e-Motivacion: Developing and pilot testing an app to improve Latinos screening colonoscopy rates

项目摘要/摘要 罹患结直肠癌(CRC)的风险随着年龄的增长而直接增加，89%的CRC发生在 50岁以上的个人。在快速增长和服务不足的拉丁裔中，儿童权利委员会是第三个 癌症死亡的主要原因。与非拉丁裔白人相比，拉丁裔被诊断出患有 局部性结直肠癌，更有可能被诊断为晚期疾病。因此，改进是至关重要的。 这一人群的CRC预防工作。已公布的指南建议，中等风险人群从 在50岁时筛查结直肠癌。在推荐的结直肠癌筛查检查中，可以考虑结肠镜检查。 黄金标准，因为它允许检测和切除癌前病变和癌性息肉。 尽管筛查结肠镜检查可以发现和预防结直肠癌，但超过一半的拉丁裔人还没有接受过结肠镜检查 在推荐时间范围内筛查结肠镜检查(每十年筛查一次结肠镜检查)。它是 提高拉丁裔人的结肠镜检查筛查率至关重要，以帮助预防这种脆弱和 不断增长的人口。米勒博士之前的研究以及目前的文献表明， 电子传递的动机面试(e-MI)干预可能会改善拉丁裔的筛查 结肠镜检查。通过消除对现场专业人员的需求，e-MI干预是潜在的 高覆盖、低成本干预。尽管承诺进行电子MI干预以改善拉美裔的筛查 在结肠镜检查方面，到目前为止还没有研究开发和测试这种干预措施。拟议的NIA R34的目标是开发并开始测试一款名为e-Motivión的e-MI平板电脑应用程序(APP)。这个 E-Motivisión应用程序将提供英语和西班牙语两种版本，并将交付给初选参与者 在他们收到结肠镜筛查的转介后，他们会去护理诊所。拟议的项目将首先创建和 测试一款互动的e-Motival应用程序原型。届时将有四个有关键利益相关者的焦点小组 提供他们对应用程序原型的反馈(N=34)。焦点小组成员的反馈将指导 电子汽车应用程序的开发和编程。接下来，该应用程序将进行现场测试，使用迭代 方法，与拉丁裔转介筛查结肠镜检查(N=40)。现场测试结果将指导 电子汽车应用程序的开发、修订和定稿。然后，将进行一项试点研究，以开始 检查e-Motivisión应用程序在改善拉丁裔结肠镜检查摄取率方面的有效性。 参与者(N=80)将被随机分配到两组中的一组：E-Motivisión APP (n=40)或一般健康资讯APP(n=40)。初步研究的结果将为电力计算提供参考 用于未来的随机临床试验，该试验将正式测试APP的疗效。如果这个研究项目 证明e-Motivión应用程序有效。有强有力的理由将该应用程序整合到标准临床中 关注儿童权利，以减轻儿童权利委员会在日益壮大和脆弱的拉丁裔社区中的总体负担。

PROJECT SUMMARY/ABSTRACT The risk of developing colorectal cancer (CRC) directly increases with age, with 89% of all CRC occurring in individuals over the age of 50. Among Latinos, a fast growing and underserved population, CRC is the third leading cause of cancer death. Compared to non-Latino whites, Latinos are less likely to be diagnosed with localized CRC and more likely to be diagnosed with advanced stage disease. Therefore, it is critical to improve this population’s CRC prevention efforts. Published guidelines recommend that average risk people begin screening for CRC at the age of 50. Of the recommended CRC screening tests, a colonoscopy is considered the gold standard because it allows for both the detection and removal of precancerous and cancerous polyps. Although screening colonoscopies can detect and prevent CRC, more than half of Latinos have not received a screening colonoscopy within the recommended time frame (one screening colonoscopy per ten years). It is critical to increase Latinos’ screening colonoscopy rates in order to help prevent CRC in this vulnerable and growing population. Dr. Miller’s previous research, as well as the current literature, suggests that an electronically-delivered motivational interviewing (e-MI) intervention may improve Latinos’ screening colonoscopy uptake. By eliminating the need for an on-site professional, an e-MI intervention is a potentially high reach, low cost intervention. Despite the promise of an e-MI intervention to improve Latinos’ screening colonoscopy uptake, no research to date has developed and tested such an intervention. The proposed NIA R34 aims to develop and begin to test an e-MI tablet application (app), called e-Motivación (e-Motivation). The e-Motivación app will be offered in both English and Spanish and will be delivered to participants in the primary care clinic after they receive a referral for a screening colonoscopy. The proposed project will first create and test an interactive prototype of the e-Motivación app. Four focus groups with key stakeholders will then provide their feedback on the app’s prototype (N=34). The focus group members’ feedback will guide the development and programming of the e-Motivación app. Next, the app will be field-tested, using an iterative approach, with Latinos referred for a screening colonoscopy (N=40). The field-testing results will guide the development, revisions and finalization of the e-Motivación app. Then, a pilot study will be conducted to begin to examine the efficacy of the e-Motivación app for improving screening colonoscopy uptake among Latinos. Participants (N=80) will be randomly assigned, stratified for language, to one of two groups: e-Motivación app (N=40) or general health information app (N=40). The results of the pilot study will inform power calculations for a future randomized clinical trial that will formally test the efficacy of the app. If this program of research proves the e-motivación app efficacious there is a strong argument to integrate the app into standard clinical care in order to reduce the overall burden of CRC in the growing and vulnerable Latino community.