Cultural Sensitivity in CRC Screening with AA's

描述(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死亡率高于白人。临床研究表明，通过适当的筛查，然后进行相对简单的手术切除息肉，可以防止相当数量的CRC死亡。不幸的是，大多数人没有接受筛查。对于AAS来说，这个问题甚至更严重，他们对国家筛查建议的遵守程度明显低于白人。不幸的是，通过提供教育材料增加筛查参与度的努力在很大程度上是无效的。越来越多的证据表明，传统干预对干预目标的不同动机或文化价值观的差异并不敏感。传统的干预措施以单一的习惯用法和格式呈现标准信息，这不能确保所呈现的内容与个人需要或可以使用的内容相匹配。归根结底，问题在于一刀切并不适合所有人；一种干预措施不太可能对所有人有效。干预措施的设计必须使其能够个性化，以满足一个人的变革动机/准备程度以及他/她的文化价值观和信仰。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。这一问题将在拟议的随机临床试验中进行研究，该试验采用分期匹配、文化敏感的干预措施，以增加51岁或51岁以上AAS的CRC筛查参与率。 拟议的研究建立在以下基础上：研究人员对少数群体癌症筛查的先前研究，他们对癌症预防的分期配对干预的研究，以及他们对少数群体适当护理标准障碍的研究。它将与东哈莱姆癌症意识伙伴关系合作进行，这是NCI资助的一个项目，旨在：在医疗服务不足的少数群体中增加对癌症及其预防和治疗的知识，并增加他们对癌症预防和控制研究的参与。 具体目标： 1.调查文化敏感和分期匹配(CS/S-M)相结合的心理教育干预对51岁及以上AA增加结直肠癌筛查的影响：a)他们接受内窥镜结直肠癌筛查(STAGE)的意愿；b)他们参与内窥镜结直肠癌筛查；c)他们对结直肠癌和结直肠癌的知识、态度和感觉。CS/S-M干预措施的影响将与文化敏感性、分期匹配和标准的CRC干预措施进行比较。 2.探讨社会人口、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调解模式(例如，通过其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).