Implementation of evidence-based cancer early detection in Black churches

描述(由申请人提供)：非裔美国人因乳腺癌、前列腺癌和结直肠癌而承受着不成比例的发病率和死亡率负担。虽然这些癌症差异的原因在本质上可能是多因素的，但毫无疑问，早期发现的差异是造成死亡率差异的原因。在努力提高对这些癌症的认识和及早发现方面，基于社区的方法一直在增加。然而，通常情况下，这些干预措施在随机对照试验中进行测试，成为基于证据的，然后无法在社区进一步实施。拟议项目的目的是使用一套旨在增加非裔美国人乳腺癌、前列腺癌和结直肠癌早期检测的循证干预措施作为模式，确定最佳实施战略。这三种干预措施将被打包并交织成一个单独的“癌症早期检测事工”(CEDM)，它将通过教会中训练有素的社区卫生顾问来提供。将使用RE-AIM框架评估执行情况和可持续性。14个当地的非裔美国人教会将被随机分为高或低社区自治实施战略，其中技术援助的水平各不相同(分别是监测和评估与监测/评估加技术援助和培训)。通过改变技术援助的水平，我们将能够确定什么水平的技术援助能够成功实施和实现可持续性。我们还将确定导致成功实施和可持续性的教会组织能力特征。本研究的具体目的是：(1)将三项干预措施打包成一个癌症早期检测部(CEDM)，制定当地的癌症筛查资源指南，并对材料和培训进行中试。(2)在马里兰州乔治王子郡的14座教堂实施CEDM。我们将评估涉及治疗忠诚度的执行结果，并确定导致成功执行的教会组织能力特征。我们将比较两种实施战略(高度社区自治和低社区自治)，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(高社区自治与低社区自治)，以确定成功实现可持续发展的最佳技术援助水平。 与公共卫生的相关性：拟议的项目将开始提供一些答案，为传播/实施研究这一新兴但至关重要的领域提供信息。

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.