Reducing Health Disparities in Maryland Along the National Capital Border

简介(申请人提供)：癌症是亚裔美国人及太平洋岛民(AAPIs)的首要死因，而结直肠癌(CRC)的死亡率在AAPIs的癌症死亡人数中排名第三。然而，亚裔美国人的结直肠癌筛查率明显低于其他种族/民族。考虑到结直肠癌筛查可降低高达79%的死亡率，华裔和韩裔美国人的结直肠癌死亡率在过去十年中没有下降也就不足为奇了，而在其他种族/民族中观察到了下降的趋势。迫切需要了解结直肠癌筛查行为，特别是关于结直肠癌筛查的障碍和促进者，以及在华裔和韩裔美国人中增加结直肠癌筛查的策略。很少有研究探讨与华裔和韩裔美国人结直肠癌筛查相关的因素。这些研究中的大多数使用封闭式调查收集数据。因此，关于筛查决定因素的更深入的数据一直是有限的。为了解决文献中的这一显著差距，我们建议进行一项研究，以更好地了解结直肠癌筛查的障碍和促进者，采用混合方法。要探索的潜在因素将基于健康信念模式和社会生态模式的概念。具体地说，我们提出了以下两个目标：第一，通过20次关键的线人访谈，初步了解50岁及以上的华裔和韩裔美国人筛查结直肠癌的障碍和促进者。根据这些调查结果，我们将最终确定或通知我们的焦点小组指南草案。第二，提供对这一人群中筛查结直肠癌的障碍和促进者的了解，方法是：进行12个焦点小组，120名参与者，按华裔和韩裔美国人种族划分；与焦点小组参与者进行调查，以获得量化数据；并使用三角方法，汇聚关键线人访谈、焦点小组和调查答复的结果，以探索主要结果。考虑到在这一研究不足的中韩裔美国人中，持续的结直肠癌死亡率和较低的结直肠癌筛查率，这项两阶段混合方法研究的结果将有助于加强对结直肠癌筛查障碍和促进者的了解。此外，研究结果将为未来干预措施的发展提供信息，这些干预措施将文化和语言上适当的战略纳入交流信息、社区推广和教育以及环境和制度，以提高亚裔美国人人口中的筛查率。此外，拟议的研究将涉及2020年健康人的总体目标，以减少健康差距，以及减少新的CRC病例和死亡人数。

DESCRIPTION (provided by applicant): Cancer is the leading cause of death among Asian American and Pacific Islanders (AAPIs), and mortality from colorectal cancer (CRC) is ranked as the third most common in cancer deaths among AAPIs. However, CRC screening rates among Asian Americans are significantly lower than in other racial/ethnic groups. Considering that CRC screening reduces mortality by up to 79%, it is not surprising that CRC mortality has not been reduced among Chinese- and Korean Americans during last decade unlike in other racial/ethnic groups where a decreasing trend has been observed. There is a strong need to understand CRC screening behaviors particularly regarding barriers to and facilitators of CRC screening and strategies to increase CRC screening among Chinese- and Korean Americans. Few studies have examined the factors associated with CRC screening among Chinese- and Korean Americans. The majority of these studies collected data using closed-ended surveys. Therefore, more in-depth data on the factors underlying screening decisions have been limited. To address this notable gap in the literature, we propose to conduct a study to better understand the barriers to and facilitators of CRC screening, using a mixed methods approach. Potential factors to be explored will be based on concepts from the Health Belief Model and the Social Ecological Model. Specifically, we propose the following two aims: First, gain a preliminary understanding of barriers to and facilitators of CRC screening among Chinese- and Korean Americans age 50 and older by conducting 20 key informant interviews. Based on these findings, we will then finalize or inform the draft of our focus group guide. Second, provide understanding of barriers to and facilitators of CRC screening among this population by: conducting 12 focus groups with 120 participants that are segmented by Chinese- and Korean American ethnicity; conducting surveys with focus group participants to obtain quantitative data; and using a triangulation approach to converge results from the key informant interviews, focus groups, and survey responses to explore major findings. Considering the sustained CRC mortality and low CRC screening rates in this understudied Chinese- and Korean American population, findings from this two-stage mixed methods study will help enhance the understanding of the barriers to and facilitators of CRC screening. Moreover, the findings will inform the development of future interventions that incorporate culturally and linguistically appropriate strategies into communication messages, community outreach and education, and environmental and system to increase screening rates within the Asian American population. Furthermore, the proposed study will address the overarching Healthy People 2020 objective to reduce health disparities, as well as to reduce the number of new CRC cases and deaths.