An Exploration of the Determinants that Impact Breast and Cervical Cancer Control

描述(由申请人提供)： 非专业健康顾问(LHA)干预模式在美国印第安人和阿拉斯加原住民(AI/AN)社区中得到了越来越多的使用，以解决在获得和使用推荐的乳腺癌和宫颈癌早期检测检查(包括乳房X光检查和巴氏检查)方面的差异。虽然最近的研究记录了非信徒健康顾问计划在提高AI/AN社区的乳腺癌和宫颈癌筛查率方面的适度有效性，但还没有研究探索部落非信徒健康顾问本身的态度、信念和规范，特别是在针对高度污名化疾病(如癌症)的干预措施中。此外，研究人员还没有探索外部因素，如分散的医疗保健系统和权力失衡，这可能会影响LHA提供乳腺癌和宫颈癌特定服务的能力。因此，对这些因素的调查对于阐明部落业馀健康顾问计划未来的能力发展和干预战略至关重要，以最大限度地提高他们在其社区支持乳腺癌和宫颈癌早期发现的能力。为了解决科学知识方面的这一关键差距，本研究项目将对部落业馀健康顾问进行深入访谈，以探索和分析影响他们将癌症控制活动纳入其服务范围的能力的关键决定因素。据推测，许多决定因素，而不仅仅是癌症特有的知识和教育，解释了部落LHA执行这一关键健康促进作用的行为意图的差异。本研究的具体目的是：(1)制定包含计划行为理论的访谈时间表，探索部落LHA的态度、主观规范和感知的行为控制，并阐明这些因素通过何种途径影响他们向社区妇女提供针对乳腺癌和宫颈癌的特定健康教育和/或导航服务的行为意向；(2)对至少30名部落LHA和LHA主任进行开放式、深入的访谈；(3)利用扎根理论系统地分析访谈记录，并确定相关的模式、主题和理论关联，以解释态度、主观规范和感知的行为控制与部落LHA的行为意图之间的联系，以将癌症控制活动纳入其服务范围；(4)确定部落社区的社会、文化和政治背景要素，这些要素可以整合到部落LHA的干预前能力发展中，以最大限度地提高其在提供针对癌症的教育和导航服务方面的有效性；以及(5)确定社区和卫生保健系统的干预杠杆点，可在实施LHA干预措施的同时有针对性地进行干预，以改善部落社区乳腺癌和宫颈癌早期发现服务的协调和提供。这项研究将探索和分析影响部落业馀健康顾问促进早期发现乳腺癌和宫颈癌的能力的因素。乳腺癌和宫颈癌是美国印第安人存活率极低的两种高度耻辱的疾病。它还将告知部落业馀健康顾问的能力发展需求，以最大限度地提高他们在提供针对乳腺癌和宫颈癌的教育和导航服务方面的效力。此外，这项调查将导致确定部落社区和卫生保健系统的干预点，这些点可以在实施部落业馀健康顾问干预的同时有针对性地进行，以改善美国印第安人社区内乳腺癌和宫颈癌早期检测服务的协调和提供。

DESCRIPTION (provided by applicant): Lay health advisor (LHA) intervention models have been increasingly utilized in American Indian and Alaskan Native (AI/AN) communities to address disparities in access to and utilization of recommended breast and cervical cancer early detection exams, including mammograms and Pap exams. While recent studies have documented moderate effectiveness of lay health advisor programs in increasing breast and cervical cancer screening rates in AI/AN communities, no studies have explored the attitudes, beliefs, and norms of tribal lay health advisors themselves, especially in interventions that target a highly stigmatized disease such as cancer. Further, researchers have yet to explore factors external to lay health advisors, such as fragmented health care systems and power imbalances, which may affect the capacity of LHAs to provide breast and cervical cancer-specific services. An investigation of these factors is therefore essential to elucidate future capacity development and intervention strategies for tribal lay health advisor programs to maximize their ability to bolster breast and cervical cancer early detection in their communities. To address this critical gap in scientific knowledge, this research project will conduct in-depth interviews with tribal lay health advisors to explore and analyze the key determinants which impact their ability to integrate cancer control activities into their scope of services. It is hypothesized that a host of determinants, not just cancer-specific knowledge and education alone, explains the variation in behavioral intentions of tribal LHAs to perform this critical health promotion role. Specific aims of this study are to: (1) develop an interview schedule that incorporates the constructs of the Theory of Planned Behavior, to explore the attitudes, subjective norms, and perceived behavioral control of tribal LHAs, and to elucidate the pathways through which these factors impact their behavioral intentions to provide breast & cervical cancer- specific health education and/or navigational services to community women; (2) conduct open-ended, in- depth interviews with at least 30 tribal LHAs and LHA Directors; (3) utilize Grounded Theory to systematically analyze interview transcripts and identify relevant patterns, themes, and theoretical associations that explain the linkages between attitudes, subjective norms and perceived behavior control and the behavioral intentions of tribal LHAs to incorporate cancer control activities into their scope of services; (4) identify elements of the social, cultural, and political context of tribal communities that can be integrated into pre-intervention capacity development with tribal LHAs to maximize their effectiveness in providing cancer-specific educational and navigational services; and (5) identify community and health care system leverage points for intervention, which can be targeted concurrently with the implementation of LHA interventions, to improve the coordination and delivery of breast and cervical cancer early detection services in tribal communities. This study will explore and analyze the factors that impact the ability of tribal lay health advisors to promote early detection of breast and cervical cancer, two highly stigmatized diseases for which American Indian people experience disproportionately poor survival rates. It will also inform the capacity development needs of tribal lay health advisors to maximize their effectiveness in providing breast and cervical cancer-specific educational and navigational services. Moreover, this investigation will lead to the identification of tribal community and health care system leverage points for intervention, which can be targeted concurrently with the implementation of tribal lay health advisor interventions, to improve the coordination and delivery of breast and cervical cancer early detection services within American Indian communities.