Cultural Sensitivity in CRC Screening with AA's

描述（由申请人提供）：结直肠癌（CRC）是美国非裔美国人（AAs）中第二常见的癌症，AAs的CRC死亡率高于高加索人。临床研究表明，通过适当的筛查，然后通过相对简单的手术切除息肉，可以预防大量的CRC死亡。不幸的是，大多数人没有得到筛查。这个问题对AA来说更严重，他们对国家筛查建议的遵守率明显低于白色。不幸的是，通过提供教育材料来增加筛查参与的努力基本上没有效果。越来越多的证据表明，传统的干预措施对不同程度的动机或干预对象的文化价值观差异不敏感。传统的干预措施以单一的习惯用法和格式提供标准信息，这不能确保所提供的信息与个人需要或可以使用的信息相匹配。归根结底，问题是不能一刀切;一种干预措施不可能对所有人都有效。干预措施的设计必须使其能够个性化，以满足一个人改变的动机/准备程度及其文化价值观和信仰。研究表明，这些问题在制定干预措施以改变少数民族人群的预防性健康行为方面尤为重要。这个问题将在拟议的阶段匹配的随机临床试验中进行检查，文化敏感的干预措施，以增加51岁或以上AA的CRC筛查参与率。 拟议的研究建立在：研究人员先前对少数群体癌症筛查的研究，他们对癌症预防阶段匹配干预的研究，以及他们对少数群体获得适当护理标准的障碍的研究。它将与东哈莱姆癌症意识伙伴关系合作进行，这是一个NCI资助的项目，旨在：增加对癌症的了解，在医疗服务不足的少数群体中预防和治疗，并增加他们对癌症预防和控制研究的参与。 具体目标： 1.调查文化敏感性和阶段匹配（CS/S-M）心理教育干预相结合，以增加51岁及以上AA的CRC筛查对以下方面的影响：a）他们接受内镜CRC筛查（阶段）的准备程度; B）他们参与内镜CRC筛查;以及c）他们对CRC和CRC的知识、态度和感受。CS/S-M干预措施的影响将与文化敏感、阶段匹配和标准CRC干预措施的影响进行比较。 2.探讨社会人口统计学、卫生保健和文化因素对文化敏感和阶段匹配干预的影响。 3.制定干预措施如何发挥作用的中介模型（例如，通过它们对知识或态度的影响）。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the second most common cancer among African Americans (AAs) in the United States and CRC mortality is greater for AAs than for Caucasians. Clinical research indicates that a substantial number of CRC deaths could be prevented through appropriate screening, followed by relatively simple surgical procedures to remove polyps. Unfortunately the majority of the population does not get screened. This problem is even worse for AAs, whose adherence to national screening recommendations is significantly lower than for white. Unfortunately, efforts to increase screening participation through the provision of educational materials have been largely ineffective. Growing evidence suggests that traditional interventions are not sensitive to the diverse levels of motivation, or differences in cultural values of those targeted for intervention. Traditional interventions present standard information in a single idiom and format, which do not insure a match between what is presented, and what the individual needs or can use. It comes down to the problem that one size does not fit all; one intervention is unlikely to be effective with all individuals. Interventions must be designed so that they can be individualized to meet the level of a person's motivation/readiness to change, and his/her cultural values and beliefs. Research suggests that these issues are especially important in the development of interventions to change preventive health behaviors in minority populations. This problem will be examined in the proposed randomized clinical trial of stage matched, culturally sensitive intervention to increase participation in CRC screening of AAs age 51 years or older. The proposed research builds on: the investigators' prior research on cancer screening in minority groups, their studies of staged-matched intervention in cancer prevention, and their research on barriers to adequate standards of care in minority groups. It will be conducted in collaboration with the East Harlem Partnership for Cancer Awareness, an NCI funded program seeking to: increase knowledge about cancer, its prevention and treatment among medically underserved minority groups and increase their participation in cancer prevention and control research. Specific Aims: 1. Investigate the impact of the combination of culturally sensitive and stage-matched (CS/S-M) psychoeducational intervention to increase CRC screening in AAs 51 years of age and older on: a) their readiness to undergo endoscopic CRC screening (stage); b) their participation in endoscopic CRC screening; and c) their knowledge, attitudes and feeling about CRC and CRC. The impact of the CS/S-M intervention will be compared to that of culturally sensitive, stage-matched and standard CRC interventions. 2. Explore the influence of socio-demographic, health care, and cultural factors on the impact of the culturally sensitive and stage-matched intervention. 3. Develop a mediational model of how the interventions work (e.g., through their impact on knowledge or attitudes).