Implementation of evidence-based cancer early detection in Black churches

描述（由申请人提供）：非裔美国人在乳腺癌、前列腺癌和结直肠癌的发病率和死亡率方面承受着不成比例的负担。虽然这些癌症差异的原因可能是多因素的，但毫无疑问，早期发现的差异导致了死亡率的差异。以社区为基础的方法一直在努力提高对这些癌症的认识和早期发现。然而，通常情况下，这些干预措施在随机对照试验中进行了测试，成为基于证据的，然后未能在社区中进一步实施。拟议项目的目的是利用一套以证据为基础的干预措施，以提高非裔美国人乳腺癌、前列腺癌和结直肠癌的早期检测为例，确定一种最佳的实施策略。这三种干预措施将被打包并交织成一个单一的“癌症早期检测部”（CEDM），该部将通过训练有素的社区卫生顾问在教堂环境中提供服务。将使用RE-AIM框架对实施和可持续性进行评估。14个当地非裔美国人教会将被随机分配到高或低社区自治实施策略，其中技术援助水平各不相同（分别为监测和评估与监测/评估加技术援助和培训）。通过改变技术援助的水平，我们将能够确定何种水平的技术援助导致成功的执行和可持续性。我们也会找出教会组织能力的特点，使之能成功的执行和可持续性。本研究的具体目的是：(1)将三种干预措施整合到一个单一的癌症早期检测部（CEDM）中，制定当地的癌症筛查资源指南，并对材料和培训进行试点测试。(2)在马里兰州乔治王子县的14个教堂实施CEDM。我们将评估涉及治疗保真度的实施结果，并确定导致成功实施的教会组织能力特征。我们将比较两种实施策略（高社区自主权和低社区自主权），以确定成功实施所需的最佳技术援助水平。(3)评估可持续发展机制在两年内的可持续性。我们将确定导致可持续性的教会组织能力特征，并比较两种实施策略（高与低社区自治），以确定成功可持续性的最佳技术援助水平。

DESCRIPTION (provided by applicant): African Americans suffer a disproportionate burden of incidence and mortality from breast, prostate, and colorectal cancer. Though the causes of these cancer disparities are likely multi-factorial in nature, there are no doubt disparities in early detection that contribute to the mortality disparities. Community-based approaches have been increasing in the effort to raise awareness and early detection for these cancers. However, more often than not, such interventions are tested in randomized controlled trials, become evidence- based, and then fail to reach further implementation in the community. The aim of the proposed project is to identify an optimal implementation strategy using a set of evidence-based interventions that aim to increase early detection of breast, prostate, and colorectal cancer among African Americans as a model. These three interventions will be packaged and interwoven into a single "Cancer Early Detection Ministry" (CEDM), which will be delivered through trained Community Health Advisors in church settings. The implementation and sustainability will be evaluated using the RE-AIM Framework. Fourteen local African American churches will be randomized to a high or a low community autonomy implementation strategy, in which the level of technical assistance is varied (monitoring and evaluation only vs. monitoring/evaluation plus technical assistance and training, respectively). By varying the level of technical assistance, we will be able to determine what level of technical assistance leads to successful implementation and sustainability. We will also identify church organizational capacity characteristics that lead to successful implementation and sustainability. The specific aims of this research are to: (1) Package the three interventions into a single Cancer Early Detection Ministry (CEDM), develop a local cancer screening resource guide, and pilot test the materials and training. (2) Implement the CEDM in 14 churches in Prince George's County, Maryland. We will evaluate the implementation outcomes involving treatment fidelity and identify church organizational capacity characteristics that led to successful implementation. We will compare the two implementation strategies (high vs. low community autonomy) to determine the optimal level of technical assistance necessary for successful implementation. (3) Evaluate the sustainability of the CEDM over a two-year period of time. We will identify church organizational capacity characteristics that led to sustainability, and compare the two implementation strategies (high vs. low community autonomy) to determine the optimal level of technical assistance for successful sustainability.