A RCT TO PROMOTE MAMMOGRAPHY ADHERENCE AMONG CHINESE IMMIGRANT WOMEN

描述（由申请人提供）：美籍华人是美国最大的亚裔人口，其中70%是移民。与美国总人口中乳房x光检查的普遍高使用率和乳腺癌死亡率下降相比，华裔美国妇女的乳房x光检查率要低得多，她们的乳腺癌死亡率尚未下降。患乳腺癌的中国移民女性比在美国出生的女性更容易被诊断为大肿瘤并在5年内死亡。她们的低乳房x光检查使用率与筛查的知识、文化和态度障碍有关。在健康信念模型的指导下，我们为中国女性制作了一个具有文化敏感性的视频。我们的初步研究表明，在6个月的随访后，在家观看文化视频（单视频模式）比阅读印刷媒体（对照组）有效地提高了中国女性乳房x光检查使用率12个百分点。与对照组相比，文化视频也显著增加了知识，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，仍有很高比例的中国女性（59%）没有进行乳房x光检查，这表明需要对这一人群进行更密集的检查。因此，在社会网络理论的指导下，我们在一个小组环境中对视频进行了试点测试，在这个小组环境中，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）。小组视频讨论对干预后6个月中国女性乳房x光检查使用的促进作用大于单一视频模式。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能显著改变个人信念和障碍，并进一步促进筛查行为，也不知道这两种干预方法是否能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，以确定提高中国移民妇女乳房x光检查依从性的最佳干预方法。在这个拟议的试验中，我们将通过大华盛顿特区、纽约和南加州的华人社区伙伴关系招募910名中国妇女。这些妇女将是移民，她们不遵守美国癌症协会的指导方针，该指导方针建议40岁以上的妇女每年进行乳房x光检查。参与者将被随机分为两组：1)小组文化视频讨论和2)单一文化视频模式。参与者将在干预前后接受电话访谈，以评估他们在干预后6个月和18个月的主要障碍和乳房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卫生教育工作者和一名研究人员在所有地点使用标准化协议进行。如果我们的理论指导，社区主导的干预项目是有效的，这些项目可以在美籍华人社区广泛传播，并转化为其他亚洲群体，以提高中国和亚洲妇女的乳房x光检查率。

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.