Family Cancer Literacy to Promote Mammography Screening among Navajo Women

描述（由申请人提供）：本提案描述了一项基于社区的参与性研究，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光检查。从公共卫生的角度来看，这项干预措施有可能惠及许多纳瓦霍妇女，因为80%的妇女计划接受乳房x光检查，但没有坚持到底。这些妇女（每年超过1500人）被转介到国家乳腺癌和宫颈癌预防计划（NNBCCPP）。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知识或关于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），以及对癌症病因和早期发现的重要性缺乏了解。因此，关于癌症的交流在纳瓦霍家庭和社区中受到阻碍。这项提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。拟议的研究旨在评估以癌症扫盲为重点、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功效。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发展家庭癌症素养干预。此外，将通过焦点小组和个人访谈，使《癌症扫盲措施》适用于纳瓦霍妇女。第二阶段将包括对干预的形成性评估。将NNBCCPP患者和一名女性家庭成员随机分为两组，对照组（现有的NNBCCPP健康教育服务组，N=40对）或接受健康教育服务加家庭癌症素养干预组（N=40对）。我们将通过招募率和保留率以及治疗可接受性的定性评分来评估干预措施的可行性和可接受性。此外，我们将通过NNBCCPP记录的3个月随访中完成乳房x光检查的妇女比例，与对照组比较干预的影响。我们还将检查从基线到患者及其家属随访3个月期间癌症扫盲测量评分的变化。我们期望通过这个项目，我们将开发出一种可复制的、可行的、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，改编后的癌症扫盲措施可用于纳瓦霍民族未来的癌症预防和控制项目。总的目标是降低纳瓦霍妇女的乳腺癌发病率和死亡率。

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.