Efficacy-to-Effectiveness Transition of an Educational Program to Increase Colore

描述(申请人提供)：非洲裔美国人的发病率和死亡率最高，比白人更不可能接受结直肠癌(CRC)的筛查。我们最近完成了一项为期五年的随机对照社区干预试验，证明了小群体教育干预(现在称为EPICS或增加结直肠癌筛查的教育计划)的有效性，与对照组相比，结直肠癌筛查率翻了一番。EPICS随后与当地卫生部门合作付诸实施，并同样有效。我们现在正在格鲁吉亚全州传播干预行动。在这项申请中，我们提出了一项全国性的传播和实施研究。我们建议使用罗杰斯的创新扩散理论和格拉斯哥的RE-AIM(REACH，Efficiency，Adption，Implementation，Maintenance)评估框架来追求以下具体目标：1)测试传播EPICS的被动和主动方法，以提高非裔美国人的结直肠癌筛查率；2)衡量EPICS被社区联盟接受的程度和在不同环境下实施的保真度，以及3)评估EPICS的潜在可译性和对公共健康的影响。创新扩散理论将指导史诗的传播过程，RE-AIM将用于评估这种传播及其影响。在这项研究中，我们建议对来自美国各地的20个社区联盟进行整群随机对照试验，分配到四种条件之一：(1)被动地基于网络访问主持人培训材料和工具包(TA)；(2)被动地访问SAM AS 1，但有TA；(3)主动地面对面地访问主持人培训材料和工具包(IP 没有助教和(4)有助教的(4)主动IP访问辅导员培训材料和工具包。每个社区联盟将与三个实施环境合作：教堂、诊所和社区站点。非裔美国人，50-74岁，目前没有参加儿童权利公约筛查，有资格参加研究(n=7,200或n=360符合条件的个人，每个社区联盟)。这假设每个研究组的样本量为1800，显著性水平为5%(即α=0.05)，并采用双侧两组卡方比例检验。假设我们在我们的研究中观察到，主动组参与者的结直肠癌筛查率比被动组参与者的筛查率更高，我们将有超过99%的能力来检测在统计上显著差异的比例。为这项研究提出的所有统计检验都将是双面的，并将使用5%的显著性水平(即，α=0.05)来执行。

DESCRIPTION (provided by applicant): African Americans have the highest incidence and mortality and are less likely than whites to have screening for colorectal cancer (CRC). We recently completed a five-year randomized controlled community intervention trial that demonstrated the efficacy of a small group education intervention (now named EPICS or Educational Program to Increase Colorectal Cancer Screening) that doubled the CRC screening rate compared to the control group rate. EPICS was then put into practice in partnership with the local health department and was equally effective. We are now disseminating the intervention across the state of Georgia. In this application we propose a national dissemination and implementation study. We propose using Rogers' Diffusion of Innovation Theory and Glasgow's RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation framework to pursue the following specific aims: 1) test passive and active approaches to disseminating EPICS to increase screening rates for colorectal cancer among African Americans; 2) measure the extent to which EPICS is accepted by community coalitions and the fidelity of implementation in various settings and 3) estimate the potential translatability and public health impact of EPICS. Diffusion of Innovations Theory will guide the process of EPICS dissemination and RE-AIM will be used to assess this dissemination and its impact. For this study we propose a cluster randomized controlled trial of 20 community coalitions from across the United States, assigned to one of four conditions: (1, passive) web-based access to facilitator training materials and toolkits without technical assistance (TA); (2, passive) the sam as 1, but with TA; (3, active) in-person access (IP) to facilitator training materials and toolkits without TA and (4, active) IP access to facilitator training materials and toolkits with TA. Each community coalition will partner with three settings for implementation: a church, clinic and community site. African Americans, 50-74 years of age, who are not current on CRC screening are eligible for study participation (n=7,200 or n=360 eligible individuals per community coalition). This assumes a sample size of 1800 per study arm, a significance level of 5% (i.e. alpha = 0.05), and a two-sided two-group chi-square test of proportions. Assuming that we observe in our study an increase in screening rates of colorectal cancer among participants in active arms compared to screening rates among participants in the passive arms, we will have greater than 99% power to detect statistically significant differences in the proportions. All statistical tests proposed for this study will be two-sided and will be performed using a significance level of 5% (i.e., alpha=0.05).