampling; Self Efficacy; System; Testing; Time; Woman; Work; acceptability and feasibility; aged; base; design; disparity reduction; effectiveness evaluation; effectiveness implementation design; effectiveness implementation study; health disparity; health literacy; implementation evaluation; implementation science; implementation strategy; informant; intervention refinement; mortality; novel strategies; patient oriented; patient population; post implementation; post intervention; premalignant; prevent; primary care setting; screening; screening disparities; screening participation; social cognitive theory; system-level barriers; treatment as usual; uptake

SUMMARY/ABSTRACT Somali women living in the U.S. have lower cervical cancer screening rates than the U.S. general female population. This disparity is due to a range of factors, including limited awareness of HPV and cervical cancer, cultural and religious beliefs, mistrust of health care providers, concerns around modesty and circumcision, and low provider self-efficacy to perform Pap tests on circumcised women. HPV self-sampling is an emerging cervical cancer screening modality that may address common screening barriers among Somali women, particularly those related to modesty and circumcision. HPV self-sampling is accurate for detecting pre- cancerous cervical lesions and effective in reaching underscreened women. In addition, our pilot work has demonstrated the feasibility and acceptability of HPV self-sampling in Somali women. While research has focused primarily on home-based HPV self-sampling, there is an untapped opportunity to offer HPV self- sampling in the primary care setting. Offering HPV self-sampling in primary care could effectively increase cervical cancer screening rates in Somali women by positioning providers to address screening barriers, enabling clinics to opportunistically fit in HPV self-sampling with other appointments, and providing an alternative modality for circumcised women. We propose a Hybrid Type 2 effectiveness-implementation design to assess the effectiveness and implementation of a patient-centered, culturally-tailored HPV self-sampling intervention for Somali women. Guided by the Consolidated Framework for Implementation Science and Social Cognitive Theory, we will conduct focus groups with Somali patients and interviews with providers to identify patient-, provider-, clinic-, and systems-level factors to inform refinement of intervention materials and development of implementation strategies (Aim 1). After tailoring the intervention, we will then implement HPV self-sampling in 2 primary care clinics, and evaluate changes in Somali women’s cervical cancer screening rates one-year pre and one-year post implementation (Aim 2). Changes will be compared with Somali women attending 27 control clinics followed over the same time period, using difference-in-difference methods. Finally, using RE-AIM, we will conduct a post-implementation mixed methods analysis of the processes and strategies needed to successfully implement HPV self-sampling in primary care for Somali patients (Aim 3), including interviews with providers and Somali women. Our hypothesis is that implementing HPV self-sampling in primary care will lead to increased uptake of cervical cancer screening in Somali women and that an implementation science based analysis of the processes needed to successfully implement the intervention will lead to sustainable, novel strategies to support the sustained integration of HPV self-sampling into primary care.

摘要/摘要 居住在美国的索马里女性的宫颈癌筛查率低于美国普通女性 人口。这种差异是由一系列因素造成的，包括对 HPV 和宫颈癌的认识有限， 文化和宗教信仰、对医疗保健提供者的不信任、对谦虚和包皮环切的担忧， 提供者对割礼妇女进行巴氏检查的自我效能感较低。 HPV自我采样是一种新兴的 宫颈癌筛查方式可能会解决索马里妇女中常见的筛查障碍， 特别是那些与谦虚和割礼有关的内容。 HPV 自采样可准确检测预检 宫颈癌病变，可有效覆盖筛查不足的女性。此外，我们的试点工作还 证明了索马里妇女 HPV 自我采样的可行性和可接受性。虽然研究已 主要侧重于家庭 HPV 自我采样，有一个尚未开发的机会来提供 HPV 自我采样 在初级保健机构进行抽样。在初级保健中提供 HPV 自我采样可以有效提高 通过定位提供者解决筛查障碍，提高索马里妇女的宫颈癌筛查率， 使诊所能够机会性地将 HPV 自我采样与其他预约相结合，并提供 接受割礼的妇女的替代方式。我们提出混合型 2 型有效性实施设计 评估以患者为中心、根据文化定制的 HPV 自我采样的有效性和实施情况 对索马里妇女的干预。以科学和社会综合实施框架为指导 认知理论，我们将与索马里患者进行焦点小组讨论，并与提供者进行访谈，以确定 患者、提供者、诊所和系统层面的因素，以指导完善干预材料和 制定实施战略（目标 1）。制定干预措施后，我们将实施 HPV 在 2 个初级保健诊所进行自我采样，并评估索马里妇女宫颈癌筛查的变化 实施前一年和实施后一年的利率（目标 2）。变化将与索马里妇女进行比较 使用双差法对 27 个对照诊所进行了同期随访。最后， 使用 RE-AIM，我们将对流程和策略进行实施后混合方法分析 需要在索马里患者的初级保健中成功实施 HPV 自我采样（目标 3），包括 对提供者和索马里妇女的采访。我们的假设是，实施 HPV 自我采样 初级保健将导致索马里妇女更多地接受宫颈癌筛查，并且 对成功实施干预措施所需流程进行基于科学的分析 制定可持续的新颖策略，支持将 HPV 自我采样持续纳入初级阶段 关心。