CBPR Strategies to Increase Colorectal Cancer Screening in Ohio Appalachia

描述(申请人提供)：结直肠癌发病率和死亡率不成比例的负担，主要是由于推荐的结直肠癌筛查测试使用率较低。俄亥俄州的阿巴拉契亚地区除了更高的贫困、更低的就业和更低的教育水平外，还遭受着这种疾病的负担。为了解决这种癌症健康差异，我们俄亥俄州立大学(OSU)的健康差异研究团队与四个以阿巴拉契亚为基础的社区联盟合作，使用基于社区的参与性研究(CBPR)方法设计并试点测试了两种干预措施，旨在提高阿巴拉契亚一个县(第一阶段)的CRC筛查率。该应用程序的目标是在12个俄亥俄州阿巴拉契亚地区县(第二阶段)测试这些CRC筛查干预措施，为在阿巴拉契亚社区癌症网络(ACCN)内另外6个阿巴拉契亚州进行全面传播试验(第三阶段)做准备。 这项第二阶段提案的具体目标是：1)利用CBPR方法来完善特定的县级媒体宣传活动和基于诊所的关于结直肠癌筛查的信息(标题为“支持您的健康！”)或在俄亥俄州阿巴拉契亚州的12个县发布注意力控制信息(名为“桃子”的健康饮食运动)；2)使用群组随机设计，实施并测试交错的全县干预计划，该计划将以当地CRC幸存者为特色的县特定媒体活动、诊所特定的特许提醒系统以及在随机选择的6个干预县中的两种策略的组合与在6个随机选择的县中使用以当地农民为特色的县特定健康饮食运动以及将教育材料放置在诊所中的相同运动策略进行比较；3)利用过程(县居民的便利样本)和结果评估(对每个县的居民进行4次独立的横断面调查)战略，评估每项战略在提高儿童癌症筛查率方面的效果；以及4)利用结果，计划在后续的第三阶段研究中将干预措施推广到ACCN另外6个邦的36个阿巴拉契亚县。 所有的具体目标将使用CBPR原则，与这四个俄亥俄州阿巴拉契亚社区癌症联盟充分合作，并将由跨理论模型的基本理论框架以及与行为变化相关的三个行为理论(社会认知理论、理性行动理论和态度可及性理论)指导。因此，这项研究的结果将在这些阿巴拉契亚地区产生立竿见影的影响，因为社区将能够将成功的战略制度化，纳入现有的全县卫生运动。

DESCRIPTION (provided by applicant): a disproportionate burden of CRC incidence and mortality, mainly due to lower utilization of recommended CRC screening tests. The Appalachian region of Ohio suffers from this burden of disease in addition to higher poverty, lower employment, and lower educational levels. To address this cancer health disparity, our health disparities research team at The Ohio State University (OSU) in partnership with four Appalachia-based community coalitions have used community-based participatory research (CBPR) methods to design and pilot test two interventions intended to increase CRC screening rates in one Appalachian county (Phase 1). The goal of this application is to test these CRC screening interventions in 12 Ohio Appalachian counties (Phase 2) in preparation for a full-scale dissemination trial (Phase 3) in 6 additional Appalachian states within the Appalachia Community Cancer Network (ACCN). The specific aims of this Phase 2 proposal are to: 1) utilize CBPR methods to refine specific county-level media campaigns and clinic-based messages about CRC screening (entitled "Get Behind Your Health!") or an attention control message (a healthy eating campaign entitled "PEACHES") in 12 Ohio Appalachia counties; 2) implement and test, using a group-randomized design, a staggered county-wide intervention program that compares county-specific media campaigns featuring local CRC survivors, clinic-specific charter reminder systems, and a combination of the two strategies in 6 randomly selected intervention counties to the same campaign strategies in 6 randomly selected attention control counties using county specific healthy eating campaigns featuring local farmers and educational material placed in clinics; 3) utilize process (convenience samples of county residents) and outcome evaluation (4 independent cross-sectional surveys of residents of each county) strategies to assess the efficacy of each strategy on improving CRC screening rates; and 4) utilize the results, to plan the dissemination of the intervention into 36 Appalachian counties in 6 additional states of the ACCN in a subsequent Phase 3 study. All specific aims will be carried out using CBPR principles, in full partnership with these four Ohio Appalachian community-based cancer coalitions, and will be guided by an underlying theoretical framework of the Transtheoretical Model, in conjunction with three behavioral theories relevant to behavior change (Social Cognitive Theory, Theory of Reasoned Action, and Attitude Accessibility Theory). The results of this study, thus, will have immediate impact in these Appalachian counties, as the community will be able to institutionalize successful strategies into existing county-wide health campaigns.