Overcoming barriers to cancer screening among women living in rural and segregated communities

项目总结 2018年，4170名妇女将死于宫颈癌，23240名妇女将死于结直肠癌，但许多人 这些死亡是可以通过癌症筛查避免的。癌症死亡率和筛查患病率因 地理上，生活在农村和种族隔离地区的妇女更有可能死于，但不太可能死于 与其他地区的女性相比，筛查这些癌症。农村和种族隔离地区的妇女面临着 独特的多层次筛查障碍(例如，低癌症风险认知、高旅行负担)。以家为本的自我 收集子宫颈癌的人乳头瘤病毒(HPV)检测和粪便免疫化学检测(FIT) 结直肠癌，配以适合文化的教育材料，可以克服这些障碍。 然而，要在农村和隔离社区成功实施这种干预措施， 未得到充分研究。拟议的研究将使用健康行为理论以及干预设计和适应 阐明与农村妇女癌症筛查相关的人和环境水平因素的技术 和隔离区。 在拟议的K22项目中，首席调查员(PI)和合作者将采用混合方法 形成性研究(包括空间数据分析、深度访谈、调查和焦点小组) 检查环境和个人水平与妇女(50-65岁)癌症筛查的相关性 农村、隔离地区(目标1)。利用这些发现，研究小组将适应现有的、基于证据的癌症 筛选教育材料，这些材料将在#年分发给农村隔离社区的合格妇女 结合自我收集的HPV检测和FIT(目标2)。该小组将研究可行性和初步 这项先导研究的结果数据支持R01水平的随机混合有效性-实施试验 在这些服务不足和研究不足的社区改善癌症筛查的干预材料。 除了这些研究活动外，拟议的K22项目还包括几项培训活动，以支持 私家侦探詹妮弗·L·莫斯博士的职业发展。莫斯博士的长期职业目标是成为一名 在癌症预防行为和地理差异的跨学科研究中处于科学领先地位 结果。她的短期职业目标包括获得混合方法分析方面的额外培训， 干预设计，以及赠款写作。有了受保护的研究和进一步培训时间，莫斯博士可以使用 拟议的K22项目将作为一名独立的行为科学家开始职业生涯，为国家 癌症研究所的使命是减少人口中的癌症负担。

PROJECT SUMMARY In 2018, 4,170 women will die from cervical cancer and 23,240 will die from colorectal cancer, yet many of these deaths avoidable through cancer screening. Cancer mortality rates and screening prevalence vary by geography, with women living in rural and racially-segregated areas more likely to die from, but less likely to screen for, these cancers compared to women in other areas. Women in rural and segregated areas face unique multilevel barriers to screening (e.g., low cancer risk perceptions, high travel burden). Home-based self- collection of human papillomavirus (HPV) tests for cervical cancer and fecal immunochemical tests (FIT) for colorectal cancer, paired with culturally-appropriate educational materials, could overcome these barriers. However, the successful implementation of such interventions in rural and segregated communities is understudied. The proposed study will use health behavior theory and intervention design and adaptation techniques to clarify person- and environment-level factors related to cancer screening among women in rural and segregated areas. In the proposed K22 project, the principal investigator (PI) and collaborators will conduct mixed methods formative research (including analysis of spatial data, in-depth interviews, surveys, and focus groups) to examine environment- and person-level correlates of cancer screening among women (ages 50-65 years) in rural, segregated areas (Aim 1). Using those findings, the team will adapt existing, evidence-based cancer screening educational materials, which will be delivered to eligible women in rural, segregated communities in conjunction with self-collected HPV tests and FIT (Aim 2). The team will examine feasibility and preliminary outcomes data for this pilot study to support an R01-level randomized hybrid effectiveness-implementation trial of the intervention materials to improve cancer screening in these underserved and understudied communities. In addition to these research activities, the proposed K22 project includes several training activities to support the career development of the PI, Dr. Jennifer L. Moss. Dr. Moss’s long-term career goal is to become a scientific leader in transdisciplinary research on geographic disparities in cancer prevention behaviors and outcomes. Her short-term career goals include obtaining additional training in mixed methods analysis, intervention design, and grant writing. With protected time for research and further training, Dr. Moss can use the proposed K22 project to launch a career as an independent behavioral scientist contributing to the National Cancer Institute’s mission to reduce the burden of cancer in the population.