REACH UP & OUT: Eliminating Breast and Cervical Cancer Disparities

描述（由申请人提供）：有充分证据表明，非裔美国人和白色妇女在乳腺癌和宫颈癌相关的发病率和死亡率方面存在差异。我们建立了一个非常积极的联盟，进行了全面的需求评估，并制定和试点测试了一项社区行动计划，以减少亚拉巴马黑带地区白色和非洲裔美国妇女之间的乳腺癌和宫颈癌筛查差距。虽然这种干预措施有效，并受到社区的欢迎，但并没有导致目标人群中所有妇女的行为改变。拟议干预措施的总体目的是通过提高巴氏涂片检查和乳房X光检查率，进一步减少亚拉巴马黑带地区白色和非洲裔美国妇女之间的乳腺癌和宫颈癌差异。我们建议开发和实施一个多组件的干预，使用媒体，教育和增强访问，将社会学和认知行为的方法在开发和实施的消息。这种干预是我们利用社区健康顾问（CHAs）（社会学方法）的试点工作的延伸。虽然试点干预措施显示，在黑带的非裔美国妇女中，乳腺癌和宫颈癌筛查显著增加，但仍有一个难以接触的群体，尽管我们作出了努力，但他们没有进行乳腺癌和宫颈癌筛查。根据对这组妇女的后续访谈以及与我们的联盟成员和CHA的讨论结果，我们建议制定、实施和评估一种强化干预措施，其中包括挑战障碍的认知行为方法（例如，害怕发现他们患有癌症，相信筛查不会有任何区别）并加强动机（例如，在其他妇女的支持下）让这一群体参与乳腺癌和宫颈癌筛查。虽然以社区为基础的前瞻性研究和赋权模式将是本研究中使用的总体概念框架，PEN-3和健康信念模式将指导干预措施的制定和实施。干预县将接受CHAs提供的教育和认知/行为技能培训，而对照县将继续接受我们目前已被证明是成功的干预措施。这项研究将分两个阶段进行。在第一阶段，我们会透过形成性评估，改善经改良的介入和评估工具。在第二阶段，我们将随机分配各县到干预/对照组，实施和评估干预措施。

DESCRIPTION (provided by applicant): It has been well documented that disparities exist between African American and white women with regard to morbidity and mortality associated with breast and cervical cancer. We have established a very active coalition, conducted comprehensive needs assessments, and developed and pilot-tested a community action plan to reduce breast and cervical cancer screening disparities between white and African American women in Alabama's Black Belt. Although effective and well received by the community, this intervention did not lead to behavior change among all women within the targeted population. The overall purpose of the proposed intervention is to further reduce breast and cervical cancer disparities between white and African American women in the Black Belt of Alabama by increasing Pap smear and mammography rates. We propose to develop and implement a multi-component intervention that uses media, education, and enhanced access, incorporating sociological and cognitive behavioral approaches in the development and implementation of the messages. This intervention is an extension of our pilot work utilizing community health advisors (CHAs) (sociologic approach). Although the pilot intervention showed significant increase in breast and cervical cancer screening among African American women in the Black Belt, there is still a hard to-reach group, which, despite our efforts, has not engaged in breast and cervical cancer screening. Based on the results of follow-up interviews with this group of women and discussions with our coalition members and CHAs, we propose the development, implementation, and evaluation of an enhanced intervention, which incorporates cognitive behavioral approaches that will challenge the barriers (e.g., fear of finding out they have cancer, the belief that screening will not make any difference) and reinforce the motivators (e.g., support from other women) to engage this group in breast and cervical cancer screening. Although the Community-Based Participatory Research and the Empowerment Model will be the overall conceptual framework used in this study, the PEN-3 and the Health Belief Model will guide intervention development and implementation. The intervention counties will receive education and cognitive/behavioral skills training delivered by CHAs, while the control counties will continue to receive our current intervention that has proven to be successful. The study will be carried out in two phases. In Phase I, we will refine the enhanced intervention and assessment tools through formative assessment. In Phase II, we will randomly assign the counties to intervention/control groups, implement, and evaluate the intervention.