Developing and evaluating scalable and culturally relevant interventions to improve breast cancer screening among White Mountain Apache women

项目摘要 白色山区阿帕奇（WMA）领导人表示迫切需要优先考虑乳腺癌筛查 由于对低筛查率的担忧，在NINESTIRE Xi进行了研究。截至2018年， 符合条件的WMA女性比2020年健康人群目标低2倍以上，为39.1% 相比之下，81.1%，大大低于全国AI/AN妇女的筛查率。在 亚利桑那州（AZ），WMA部落土地所在地，32%的AI女性在后期被诊断出来 疾病（即，无论是区域或远距离与当地疾病）相比，25%的AZ妇女整体。有 非常需要文化上适当的干预措施，以提高筛查率和降低死亡率， WMAT人群乳腺癌发病率。 该项目将支持WMA-JHU合作伙伴和我们建立的癌症护理社区咨询 董事会将根据有关乳腺癌障碍和促进因素的调查结果设计两种激励工具 在阿帕奇妇女中进行筛查，提供者缺乏时间和资源来提供诊所- 基础教育。第一个工具将在诊所的平板电脑上提供， 一致的乳腺癌筛查信息。它被命名为基于平板电脑的教育，以提高 接受乳房X光检查”或“团队”。第二个工具将是基于个人的一对一 由一名准专业的阿帕奇妇女健康教练提供的同伴教育模块，称为 “教练”，以解决个人的个人障碍和促进乳腺癌和筛查 关注并提供一对一的支持，安排，运输和完成乳房X光检查。 我们将通过随机对照试验对这些干预工具进行评估，随机对照试验有500名50岁以上的女性接受了 在当地门诊就诊后转介乳房X光检查。女性将根据既往病史进行分层， 乳房X光检查（从未或曾经）和年龄（<65或65+），然后1：1随机接受TEAM 团队+教练WMA-JHU合作伙伴带来了丰富的经验建设和评估 激励行为改变课程提供一对一和移动的健康工具， 已扩展到21个州的140多个部落社区。

PROJECT SUMMARY White Mountain Apache (WMA) leaders have voiced an urgent need to prioritize breast cancer screening research in NARCH XI due to concern about low screening rates. As of 2018, screening rates among eligible WMA women were more than 2 times lower than the Healthy People 2020 target, 39.1% compared to 81.1%, and substantially lower than screening rates among AI/AN women nationally. In Arizona (AZ), where the WMA tribal lands are located, 32% of AI women are diagnosed at later stage disease (i.e., either regional or distant vs. local disease) compared to 25% of AZ women overall. There is a great need for culturally appropriate interventions to improve screening rates and reduce mortality and morbidity from breast cancer in the WMAT population. This project will support the WMA-JHU partners and our established cancer care Community Advisory Board to design two motivational tools based on findings regarding barriers and facilitators to breast screening among Apache women, and he shortage of providers’ time and resources to provide clinic- based education. The first tool will be delivered on a tablet in the clinic with highly graphic, culturally congruent breast-cancer screening information. It is named Tablet-based Education to improve Acceptance of Mammography” or “TEAM.” The second tool will be an Individual-based one-to-one peer-educational module delivered by a paraprofessional Apache women’s health coach, called “COACH,” to address individuals’ personal barriers and facilitators to breast cancer and screening concerns and provide one-to-one support for scheduling, transportation and completing a mammogram. We will evaluate these intervention tools through an RCT with n= 500 women aged 50+ who receive a mammography referral after a local outpatient visit. Women will be stratified by prior history of mammography (never or ever) and age (<65 or 65+), and then randomized 1:1 to receive either TEAM alone or TEAM+Coach. The WMA-JHU partners bring extensive experience building and evaluating motivational behavior change curricula delivered one-on-one and with mobile health tools that have now been scaled to >140 tribal communities across 21 states.