Adapting patient navigation to promote cancer screening in Chicagos Chinatown

调整患者导航以促进芝加哥唐人街的癌症筛查

• 批准号: 8223013
• 负责人: MELISSA A. SIMON
• 金额: $ 60.22万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-15 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8223013
• 关键词: Academic Medical Centers; Address; Advocate; African American; Area; Asians; Behavior; Breast; Cancer Control; Cancer Hospital; Cervical Cancer Screening; Chicago; Chinese American; Chinese People; Cities; Communities; Community Health; Community Healthcare; Comprehensive Cancer Center; County Hospitals; Data; Diffuse; Economics; Education; Effectiveness; Epidemiology; Evaluation; Family; Female; Funding; Future; Generations; Grant; Health; Health Educators; Health Personnel; Health Services; Health system; Healthcare Systems; Household; Illinois; Immigrant; Income; Individual; Information Systems; Institutes; Insurance; Insurance Coverage; Intervention; Interview; Knowledge; Latina; Latino; Laws; Learning; Life; Linguistics; Link; Low Income Population; Low income; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Mammography; Maps; Medical center; Medicare/Medicaid; Methods; Monitor; Neighborhoods; Network-based; Outcome; Pap smear; Participant; Pathway Analysis; Patients; Perception; Plant Roots; Poaceae; Population; Population Research; Process; Provider; Qualitative Methods; Qualitative Research; Research; Research Design; Research Infrastructure; Research Methodology; Resources; Role; Screening for cancer; Screening procedure; Series; Services; Social Change; Social Network; Sustainable Development; Techniques; Test Result; Testing; Time; Trust; Uninsured; United States National Institutes of Health; Universities; Vulnerable Populations; Woman; Work; base; behavioral health; cancer health disparity; cancer prevention; catalyst; community based participatory research; community organizations; empowered; follow-up; healthy aging; improved; intervention effect; malignant breast neoplasm; member; neighborhood safety; programs; psychologic; safety net; service intervention; social; success; therapy design; trend; uptake

DESCRIPTION (provided by applicant): Despite the presence of five major academic medical centers, a large county hospital, and two NCI designated comprehensive cancer centers, Chicago has some of the worst cancer disparities between income groups in the US. This burden is accentuated with respect to linguistically and culturally isolated immigrants who do not traditionally benefit from nor participate in research. In particular, Chinese women in Chicago, a significantly understudied population, have unacceptably low breast and cervical cancer screening rates which are only half the rates of white women. This application is a direct outgrowth of concerns expressed by leaders of Chicago's Chinatown community about the need to educate and empower low income Chinese women about cancer prevention and control. Patient navigators (PN) have been studied in African American, Latino, and white populations. However, PN research has largely focused on follow-up of patients with cancer or abnormal findings, rarely to improve screening rates. We seek to study the dissemination of PN behavioral health services interventions by implementing a tailored PN intervention with a focus on increasing breast and cervical cancer screening as well as follow-up for the largely immigrant population of low income women in Chinatown. Our proposed research builds on two NIH funded PN studies, our Chinatown RC4 research infrastructure grant activities, including a community data resource center, and our long-standing community based participatory research (CBPR) partnership with Chinatown's major safety net provider, Mercy Medical Center. Using mixed methods within a CBPR approach, we aim to evaluate the effectiveness of PN adaptation and extension to cancer control education and screening under the auspices of our community research partner, the Chinese American Service League. We will study the fundamental mechanisms required to optimally adapt interventions focused on immigrant populations that are culturally and linguistically isolated. The proposed project seeks to expand the role of PNs, to learn more about what determines the effectiveness of PNs as health educators, how to encourage breast and cervical cancer screening, and how PNs can become trusted and respected community health workers and advocates that provide essential links between the community and the health care system for low income women in Chicago's Chinatown. This research will assess how Chinese women interact with health information and resources via a PN team to make health decisions and access the health care system. Women comprise the largest segment of health workers, health consumers, and health decision makers for their families and communities, but are underrepresented accessing appropriate health services among Asian immigrant populations. Once women are empowered, informed health consumers, they become catalysts for social change. PUBLIC HEALTH RELEVANCE: This proposed project aims to adapt the rapidly growing phenomenon of patient navigation into a broader effort to use community health workers for culturally competent cancer control and prevention. Our CBPR approach, grounded in the long-standing prestige of our community organization and safety net provider partners, offers the opportunity to close the loop between community-defined health problems and access to the local health care system. Because many women in Illinois already have public insurance coverage for cancer screening and follow-up but do not take advantage of this resource, this proposal has major relevance for future efforts to increase access for vulnerable populations once broader health reform laws are implemented.

描述（由申请人提供）：尽管存在五个主要的学术医疗中心，一个大型县医院和两个NCI指定的综合癌症中心，芝加哥有一些最严重的癌症收入群体之间的差距在美国。这种负担在语言和文化上与世隔绝的移民方面更为严重，他们传统上既不受益于研究，也不参与研究。特别是，芝加哥的中国女性是一个研究严重不足的人群，乳腺癌和宫颈癌筛查率低得令人难以接受，仅为白色女性筛查率的一半。 该申请是芝加哥唐人街社区领导人对需要教育和增强低收入中国妇女对癌症预防和控制的能力表示关注的直接结果。已在非裔美国人、拉丁裔和白色人群中对患者导航仪（PN）进行了研究。然而，PN研究主要集中在癌症或异常结果患者的随访，很少提高筛查率。我们寻求研究PN行为健康服务干预措施的传播，通过实施量身定制的PN干预措施，重点是增加乳腺癌和宫颈癌筛查以及唐人街低收入妇女的主要移民人口的后续行动。我们提出的研究建立在两个NIH资助的PN研究，我们的唐人街RC4研究基础设施赠款活动，包括社区数据资源中心，以及我们与唐人街主要安全网提供商Mercy Medical Center的长期社区参与式研究（CBPR）合作伙伴关系。 在CBPR方法中使用混合方法，我们的目标是在我们的社区研究合作伙伴华裔美国服务联盟的主持下，评估PN适应和扩展到癌症控制教育和筛查的有效性。我们将研究所需的基本机制，以最佳适应干预措施，重点是文化和语言上孤立的移民人口。拟议的项目旨在扩大PNs的作用，更多地了解是什么决定了PNs作为健康教育者的有效性，如何鼓励乳腺癌和宫颈癌筛查，以及PNs如何成为值得信赖和尊重的社区卫生工作者和倡导者，为芝加哥唐人街的低收入妇女提供社区和医疗保健系统之间的重要联系。 本研究将评估中国妇女如何通过PN团队与健康信息和资源互动，以做出健康决策并进入医疗保健系统。妇女在家庭和社区的保健工作者、保健消费者和保健决策者中占最大比例，但在亚洲移民人口中，获得适当保健服务的人数不足。一旦妇女被赋予权力，成为知情的保健消费者，她们就会成为社会变革的催化剂。 公共卫生关系：这个拟议的项目旨在将迅速增长的患者导航现象转变为更广泛的努力，利用社区卫生工作者进行文化上胜任的癌症控制和预防。我们的CBPR方法基于我们社区组织和安全网提供商合作伙伴的长期声誉，为社区定义的健康问题和获得当地医疗保健系统之间的闭环提供了机会。由于伊利诺伊州的许多妇女已经有了癌症筛查和随访的公共保险，但没有利用这一资源，因此一旦实施更广泛的卫生改革法律，这项提案对今后增加弱势群体获得服务的努力具有重大意义。