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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

基本信息

批准号：
10325077
负责人：
Samantha L. Leaf
金额：
$ 72.36万
依托单位：
ISA ASSOCIATES, INC.
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-11 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10325077
关键词：
Address Adherence Adoption Adult African American Age Algorithms Behavior Belief Benchmarking Cancer Etiology Car Phone Caring Cellular Phone Cessation of life Clinic Collaborations Colonoscopy Colorectal Cancer Communities Complex Counseling Death Rate Development Diagnosis Education Effectiveness Effectiveness of Interventions Enrollment Exclusion Family Feces Federally Qualified Health Center Gender Health Human Resources Imagery Incidence Individual Instruction Intervention Knowledge Language Lead Link Malignant Neoplasms Malignant neoplasm of cervix uteri Measures Medical Meta-Analysis Modeling Online Systems Participant Patient Care Patients Persons Phase Positioning Attribute Poverty Precancerous Polyp Preventive service Primary Health Care Provider Public Health Race Randomized Recording of previous events Reporting Research Resources Screening for cancer Services Site Socioeconomic Status Survival Rate Telephone Testing Text Text Messaging Underinsured Underserved Population Uninsured United States base black men cancer health disparity cancer invasiveness care providers colorectal cancer screening community based care cost design follow-up group intervention health belief health care settings health disparity health literacy high school improved low socioeconomic status mHealth malignant breast neoplasm medically underserved men mortality non-compliance outreach patient-level barriers peer personalized intervention preference prevent primary care setting programs prototype racial disparity racism screening screening guidelines skill acquisition systematic review therapy design tool uptake usability

项目摘要

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. Screening (e.g., colonoscopy, stool-based tests) can prevent most cases of invasive CRC. However, uptake is inadequate, especially among low SES African American men. Indeed, 40% of the racial disparity in CRC incidence and 20% of mortality differences can be attributed to lack of screening. Being Black, male, and low SES in the U.S. intersect to form a complex set of institutional, provider, and patient-level barriers that lead to differential screening rates. Most efforts to increase CRC screening in this group utilize in-person or telephone- based education and navigation. While effective, these approaches are resource intensive, limiting their adoption by organizations that serve low SES Black men, such as Federally Qualified Health Centers (FQHCs). To address the need for an effective, affordable, and scalable strategy to increase CRC screening among medically underserved African American men, this project will develop a mobile colorectal cancer screening intervention (m-CRCSI) for this group. m-CRCSI 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. Some text messages will include links to one of three types of videos: educational instruction, scripted vignettes, and unscripted peer narratives. Program content will reduce health literacy barriers and promote CRC screening adherence. Finally, it will be culturally targeted by contextualizing HBM constructs with the health beliefs most relevant to low SES Black men and by integrating gender- and race-congruent imagery, language, and values. A prototype m-CRCSi was developed in Phase I. This development was informed by formative research with community-based care providers and target end-users. The results of Phase I far exceeded the proposed benchmarks and strongly support the usability, acceptability, and potential effectiveness of the intervention. During Phase II we will complete development of the m-CRCSi. Then, in collaboration with Family and Medical Counseling Service (our partner FQHC), we will examine the effectiveness of the m-CRCSi to increase CRC screening in African American men. Participants will be randomly assigned to either the intervention condition or to a matched control condition. Secondary measures will assess health beliefs, medical mistrust, cancer fatalism, patient-provider interaction, and knowledge.

项目总结/文摘