A RCT TO PROMOTE MAMMOGRAPHY ADHERENCE AMONG CHINESE IMMIGRANT WOMEN

描述(申请人提供)：华裔美国人是美国最大的亚裔人口，其中70%是移民。与美国总体人口中乳房X光检查的使用率普遍较高和乳腺癌死亡率下降形成对比的是，华裔美国女性的乳房X光检查筛查率要低得多，她们的乳腺癌死亡率尚未下降。与在美国出生的女性相比，患有乳腺癌的中国移民女性更有可能被诊断出患有大肿瘤，并在5年内死亡。他们乳房X光检查使用率低与筛查的知识、文化和态度障碍有关。在健康信念模式的指导下，我们为中国女性制作了一部具有文化敏感性的视频。我们的初步研究表明，在家中观看文化视频(单一视频模式)有效地增加了中国女性在6个月后阅读印刷媒体(对照组)的乳房X光检查使用量12个百分点。与对照组相比，文化视频还显著增加了知识，减少了文化和态度障碍。然而，我们的数据显示，在视频干预后，很高比例的中国女性(59%)仍然没有做过乳房X光检查，这表明需要对这一人群采取更密集的方法。因此，在社交网络理论的指导下，我们在小组环境中对视频进行了试点测试，在小组环境中，女性一起观看视频，然后进行同伴主导的讨论(小组视频讨论)。小组视频讨论加强了中国女性乳房X光检查干预后六个月的使用，而不是单一的视频模式。我们不知道通过社会支持和网络进行的小组视频讨论是否显著改变了个人的信念和障碍，并进一步促进了筛查行为，以及这两种干预方式是否可以对行为改变产生长期影响。为了填补这些空白，我们的多学科研究团队提出了一项随机对照试验，以确定在中国移民妇女中提高乳房X光检查依从性的最佳干预方法。在这项拟议的试验中，我们将通过大华盛顿特区、纽约和南加州的华人社区合作伙伴关系招募910名中国女性。这些女性将是不遵守美国癌症协会指南的移民，该指南建议40岁以上的女性进行年度乳房X光检查。参与者将随机分为两种模式：1)小组文化视频讨论模式和2)单一文化视频模式。参与者将在干预前和干预后接受电话采访，以评估他们在干预后6个月和18个月时关键障碍和接受乳房X光检查的变化。小组视频讨论将由一名训练有素的中国社区健康教育者和一名在所有地点使用标准化方案的研究人员领导。如果我们的理论指导、社区主导的干预计划是有效的，这些计划可以在广大的华裔美国社区传播，并被翻译到其他亚洲群体，以提高中国和亚洲女性的总体乳房X光检查筛查率。 公共卫生相关性：华裔美国女性的乳房X光检查筛查率远远低于《健康人物》2010年针对40岁及以上女性的目标筛查率(70%)。这项拟议的研究将测试观看基于理论和文化敏感的视频，然后进行小组讨论(与单一观看相比)在增加乳房X光检查使用量方面的有效性。我们将从华盛顿特区、纽约市和南加州招募910名华裔移民妇女(年龄E41岁，最后一次乳房X光检查1年)参加我们的干预计划。我们将在干预后6个月和18个月评估女性遵守年度乳房X光检查指南的情况。这项研究的结果将确定接触到中国移民妇女并增加她们定期筛查行为的最佳途径。这项研究的结果将引导癌症控制努力，有效地减少华裔美国女性经历的乳腺癌筛查差距。

DESCRIPTION (provided by applicant): Chinese-Americans are the largest Asian population in the US, of which 70% are immigrants. In contrast to the generally high use of mammography screening and decline in breast cancer mortality seen in the total US population, Chinese-American women have much lower mammography screening rates and their breast cancer mortality rates are not yet declining. Chinese immigrant women with breast cancer are more likely to be diagnosed with large tumors and die within 5 years than their US-born counterparts. Their low rates of mammography use are associated with knowledge, cultural and attitudinal barriers to screening. Guided by the Health Belief Model, we developed a culturally sensitive video for Chinese women. Our preliminary research showed that viewing the cultural video at home (single video mode) effectively increased Chinese women's mammography use by 12 percentage points over reading a print medium (control group) after a 6-month follow-up. The cultural video also significantly increased knowledge and reduced cultural and attitudinal barriers compared to the control group. However, our data show that a high proportion of Chinese women (59%) still had not had a mammogram after the video intervention, suggesting that a more intensive approach is needed for this population. Thus, guided by Social Network Theory, we pilot tested the video in a small- group setting in which women viewed the video together followed by a peer-led discussion (small-group video discussion). The small-group video discussion enhanced Chinese women's mammography use six-months post-intervention more than the single video mode. We do not know whether small-group video discussion through social support and networks significantly changes personal beliefs and barriers and further promotes screening behavior and whether these two intervention approaches can have long-term effects on behavioral changes. To fill these gaps, our multidisciplinary research team proposes a randomized controlled trial to identify the best intervention approach for increasing mammography adherence among Chinese immigrant women. In this proposed trial, we will recruit 910 Chinese women through Chinese community partnerships in greater Washington DC, New York, and southern California. These women will be immigrants who are non- adherent to the American Cancer Society guidelines that recommend annual mammograms for women over age 40. Participants will be randomized to the two arms: 1) small-group cultural video discussion and 2) single cultural video mode. Participants will be telephone interviewed before and after intervention to assess their changes in key barriers and receipt of mammograms by 6 months and 18 months post-intervention. The small- group video discussion will be led by a trained Chinese community health educator and a research staff using a standardized protocol at all sites. If our theoretically-guided, community-led intervention programs are effective, these programs can be disseminated in Chinese-American communities at large and be translated to other Asian groups to promote overall mammography screening rates among Chinese and Asian women. PUBLIC HEALTH RELEVANCE: Chinese-American women's mammography screening rates are far lower than the Health People 2010 target rates (70%) for women ages 40 and older. This proposed study will test the efficacy of viewing a theoretically based and culturally sensitive video followed by group discussion (vs. single viewing) in increasing mammography use. We will enroll 910 Chinese immigrant women (age e41 and last mammogram > 1 year) from Washington DC, New York City, and southern California to participate in our intervention programs. We will assess women's adherence to annual mammography screening guidelines six months and 18 months post intervention. The results of this study will identify optimal avenues for reaching Chinese immigrant women and increasing their regular screening behavior. The results of this study will lead cancer control efforts to effectively decrease breast cancer screening disparities experienced by Chinese-American women.