Joy Luck Academy: A Culturally Sensitive Social Support Intervention

描述(申请人提供)：尽管亚裔美国人的人口规模不断增加(1730万)，他们患乳腺癌的比例也在不断上升，但很少有人关注亚裔美国人(AA)乳腺癌幸存者的信息和心理需求。更值得注意的是，我们没有找到在这一人群中进行的随机对照试验，以解决这一未得到充分研究和服务的人群的未得到满足的需求。由于他们的社会、文化和语言障碍，很大程度上无法获得具有文化能力的精神卫生保健。缺乏具有文化能力的心理健康护理，以及缺乏确定和解决亚裔美国癌症幸存者的身体、情感和社会需求的研究，构成了癌症护理中不必要和可以避免的差距。在美国约1,730万亚裔美国人中，华裔美国人是最大的亚裔美国人群体(24%)。我们的研究和社区合作伙伴团队设计了一种名为“喜悦幸运学院”的具有文化敏感性的社会支持干预措施，为华裔美国乳腺癌幸存者(BC)提供教育和同行导师支持。我们团队最近完成的一项单臂试点研究表明，JLA受到参与者的高度重视，并与华裔美国人BCS更好的生活质量有关。这项研究提出了一项随机对照试验(RCT)，以测试JLA计划的健康益处，并使用基于社区的参与性研究(CBPR)方法以及混合演绎和归纳方法来确定JLA对谁以及为什么有效。已完成初步治疗(N=210)的华裔美国乳腺癌幸存者将被随机分配到JLA组或对照组，在等待JLA期间接受加强的常规护理。在基线、干预后立即以及1个月和4个月的随访中评估健康结果。我们将使用演绎量化方法来测试健康结果、理论化的中介因素和基线个体差异。我们使用归纳和演绎的定性方法来探索和理解解释干预益处的机制，并加强对量化数据的解释。对于不同的种族群体，几乎没有经过测试的心理社会干预措施。主要的假设障碍之一是缺乏对乳腺癌含义的独特文化差异的理解，以及对乳腺癌的适当情感和社会反应。更少的研究测试了基于证据的计划在有色人种社区中的可行性、适用性和可持续性。现有的社区努力往往是试错的结果，没有理论指导，也缺乏科学 严谨。这项研究是第一次在再生障碍性障碍儿童中进行RCT社会支持干预。这项干预是创新的，因为它与AA集团的文化相关，使用了理论上有基础的CBPR方法，以及混合方法设计。我们期望，在理论和方法的指导下，对服务不足和研究不足的人群进行拟议的研究，将在未来的研究中启发新的方向，以满足健康差异研究中的这些科学和实践需求。

DESCRIPTION (provided by applicant): Despite the increasing size of the Asian American population (17.3 million) and their growing rate of breast cancer, little attention is focused on Asian American (AA) breast cancer survivors' informational and psychological needs. More notably, we have located no randomized controlled trial conducted in this population to address the unmet needs of this understudied and underserved population. Due to their social, cultural, and linguistic barriers, culturally competent mental health care is largely unavailable. The lack o both the availability of culturally competent mental health care and studies to identify and address the physical, emotional, and social needs of Asian American cancer survivors' constitute unnecessary and avoidable disparities in cancer care. Chinese Americans comprise the largest subgroup (24 percent) among the estimated 17.3 million Asian Americans in the U.S. Our research and community partner team have designed a culturally sensitive social support intervention called the "Joy Luck Academy (JLA)" that provide education and peer mentor support for Chinese American breast cancer survivors (BCS). A single-arm pilot study recently completed by our team has shown that the JLA is highly valued by participants and is associated with better quality of life among Chinese American BCS. This study proposes a randomized controlled trial (RCT) to test the health benefits of the JLA program and to identify for whom and why the JLA works using a community based participatory research (CBPR) approach, and mixed deductive and inductive methods. Chinese American breast cancer survivors who have completed primary treatment (N=210) will be randomly assigned to either the JLA group or a control group to receive enhanced usual care while waiting for the JLA. Health outcomes are assessed at baseline, immediately post intervention, and 1 and 4 months follow-ups. We will use deductive quantitative methods to test health outcomes, theorized mediators, and baseline individual differences. We use inductive and deductive qualitative methods to explore and understand mechanisms explaining the benefits of the intervention and to enhance the interpretation of the quantitative data. Few tested psychosocial interventions exist for diverse ethnic groups. One of the major hypothesized barriers is the lack of understanding of unique cultural differences in the meaning of and appropriate emotional and social responses to breast cancer. Even fewer studies have tested evidence-based programs for their feasibility, applicability, and sustainability in communities of color. Existing communit efforts are often the result of trial and error without theoretical guidance and lack of scientific rigor. This proposed study is the first RCT social support intervention among AA BCSs. The intervention is innovative as it is culturally relevant to an AA group, using a theoretically grounded and CBPR approach, and mixed methods design. We expect that the proposed research guided by both theory and methods with an underserved and understudied population will inspire new directions in future research to address these scientific and practical needs in health disparities research.