CRC Screening Thoughts and Feelings: Increasing Engagement of African Americans

描述(申请人提供)：非裔美国人的结直肠癌(CRC)发病率和死亡率是所有族裔/种族中最高的。虽然筛查，尤其是结肠镜检查，在降低结直肠癌发病率方面是有效的，但依从性很低。事实上，最新发布的一项建模研究表明，筛查方面的差异占发病率差异的40%以上，占死亡率差异的近20%。这一点对于 非洲裔美国人；此外，他们不太可能收到有影响力的医生转介进行筛查。迫切需要提高我们对坚持和影响非裔美国人进行结直肠癌筛查决定的因素以及有效干预策略的理解。行为研究表明，在预测结直肠癌筛查和筛查意图时，认知决策因素(感知到的好处和障碍)和情感决策因素(恐惧和担忧)之间存在联系。然而，很少或没有工作系统地研究非裔美国人中的这些因素；这造成了对这些因素在预测(并可能增加)少数族裔结直肠癌筛查中的作用的认识上的显著差距。建议申请的目的是了解影响非裔美国人决定从事(或不从事)结直肠癌筛查的因素，以及通过社区一级的干预战略积极影响这些因素的能力。中心假设是：a)进行结直肠癌筛查的决定将是认知和情感因素的函数；以及b)教育干预可以有效地改变情感和认知因素，从而提高非裔美国人的结直肠癌筛查率。为了验证我们的假设，我们提出的具体目标是：目的1：检验两种随机社区干预对认知和情感因素的影响，以及由此对非裔美国人寻求医疗保健和结直肠癌筛查行为的影响。目的2：研究和探索可能影响行为改变过程的情境因素，以更好地了解社区层面的结直肠癌筛查和就医行为。这项研究将显著增加我们对影响非裔美国人关于寻求医疗保健和结直肠癌筛查行为的决定的因素的理解，以及社区干预是否能够积极影响这些因素和行为以减少差异。预期结果：这些目标中提出的工作将提供有关非洲裔美国人寻求医疗保健和结直肠癌筛查的特定行为变化的关键信息。

DESCRIPTION (provided by applicant): African Americans have the highest colorectal cancer (CRC) incidence and mortality of any ethnic/racial group. While screening, and particularly colonoscopy, is effective in reducing the incidence of CRC, adherence is low. In fact, a newly released modeling study suggests that disparities in screening accounts for over 40 percent of incidence disparities and almost 20 percent of mortality disparities. This is particularly true for African Americans; further, they are less likely to receive influential physician referrals for screening. There is a critical need to improve our understanding of adherence and the factors which influence African Americans' decisions about engaging in CRC screening, as well as efficacious intervention strategies. Behavioral research has shown links to cognitive decision-making factors (perceived benefits and barriers) and affective decision-making factors (fear and worry) in predicting CRC screening and intentions to screen. However, little or no work has systematically examined these factors in African Americans; this creates significant gaps in knowledge about the role of these factors in predicting (and potentially increasing) CRC screening for minorities. The goal of the proposed application is to understand factors influencing the decisions of African Americans to engage in (or not engage in) screening for CRC and the ability to positively impact these factors through intervention strategies at a community level. The central hypotheses are: a) that decisions to engage in CRC screening will be a function of both cognitive and affective factors; and b) that educational interventions can effectively alter both affective and cognitive factors and therefore increase CRC screening rates for African Americans. The Specific Aims proposed to test our hypotheses are: Aim 1: Examine the impact of two randomized community interventions on cognitive and affective factors and their resulting influence on health care seeking and CRC screening behaviors for African Americans. Aim 2: Examine and explore contextual factors that may influence the process of behavior change to better understand CRC screening and health care seeking behaviors at the community level. This study will significantly increase our understanding of factors which influence African Americans' decisions about health care seeking and CRC screening behavior and whether a community-based intervention can positively impact these factors and behaviors to reduce disparities. Expected outcomes: the work proposed in these aims will provide crucial information about behavioral change specific to health care seeking and CRC screening by African Americans.