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。在努力提高对这些癌症的认识和早期发现方面，以社区为基础的办法越来越多。但更多的情况是，这种干预措施在随机对照试验中得到测试，成为以证据为基础，然后未能在社区中达到进一步实施。拟议项目的目的是确定一个最佳的实施策略，使用一套以证据为基础的干预措施，旨在增加乳腺癌，前列腺癌和结直肠癌的早期发现非洲裔美国人作为一个模型。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”，将通过教会环境中训练有素的社区卫生顾问提供。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执行战略，其中技术援助的水平各不相同（分别为仅监测和评价与监测/评价加技术援助和培训）。通过改变技术援助的水平，我们将能够确定什么水平的技术援助会导致成功的执行和可持续性。我们还将确定教会组织能力的特点，导致成功的实施和可持续性。本研究的具体目标是：（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，开发当地癌症筛查资源指南，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忠诚度的实施结果，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战略（高度自治与低度自治），以确定成功实施所需的最佳技术援助水平。(3)评估CEDM在两年时间内的可持续性。我们将确定教会组织能力的特点，导致可持续发展，并比较两种实施策略（高与低社区自治），以确定成功的可持续发展的技术援助的最佳水平。 公共卫生相关性：拟议的项目将开始提供一些答案，为传播/执行研究这一新兴但关键的领域提供信息。如果能够更多地了解如何有效地传播/实施和维持以社区为基础的癌症传播干预措施，癌症控制研究可以对癌症差异产生更大的影响。在这个资源不确定的时期，有效的实施战略将是消除癌症早期发现差距的重要一步，这将对非洲裔美国人社区的死亡率产生重大影响。

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. PUBLIC HEALTH RELEVANCE: The proposed project would begin to provide some answers to inform the emerging but critical field of dissemination/implementation research. If more can be learned about ways to effectively disseminate/implement and sustain cancer community-based communication interventions, cancer control research can have significantly greater impact on cancer disparities. In this time of uncertain resources, an effective implementation strategy will be a significant step toward the elimination of disparities in cancer early detection, which would have a significant impact on mortality in African American communities.