Research Project

项目总结（见说明）： 拉丁美洲人是美国增长最快的人口。拉丁裔女性宫颈癌的发病率比非拉丁裔白人高出约70%[1]。拉丁裔妇女的宫颈癌死亡率也比非拉丁裔白人高50%[1]。拉丁美洲人宫颈癌的不成比例的负担被认为是由于筛查率低和在异常巴氏试验后对推荐的诊断随访的依从性差。拟议项目的总体目标是测试一个文化适宜的诊所为基础的计划，以增加巴氏试验的利用率和改善坚持后续异常巴氏试验后，在华盛顿州的亚基马谷的拉丁美洲妇女的样本的有效性。该项目的主要具体目标是：1）评估两个文化上适当的、量身定制的方案的相对功效，以增加拉丁美洲妇女的宫颈癌筛查，这两个方案是：a）低强度方案， 包括宫颈癌筛查的视频方法;以及B）由视频加上促进剂干预组成的更高强度的方案，以鼓励宫颈癌筛查; 2）评估两种干预方案的成本效益。该提案的第二个目的是：1）评估患者导航程序的有效性，以提高参与诊所接受异常巴氏试验的妇女的依从性并缩短随访时间。这一目标的组成部分是：a）在20名最近巴氏试验异常的拉丁美洲妇女中进行一对一的定性访谈，以确定与遵守建议的随访相关的突出因素; B）开发和试点测试一个文化上合适的患者导航程序，以提高遵守率，减少接受建议的随访的时间。在随机化后6个月，通过评估干预组和对照组在使用宫颈癌筛查服务方面的变化（基于自我报告和病历审查），对主要目标进行评价。将计算每个干预组每名接受筛查妇女的成本。 通过评估干预前后在异常巴氏试验后90天内接受推荐随访的女性比例变化以及治疗时间变化进行评估。

PROJECT SUMMARY (See instructions): Latinos are the fastest growing population in the United States (US). The incidence of cervical cancer among Latino women is about 70% higher than that among non-Latino Whites [1]. Latino women also experience 50% higher cervical cancer mortality than non-Latino whites [1]. The disproportionate burden of cervical cancer among Latinas is thought to be attributed to both low rates of screening and poor adherence to recommended diagnostic follow-up after an abnormal Pap test. The overall goal of the proposed project is to test the efficacy of a culturallyappropriate clinic-based program to increase Pap test utilization and improve adherence to follow-up after an abnormal Pap test in a sample of Latino women in the Yakima Valley of Washington State. The primary specific aims for this project are to: 1) Assess the relative efficacy of two culturally-appropriate, tailored programs to increase cervical cancer screening among Latino women, the two programs are: a) a low-intensity program, consisting of a video approach to cervical cancer screening; and b) a higher intensity program that consists of the video plus a promotora-intervention to encourage cervical cancer screening; 2) Assess the costeffectiveness of the two intervention programs. A secondary aim ofthis proposal is to: 1) Evaluate the efficacy of a patient navigator program to improve adherence and reduce time to follow-up among women who receive abnormal Pap tests in the participating clinics. The components of this aim are to: a) conduct qualitative one one-one interviews among 20 Latino women with a recent abnormal Pap test to identify salient factors related to adherence to recommended follow-up; b) develop and pilot-test a culturally-appropriate patient navigator program to improve adherence and reduce time to receipt of recommended follow-up. The primary aims will be evaluated by assessing changes in the use of screening services for cervical cancer (based on self-report and medical record review) in pair-wise comparisons of the intervention and control arms, six months following randomization. Cost per woman screened will be calculated for each intervention arm. The secondary aim will be evaluated by assessing pre- and post-intervention changes in the proportions of women who receive recommended follow-up within 90 days of an abnormal Pap test and changes in the time to treatment.