Pilot Project 1: Reducing Cervical Cancer Screening Health Disparities among Pacific Islanders Living in Guam (GU) and Hawaii (HI)

试点项目 1：减少居住在关岛 (GU) 和夏威夷 (HI) 的太平洋岛民之间的宫颈癌筛查健康差异

• 批准号: 9044682
• 负责人: Neal A. Palafox
• 金额: $ 7.33万
• 依托单位: UNIVERSITY OF HAWAII AT MANOA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-28 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9044682
• 关键词: 21 year old; Address; Advanced Malignant Neoplasm; Affect; Area; Attitude; Behavior; Belief; Biostatistics Shared Resource; Cancer Burden; Cancer Center; Car Phone; Cervical Cancer Screening; Communities; Community Outreach; Diagnosis; Disease; Economics; Effectiveness; English Language; Environment; Family; Federated States of Micronesia; Future; Goals; Guam; Hawaii; Health Care Costs; Health Promotion; Health Services; Health Services Accessibility; Health Status; Healthcare Systems; Healthy People 2020; Human Resources; Incidence; Indigenous; Information Technology; Intention; Intervention; Knowledge; Language; Lead; Life; Mainstreaming; Malignant neoplasm of cervix uteri; Marshall Islands; Methods; Micronesia; Mission; Morbidity - disease rate; Nomads; Outcome; Pacific Island Americans; Participant; Pilot Projects; Population; Populations at Risk; Prevalence; Randomized; Research Project Grants; Risk; Services; Social Welfare; Societies; Staging; Target Populations; Testing; Text; Textiles; Transportation; Treatment Efficacy; United States; Universities; Ursidae Family; Woman; Women' s Group; Work; abstracting; base; community based participatory research; cost; design; disorder prevention; experience; health disparity; health equity; health literacy; high risk; improved; mortality; neoplasm registry; peer; post intervention; programs; screening; secondary outcome

Project Summary/Abstract Pilot 1 is a 3 year hypothesis-driven research project aimed at decreasing cervical cancer screening disparities in Chuukese and Marshallese Pacific Islander women. This group of women has among the highest incidence rates of cervical cancer in the world (79.7 per 100,000 and 42.4 per 100,000 (2007-2011)) in the Republic of the Marshall Islands (RMI) and Pohnpei, Federated States of Micronesia (FSM) respectively, compared to 9.9 per 100,000 women in the US(1). Therefore, identifying culturally appropriate methods to increase screening for this preventable disease is essential for these women and the welfare of their family. Prior work has persuaded us that text messaging on mobile phones is an effective method for reaching this population of Pacific Islanders. Pilot Project 1 has three objectives: 1) to understand the knowledge, attitudes, and beliefs of Micronesian Pacific Islander migrant populations that affect cervical cancer screening behavior; 2) to develop SMS (Short Message Service) strategies that will lead to increased screening rates in the target populations; 3) to support an environment for community-based participatory research and engagement for this study. Target Population: The intervention will focus on women ages 21-65 (inclusive) from two migrant groups of Pacific Islanders who bear a disproportionate burden of cervical cancer morbidity and mortality: 1) the indigenous Chuukese women of the Federated States of Micronesia (FSM) who recently migrated to GU and 2) women from the RMI who recently migrated to HI. The overarching goal of the project is to evaluate the effectiveness of community-based SMS strategies to increase cervical cancer screening rates in underserved Pacific Islander populations who have migrated to GU and HI within the last 5 years. Specific Aim 1 Evaluate the effectiveness of community-based SMS strategies to increase cervical cancer screening rates in underserved indigenous Chuukese and Marshallese populations who have migrated to GU and HI within the last 5 years Aim 1.1: Develop SMS messaging materials encouraging cervical cancer screening in three languages: English, Chuukese and Marshallese. Aim 1.2: Implement a randomized delayed control intervention to assess the effectiveness of SMS to increase completion of cervical cancer screening among Marshallese in HI and Chuukese in GU. Hypothesis: Cervical cancer screening completion will be higher for recently migrated (2007-2014) Chuukese and Marshallese women, ages 21-65, who received the peer-led, SMS-based intervention compared to those who did not receive the intervention. The efficacy of the intervention will be assessed by comparing the prevalence of completion of cervical cancer screening between the two randomized groups in an intention-to-treat analysis at 9 months post- randomization; we will also compare the change in these outcomes before and after intervention in women across both randomized groups. As a secondary outcome, intent to screen will be tracked; the study participants who intend to obtain cervical cancer screening following the intervention but ultimately do not receive cervical cancer screening to understand what other factors, such as transportation, cultural barriers, or a low priority of screening, influence their completion of cervical cancer screening. Knowledge these barriers will be used to develop and design a more robust cervical cancer screening program in the future. SMS health messages directed to this population may be an effective method to reach these culturally isolated and vulnerable Pacific Islander populations. The pilot project will support the overall goals of the Comprehensive Partnership to Advance Cancer Health Equity (CPACHE) by focusing on decreasing the disparity in cancer burden in under-served Pacific Islanders in HI and GU. The pilot will draw support from the Community Outreach Core (COC) and Shared Resources (Biostatistics, Information Technology and Cancer Registry). Pilot project personnel are well-versed in working with Pacific Islander community coalitions, and with the implementation of CBPR within these communities. This design is consistent with the mission and overarching goals of Healthy People 2020 and its Community-Based Objectives to expand culturally relevant approaches to health promotion and disease prevention (www.healthypeople.gov). Most importantly, this project addresses an urgent need to act to reduce the extremely high risk for cervical cancer, which is a preventable disease, in at-risk under-served Pacific Islander women.

项目概要/摘要 试点 1 是一个为期 3 年的假设驱动研究项目，旨在减少宫颈癌筛查差异 楚克语和马绍尔语太平洋岛民妇女。这组女性的发病率最高 共和国的世界宫颈癌发病率（每 100,000 人 79.7 例，每 100,000 人 42.4 例（2007-2011 年）） 马绍尔群岛 (RMI) 和密克罗尼西亚联邦 (FSM) 波纳佩岛分别为 9.9 美国每 100,000 名女性(1)。因此，确定文化上适当的方法来增加筛查 因为这种可预防的疾病对于这些妇女及其家庭的福祉至关重要。之前的工作有 使我们相信手机短信是接触这一人群的有效方法 太平洋岛民。试点项目 1 具有三个目标：1) 了解人们的知识、态度和信念 影响宫颈癌筛查行为的密克罗尼西亚太平洋岛民移民群体； 2）开发 SMS（短信服务）策略将提高目标人群的筛查率； 3） 支持基于社区的参与性研究和参与本研究的环境。目标 人口：干预措施将重点关注来自太平洋地区两个移民群体的 21 岁至 65 岁（含）女性 承受着不成比例的宫颈癌发病率和死亡率负担的岛民：1) 土著居民 最近移居至 GU 的密克罗尼西亚联邦 (FSM) 楚克妇女和 2) 妇女 来自最近迁移到 HI 的 RMI。 该项目的总体目标是评估基于社区的短信策略的有效性 提高移居到 GU 的服务不足的太平洋岛民群体中的宫颈癌筛查率 以及过去 5 年内的 HI。 具体目标 1 评估基于社区的短信策略对增加宫颈癌的有效性 移居到 GU 的服务不足的土著楚克人和马绍尔人的筛查率 以及过去 5 年内的 HI 目标 1.1：以三种语言开发鼓励宫颈癌筛查的短信材料： 英语、楚克语和马绍尔语。 目标 1.2：实施随机延迟控制干预以评估 SMS 提高 完成了夏威夷州马绍尔人和格鲁吉亚楚克人的宫颈癌筛查。 假设：最近移居（2007-2014 年）的 Chuukese 人的宫颈癌筛查完成率会更高 和年龄 21-65 岁的马绍尔女性相比，她们接受了同伴主导、基于短信的干预 谁没有接受干预。 将通过比较宫颈癌的完成率来评估干预措施的效果 在治疗后 9 个月的意向治疗分析中对两个随机组进行筛选 随机化；我们还将比较对女性进行干预前后这些结果的变化 跨越两个随机组。作为次要结果，将跟踪筛查意图；研究 打算在干预后进行宫颈癌筛查但最终没有进行的参与者 接受宫颈癌筛查以了解还有哪些其他因素，例如交通、文化障碍或 筛查优先级低，影响其完成宫颈癌筛查。了解这些障碍 未来将用于开发和设计更强大的宫颈癌筛查计划。 针对这一人群的短信健康信息可能是接触这些文化孤立人群的有效方法 和弱势太平洋岛民群体。该试点项目将支持总体目标 通过专注于减少癌症健康公平的全面伙伴关系（CPACHE） HI 和 GU 服务不足的太平洋岛民的癌症负担存在差异。该试点项目将得到以下机构的支持 社区外展核心 (COC) 和共享资源（生物统计学、信息技术和癌症 注册表）。试点项目人员精通与太平洋岛民社区联盟的合作，并且 随着 CBPR 在这些社区内的实施。这个设计与使命一致 《健康人民 2020》的总体目标及其以社区为基础的目标，以扩大文化相关性 健康促进和疾病预防的方法（www.healthypeople.gov）。最重要的是，这 该项目解决了采取行动降低宫颈癌极高风险的迫切需要，宫颈癌是一个 服务不足的太平洋岛民女性中的可预防疾病。