Improving Uptake of Cervical Cancer Prevention Services in Appalachia

项目概要-总体 该计划项目的目标是解决阿巴拉契亚地区宫颈癌发病率和死亡率的负担 通过提供以诊所为基础的综合预防方案，重点关注宫颈癌的主要原因， 癌症（吸烟、人乳头瘤病毒（HPV）感染和缺乏宫颈癌筛查） 旨在针对个人、社会和社区、卫生系统和更广泛的背景层面的障碍， 子宫颈癌的负担。建立在我们长期的合作研究和社区的历史 该计划将测试以烟草为重点的卫生系统干预措施的有效性 使用，HPV疫苗接种和宫颈癌筛查（巴氏试验和/或自我检测，并对阳性检测进行随访）， 作为一个综合的基于诊所的宫颈癌预防计划的一部分。多层次的干预措施（直接 三个层次的影响-诊所，提供者和病人）将提供给符合条件的女性患者和年龄符合条件的 四个阿巴拉契亚州（俄亥俄州、肯塔基州、西弗吉尼亚州和弗吉尼亚州）的儿童和年轻人。我们的研究 这一过程由一个基于健康的社会决定因素的社会生态模型--普罗克特模型--指导 实施科学和基于社区的示范性研究（CBPR）框架。的目的 该计划项目是：1）测试综合宫颈癌预防计划的有效性， 包括三个既定的干预措施，旨在解决一个地区宫颈癌的三个原因， 美国宫颈癌发病率和死亡率最高的国家之一; 2）评估 宫颈癌预防方案的影响，包括执行情况和可接受性， 对诊所的短期和长期影响以及可持续性。四个核心-干预和联合， 调查和数据收集、生物统计和评估以及行政-将促进 所有项目的一体化运作。该计划中项目的整合和互动在几个方面很明显 方式：1）所有项目都集中在一个健康差距; 2）参与者将从相同的卫生系统招募; 3)所有项目都使用一套核心措施; 4）所有项目都包括跨学科团队; 5）所有项目都包括跨学科团队。 项目建立在我们长期合作研究和社区的基础上， 6）所有项目都侧重于使用Warnecke模型进行多层次评估和/或干预， 一个框架，并利用普罗克特等人的实施科学框架; 7）所有项目都涉及互动 以某种方式与社区合作，从而增强该计划的CBPR性质;以及8）评估将评估 项目和整个计划层面的实施、服务和客户成果，包括：成本， 满意度、有效性、可持续性和安全性，仅举几例。如果成功，这个项目 将为解决服务不足社区的差异提供新的创新方法的证据 制定了可持续性和传播计划以及成本效益数据。

PROJECT SUMMARY - OVERALL The goal of this Program Project is to address the burden of cervical cancer incidence and mortality in Appalachia through the delivery of a clinic-based integrated prevention program that focuses on the major causes of cervical cancer (tobacco smoking, Human Papillomavirus (HPV) infection, and lack of cervical cancer screening) designed to target individual, social and community, health system and broader contextual-level barriers related to the burden of cervical cancer. Building upon our long history of collaborative research and community partnerships, the Program will test the effectiveness of health system-based interventions focused on tobacco use, HPV vaccination and cervical cancer screening (Pap test and/or self-testing with follow-up of positive tests), as part of an integrated clinic-based cervical cancer prevention program. The multi-level interventions (directed to three levels of influence – clinic, provider and patient) will be offered to eligible female patients and age-eligible children and young adults in four Appalachian states (Ohio, Kentucky, West Virginia and Virginia). Our research process is guided by a socio-ecological model based on the Social Determinants of Health, the Proctor Model for Implementation Science and a Community-Based Participatory Research (CBPR) framework. The aims of this Program Project are to: 1) Test the effectiveness of an integrated cervical cancer prevention program, consisting of three established interventions, designed to address three causes of cervical cancer in a region with one of the highest cervical cancer incidence and mortality rates in the United States; and 2) Evaluate the impact of the cervical cancer prevention program, including implementation, and acceptability, with attention to both short- and long-term impact and sustainability at the clinics. Four cores – Intervention and Consortium, Survey and Data Collection, Biostatistics and Evaluation, and Administrative – will facilitate the smooth and integrated operation of all projects. Integration and interaction of the projects in this Program is evident in several ways: 1) all projects focus on one health disparity; 2) participants will be recruited from the same health systems; 3) a core set of measures is being used by all projects; 4) all projects include transdisciplinary teams; 5) all projects build upon and extend findings from our long history of collaborative research and community partnerships; 6) all projects focus on multi-level assessment and/or interventions using the Warnecke model as a framework and utilize the Proctor et al. Implementation Science Framework; 7) all projects involve interaction with the community in some way, thus enhancing the CBPR nature of the Program; and 8) evaluation will assess implementation, service and client outcomes at the project and overall Program levels including: cost, satisfaction, effectiveness, sustainability, and safety, to name a few outcomes. If successful, this Program Project will provide evidence for a novel and innovative approach to address disparities in underserved communities with plans for sustainability and dissemination, as well as cost-effectiveness data.