Family Cancer Literacy to Promote Mammography Screening among Navajo Women

描述（由申请人提供）：本提案描述了一项以社区为基础的参与性研究，旨在开发和试点测试一种新的行为干预措施，以促进纳瓦霍妇女的乳房X线检查。从公共卫生的角度来看，干预措施有可能影响到许多纳瓦霍妇女，因为80%的妇女安排进行乳房X光检查预约没有坚持到底。这些妇女（每年超过1 500人）被转介到国家乳腺癌和宫颈癌预防方案。在纳瓦霍社区实施癌症预防和控制工作的一个关键障碍是缺乏癌症扫盲或有关癌症的文化和概念知识。筛查的其他障碍是对癌症的恐惧，患者，家庭和社区经常经历的癌症耻辱（甚至谈论癌症），以及缺乏对癌症病因学和早期发现重要性的了解。因此，纳瓦霍家庭和社区内有关癌症的交流受到阻碍。 这项建议建立在我们与迪尼学院（纳瓦霍部落学院）成功的伙伴关系和合作的基础上。这项拟议的研究旨在评估以癌症扫盲为重点的、以家庭为基础的干预措施对纳瓦霍妇女完成乳房X光检查的可行性和潜在疗效。干预措施将包括在文化和语言上适当的关于癌症的教育材料（例如，纳瓦霍癌症词汇表）。该项目将分两个阶段实施。在第一阶段，我们将根据社区咨询委员会的反馈制定家庭癌症扫盲干预措施。此外，还将通过重点小组和个别访谈，为纳瓦霍妇女调整癌症扫盲措施。第二阶段将包括对干预措施的形成性评价。NNBCCPP患者和一名女性家庭成员将被随机成对分配到对照条件（现有NNBCCPP健康教育服务，N=40对）或接受这些健康教育服务加家庭癌症扫盲干预（N=40对）。我们将通过招募率、保留率和治疗可接受性的定性评级来评估干预的可行性和可接受性。此外，我们将检查干预与对照组相比对NNBCCPP记录的3个月随访时完成乳房X线摄影筛查的女性比例的影响。我们还将检查患者和家庭成员从基线到3个月随访期间癌症素养测量评分的变化。我们希望，作为该项目的结果，我们将开发出一种可复制的，可行的和可接受的干预措施，其有效性可以在未来的大规模随机临床试验中进行测试。此外，经过调整的癌症扫盲措施可用于纳瓦霍族未来的癌症预防和控制项目。总体目标是降低纳瓦霍妇女的乳腺癌发病率和死亡率。 公共卫生相关性：在美国印第安人和阿拉斯加原住民（AI/AN）妇女中，乳腺癌更有可能在晚期被诊断出来，5年乳腺癌生存率低于任何其他种族。在安排进行乳房X光检查的纳瓦霍妇女中，未出现率明显较高（80%）。这项研究建议制定一项以家庭为基础的癌症扫盲干预措施，其中包括文化和语言上适当的乳腺癌教育，以促进纳瓦霍妇女的乳房X光检查筛查。

DESCRIPTION (provided by applicant): This proposal describes a community-based participatory research study to develop and pilot test a new behavioral intervention to promote mammography screening among Navajo women. From a public health perspective, the intervention has the potential to reach many Navajo women, as 80% of women scheduled for mammography appointments do not follow through. These women (over 1,500 each year) are referred to the Nation Breast and Cervical Cancer Prevention Program (NNBCCPP). A key barrier toward implementing cancer prevention and control efforts in the Navajo community is a lack of cancer literacy or cultural and conceptual knowledge regarding cancer. Other barriers to screening are fear of cancer, stigma of cancer (even talking about cancer) often experienced by the patient, family and community, and lack of knowledge about the etiology of cancer and importance of early detection. Therefore, communication about cancer is impeded within Navajo families and the community. This proposal builds on our successful partnership and collaboration with Dini College (the Navajo tribal college). The proposed study is designed to assess the feasibility and potential efficacy of a cancer-literacy focused, family-based intervention on completion of mammography screening for Navajo women. The intervention will include culturally and linguistically appropriate educational materials about cancer (e.g., the Navajo Cancer Glossary). The project will be implemented in two phases. During Phase 1, we will develop the family cancer literacy intervention with feedback from our community advisory committee. In addition, the Cancer Literacy Measure will be adapted for Navajo women through focus groups and individual interviews. Phase 2 will consist of a formative evaluation of the intervention. The NNBCCPP patient and a female family member will be randomly assigned in pairs to the control condition (existing NNBCCPP health education services, N=40 pairs) or to receive these health education services plus the family cancer literacy intervention (N=40 pairs). We will assess the intervention's feasibility and acceptability as indicated by the recruitment and retention rates and qualitative ratings of treatment acceptability. In addition, we will examine the effect of the intervention compared with the control group on the proportion of women who complete mammography screening at 3-month follow-up documented by NNBCCPP records. We will also examine changes in Cancer Literacy Measure scores from baseline to 3-month follow-up among both patients and family members. We expect that as a result of this project, we will have developed a replicable, feasible, and acceptable intervention, the efficacy of which can be tested in future large-scale randomized clinical trials. In addition, the adapted Cancer Literacy Measure could be used in future cancer prevention and control projects within the Navajo Nation. The overall objective is to reduce breast cancer morbidity and mortality among Navajo women. PUBLIC HEALTH RELEVANCE: Among American Indian and Alaska Native (AI/AN) women, breast cancer is more likely to be diagnosed at an advanced stage and the 5 year breast cancer survival rates are lower than any other ethnic group. Among Navajo women scheduled for a mammography screening appointment, the no show rate is markedly high (80%). This study proposes to develop a family-based cancer literacy intervention that includes culturally and linguistically appropriate education about breast cancer to promote mammography screening among Navajo women.