Reducing Colorectal Cancer Health Disparities: An mHealth Intervention to Improve Screening among African American Men

减少结直肠癌健康差异：改善非裔美国男性筛查的移动医疗干预措施

• 批准号: 9907523
• 负责人: Samantha L. Leaf
• 金额: $ 22.41万
• 依托单位: ISA ASSOCIATES, INC.
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-11 至 2020-09-10
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9907523
• 关键词: Address; Adherence; Adoption; Adult; African American; Age; Behavior; Belief; Cancer Etiology; Car Phone; Caring; Cellular Phone; Cessation of life; Clinic; Clinical; Colorectal Cancer; Communication; Communities; Complex; Death Rate; Development; Diagnosis; Education; Electronic Health Record; Enrollment; Exclusion; Familiarity; Federally Qualified Health Center; Focus Groups; Frequencies; Gender; Health; Human Resources; Imagery; Incidence; Individual; Instruction; Intervention; Knowledge; Language; Lead; Link; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Methods; Modeling; Online Systems; Participant; Patient Care; Patients; Persons; Phase; Positioning Attribute; Poverty; Precancerous Polyp; Primary Health Care; Privacy; Provider; Race; Recording of previous events; Reporting; Research; Resources; Screening for cancer; Security; Series; Shapes; Site; Socioeconomic Status; Survival Rate; Telephone; Testing; Text; Text Messaging; Underinsured; Underserved Population; Uninsured; United States; base; cancer health disparity; cancer invasiveness; colorectal cancer screening; cost; design; group intervention; health belief; health disparity; health literacy; improved; intervention cost; low socioeconomic status; mHealth; male; malignant breast neoplasm; medically underserved; member; men; mobile computing; mortality; non-compliance; outreach; patient-level barriers; peer; personalized intervention; preference; prevent; primary care setting; programs; prototype; racial disparity; racism; recruit; satisfaction; screening; screening guidelines; skills; systematic review; theories; therapy design; tool; uptake; usability; web-based assessment

PROJECT SUMMARY/ABSTRACT Poverty has a myriad of pernicious effects on health, including higher incidence and mortality for most forms of cancer. Colorectal cancer (CRC), the second overall leading cause of cancer death, is no exception. CRC is diagnosed 40% more often in those lower in socioeconomic status (SES). In the United States, race and SES are inextricably linked, leading to profound health disparities. Indeed, CRC is particularly burdensome for Black people; most notably African American men. CRC incidence is 20% higher in Black men as compared to white men with death rates 52% higher. African American men have the lowest survival rates at all CRC stages. Because the precancerous polyps that cause most CRCs grow slowly, adherence to CRC screening can prevent most cases from becoming invasive cancer. Unfortunately, use of screening tests is inadequate, especially among low SES African American men. Indeed, 40% of the racial disparity in CRC incidence and 20% of the mortality differences can be attributed to lack of screening. Being Black, male, and low SES in the United States intersect to form a complex set of institutional, provider, and patient-level barriers that lead to these differential screening rates. Most existing approaches to increase CRC screening in this group utilize in- person or telephone-based education and patient navigation. While effective, these approaches are costly and resource intensive, limiting their adoption among organizations that primarily serve low SES African American men, such as Federally Qualified Health Centers (FQHCs). To address the need for an effective, affordable, and scalable intervention to increase CRC screening among medically underserved African American men, this project will develop a theory-based, tailored, and culturally- targeted CRC screening mHealth intervention for this group. The proposed intervention will be based on the health belief model (HBM) and delivered via mobile phone. It will include text messages designed to improve CRC knowledge and health beliefs. Additionally, the program will present three web-based video components: scripted vignettes, unscripted peer narratives, and educational instruction. All program content will be designed to reduce health literacy barriers and promote adherence to CRC screening recommendations. Finally, it will be culturally targeted by contextualizing HBM constructs with the health beliefs most relevant to low SES African American men and by integrating gender- and race-congruent imagery, language, and values. Eight FQHC staff members and 20 African American men will be recruited for focus group discussions to shape the proposed intervention. When a prototype version of the program is completed, 20 African American men who are nonadherent to CRC screening (i.e., target end-users) will be recruited for usability testing. The usability test will include a series of tasks intended to highlight the different features of the proposed intervention. Three usability metrics will be assessed: efficiency, accuracy, and subjective satisfaction.

项目总结/摘要 贫穷对健康有无数的有害影响，包括对大多数人来说， 癌症的形式。结直肠癌（CRC）是癌症死亡的第二大原因，也不例外。 CRC在社会经济地位较低的人群中的诊断率高出40%。在美国，种族和 社会经济地位不可避免地联系在一起，导致了深刻的健康差距。事实上，《儿童权利公约》对以下方面造成的负担尤其沉重： 黑人，尤其是非洲裔美国人。黑人男性的CRC发病率比男性高20%， 白色男性的死亡率高出52%。非裔美国人在所有CRC阶段的存活率最低。 因为引起大多数CRC的癌前息肉生长缓慢，坚持CRC筛查可以 防止大多数病例成为侵袭性癌症。不幸的是，筛查测试的使用是不够的， 特别是在低社会经济地位的非洲裔美国人中。事实上，40%的CRC发病率种族差异， 20%的死亡率差异可归因于缺乏筛查。作为黑人，男性，和低社会经济地位， 美国交叉形成一套复杂的机构，提供者和患者层面的障碍，导致 这些不同的筛查率。大多数现有的方法，以增加CRC筛查在这一组利用在- 基于个人或电话的教育和患者导航。虽然有效，但这些方法成本高， 资源密集型，限制了它们在主要为低社会经济地位的非裔美国人服务的组织中的采用 男性，如联邦合格的健康中心（CDHCs）。 为了满足对有效、负担得起和可扩展的干预措施的需求， 医疗服务不足的非洲裔美国人，这个项目将开发一个基于理论的，量身定制的，和文化- 针对这一群体的CRC筛查mHealth干预。拟议的干预措施将基于 健康信念模型（HBM），并通过移动的电话交付。它将包括旨在改善 CRC知识和健康信念。此外，该计划将提出三个基于网络的视频组件： 有脚本的小插曲，无脚本的同伴叙述，以及教育指导。所有节目内容将 旨在减少健康素养障碍，促进遵守CRC筛查建议。 最后，它将通过将HBM结构与最相关的健康信念结合起来， 低社会经济地位的非洲裔美国人和整合性别和种族一致的形象，语言和价值观。 将征聘8名阿富汗人道主义协调委员会工作人员和20名非洲裔美国男子参加重点小组讨论， 制定拟议的干预措施。当该计划的原型版本完成后，20名非洲裔美国人将在2015年10月20日至2017年10月30日期间， 不遵守CRC筛查的男性（即，目标最终用户）进行可用性测试。的 可用性测试将包括一系列任务，旨在突出所建议的 干预将评估三个可用性指标：效率、准确性和主观满意度。