Colorectal Cancer Screening in Primary Care Practice

描述(申请人提供)：背景：对拉丁裔人群关于结直肠癌(CRC)筛查的知识、态度和信念，或在这一人群中促进筛查的方法，知之甚少。目的：比较由社区卫生顾问提供的关于参与结直肠癌筛查的强化行为干预与患者信息分发、“最小干预”或常规护理的有效性。第二个主要目标是开发一种文化敏感的干预措施，将增加知识，改变文化反弹信念，并赋予患者决策能力，以参与3种公认的结直肠癌筛查策略中的任何一种。这项研究的次要目标是：1)在低收入的拉丁裔人口中确定结直肠癌筛查的障碍；2)在社区卫生中心内制度化一个具有文化敏感性和有效的癌症筛查教育计划。 方法：在这项前瞻性随机对照研究中，训练有素的双语研究人员将邀请600名在大型社区卫生中心接受常规护理的合格患者参与研究。来自一个机构的患者将被随机分成三个干预组之一：(1)社区健康顾问；(2)患者信息手册；或(3)健康饮食手册。这些参与者将完成一项关于结直肠癌和筛查问题的基线调查，以及与健康信念模型/理性行动理论概念模型相关的结构。这项调查将进一步借鉴文献中报道的经过验证的工具。受试者在参加完他们的学习小组后，将再次完成调查。对照受试者将从卫星设施中招募，并被要求完成关于一般健康和癌症筛查问题的基线调查，并将收到一份关于健康饮食的信息手册。在随机化后4个月的随访中，对于所有四组，参与任何结直肠癌筛查的结果变量将通过图表回顾来评估。数据分析：数据将包括定量和定性终点的组合。所有数据将输入计算机，并在适当时生成描述性统计数据。将计算符合CRC筛查和干预组成员的2x3列联表。卡方检验将被用来评估三个研究分支的遵从性指数是否存在总体差异。将使用Bonferroni显着性水平调整(0.05/4=0.0125)对所有组进行事后配对比较。将进行多变量分析，以调查HBM/TRA模型中的变量作为遵从性的预测因素。

DESCRIPTION (provided by applicant): Background: Little is known about the Latino population's knowledge, attitudes and beliefs on colorectal cancer (CRC) screening, or on methods to promote screening in this population. Objective: To compare the effectiveness of an intensive Community Health Advisor - delivered behavioral intervention on participation in CRC screening with a patient information handout, a "minimal intervention", or usual care. A second primary aim is to develop a culturally sensitive intervention that will increase knowledge, modify culturebound beliefs, and empower patients with the decision-making ability to participate in any 1 of 3 accepted screening strategies for CRC. Secondary aims of the study are to: 1) Identify barriers to CRC screening in a low-income Latino population; and 2) institutionalize within a community health center a culturally sensitive and effective cancer screening education program. Methods: In this prospective randomized controlled study, trained bilingual research personnel will invite 600 eligible patients who present for routine care at a large Community Health Center to participate in the study. Patients from one facility will be randomized into one of three intervention groups: (1) Community Health Advisor; (2) Patient information pamphlet; or (3) Healthy diet brochure. These participants will complete a baseline survey on colorectal cancer and screening issues and on constructs related to a combined Health Belief Model / Theory of Reasoned Action conceptual model. The survey will further draw from validated instruments reported in the literature. Subjects will again complete the survey after participation in their study group. Control subjects will be recruited from a satellite facility and asked to complete a baseline survey on general health and cancer screening issues, and will receive an information brochure on healthy diet. At 4-month follow-up from the time of randomization and for all four groups, the outcome variable of participation in any CRC screening will be assessed by chart review. Data analysis: Data will include a combination of quantitative and qualitative endpoints. All data will be entered into a computer and descriptive statistics will be generated when appropriate. A 2x3 contingency table for compliance with CRC screening and the intervention group membership will be computed. The chi-square test will be applied to assess whether there is an overall difference of the compliance index in the three study arms. Post hoc pairwise comparison will be used to compare all groups using a Bonferroni adjustment of significance level (0.05/4=0.0125). Multivariate analysis will be conducted to investigate variables from our HBM/TRA model as predictors of compliance.