Better Breast Health for Korean American Women

描述（由申请人提供）：韩裔美国人（KA）女性的乳腺癌筛查率远低于国家目标，也低于其他族裔的报告率。因此，KA妇女往往在癌症晚期才被诊断出来，这可能导致预后不良，死亡率高，以及随后的情感和经济负担。作为主要的第一代移民群体，KA妇女在获得主流卫生保健系统提供的筛查服务和关键健康信息方面面临多重障碍。为了解决教育和促进定期筛查的迫切需要，我们提出了一个试点干预计划，利用社区外展和教育战略。具体而言，基于调查小组之前对社区预防健康行为的评估以及社区卫生工作者（CHW）培训和干预的经验，我们提出了一项可行性研究，以测试基于社区的外展计划，以促进KA妇女遵循循证筛查指南进行乳腺癌筛查。利用基于社区的参与性研究（CBPR）作为业务框架，研究人员与具有共同愿景的目标社区之间的伙伴关系将成为实施这一干预措施和促进KA妇女健康的工具。本研究的具体目的是：1)规范chw对KA妇女进行乳腺癌教育和筛查随访的培训方案；2)检验CHW培训方案的有效性；3)对100名40岁及以上KA妇女进行干预方案的疗效检验。CHW干预的主要结果是自我报告接受乳房x光检查和获得乳房x光检查的意愿。次要结果包括对chw主导的教育课程和随访的满意度，其他筛查行为（即临床乳房检查和乳房自我检查）的变化，以及对乳腺癌的知识和信念。在进行更大规模的社区试验之前，CBPR建议是一项试点调查，以测试文化和语言敏感的CHW干预措施对提高KA妇女乳腺癌筛查率的有效性。通过开展这些研究活动，我们期望：(1)建立一个机制，向这些语言上孤立的人群传播健康信息；(2)加强社区网络，促进社区获得乳腺癌筛查。

DESCRIPTION (provided by applicant): Breast cancer screening rates for Korean American (KA) women are far below the national goal, and below rates reported for other ethnic groups. As a result, KA women are often diagnosed at a later stage of cancer which can lead to a poor prognosis, high mortality, and subsequent emotional and financial burden. As a predominantly first generation immigrant group, KA women face multiple barriers to obtaining screening services and critical health information available in the mainstream health care system. To address the urgent need for educating and facilitating access to regular screening, we propose a pilot intervention program that utilizes community-based outreach and education strategies. Specifically, building upon the investigative team's previous community assessment of preventive health behaviors and experience with community health worker (CHW) training and intervention, we propose a feasibility study to test a community-based outreach program to promote breast cancer screening among KA women following the evidence-based screening guidelines. Using community-based participatory research (CBPR) as an operational framework, the partnership between researchers and the target community with shared vision will serve as a vehicle to implement this intervention and promote health of KA women. The specific aims of this study are to: 1) standardize the training protocol for CHWs to conduct breast cancer education and screening follow-up for KA women; 2) test the efficacy of the CHW training program; and 3) test the efficacy of the intervention program in 100 KA women aged 40 and older. The primary outcomes of the CHW intervention are self-reported receipt of, and intention to obtain mammography. Secondary outcomes include satisfaction with CHW-led education sessions and follow-up, changes in other screening behaviors (i.e., clinical breast exam and breast self-exam), and knowledge and beliefs about breast cancer. This CBPR proposal is a pilot investigation before conducting a larger scale community trial to test the effectiveness of a culturally and linguistically sensitive CHW intervention to improve breast cancer screening rates in KA women. Through initiation of these research activities, we expect 1) to establish a mechanism for disseminating health information for this linguistically isolated population, and (2) to enhance a community network which will facilitate community access to breast cancer screening.