Development and user testing of a culturally targeted anal cancer prevention decision tool

针对文化的肛门癌预防决策工具的开发和用户测试

• 批准号: 10664409
• 负责人: Christopher W. Wheldon
• 金额: $ 23.78万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-16 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10664409
• 关键词: 3-Dimensional; AIDS prevention; Address; Adolescent; Adult; Age; Anal Sex; Anus; Bass; Behavioral; Black race; Caring; Clinic; Decision Making; Development; Dose; Effectiveness; Eligibility Determination; Equity; Evaluation; Exposure to; Face; Feedback; Female; Focus Groups; Future; Gender; General Population; Health; Health Disparities Research; Health Insurance; Healthcare; Healthcare Systems; Hispanic; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papillomavirus; Human papilloma virus infection; Incidence; Individual; Intervention; Interview; Lesion; Malignant neoplasm of anus; Malignant neoplasm of cervix uteri; Maps; Marketing; Mathematics; Medical; Methods; Modeling; Motivation; National Institute on Minority Health and Health Disparities; Needs Assessment; Oncogenic; Outcome; Patient Education; Patients; Population Heterogeneity; Preventive service; Provider; Recommendation; Research; Risk; Risk Factors; Sampling; Sexually Transmitted Diseases; Surveys; System; Techniques; Testing; Visual; Women' s Group; aged; black men who have sex with men; cancer health disparity; cancer prevention; cancer risk; care delivery; cis-female; cisgender; clinical decision-making; education resources; ethnoracial; health communication; high risk; high risk population; implementation strategy; improved; innovation; intersectionality; men who have sex with men; men' s group; mortality; novel; novel strategies; patient engagement; patient-clinician communication; pre-exposure prophylaxis; preference; premalignant; prevent; prevention service; primary care setting; prototype; screening guidelines; skills; social stigma; syndemic; tool; transgender women; uptake; vaccine acceptance; vaccine access; vaccine hesitancy; vector

Project Summary Men who have sex with men (MSM) and transgender women (TGW) are at increased risk of anal cancer because of prevalent anal human papillomavirus (HPV) infections. Anal cancer incidence among MSM ranges from 37 to 131 cases per 100,000. That is roughly 20 to 80 times higher than anal cancer rates in the general population. TGW have similar if not greater risk of precancerous anal lesions than MSM. HPV vaccination provides a unique opportunity to decrease anal cancer disparities for MSM and TGW; however, current HPV vaccine coverage is inadequate. Targeted efforts are urgently needed to increase HPV vaccine uptake among eligible adult MSM and TGW. We propose that leveraging existing HIV prevention services already utilized by MSM and TGW (e.g., pre-exposure prophylaxis [PrEP]) can help to increase the reach and equity of HPV vaccination. MSM/TGW on PrEP have increased need for HPV vaccination given high rates of anal cancer risk factors. However, HPV vaccination is not part of current screening guidelines for PrEP initiation. The long-term objective of this research is to develop a multilevel PrEP clinic-based toolkit to support shared clinical decision making for anal cancer prevention. The objective of this application is to develop patient-level anal cancer prevention content targeted to ethnoracially diverse MSM/TGW PrEP patients. This is a mixed methods health communication approach that engages PrEP patients and providers. We will use perceptual mapping and vector message modeling to create culturally responsive anal cancer prevention messaging focused on HPV vaccination. The methods are informed by the information-motivation-behavioral skills model, guided by an intersectionality framework, and applies best practices in health communication. There are three specific aims: (1) Determine anal cancer prevention information needs and messaging strategies for MSM/TGW on PrEP; (2) Develop targeted anal cancer prevention messages for MSM/TGW on PrEP; and (3) Assess the acceptability, relevance, and comprehensibility of anal cancer prevention messages and identify implementation strategies. In-depth qualitative interviews and focus groups with MSM/TGW on PrEP and PrEP providers will provide qualitative evidence (aims 1 and 3). Perceptual mapping surveys and vector message modeling (aim 2) will be used to develop content for the anal cancer prevention toolkit. This project will help reduce cancer disparities by improving medical decision making and patient-provider communication regarding anal cancer prevention. The multi-level approach addresses gaps as outlined in the National Institute on Minority Health and Health Disparities Research Framework. We focus on behavioral and healthcare system domains at individual and interpersonal levels. The content developed in this study will be included in a multilevel PrEP clinic-based toolkit, providing patient education, provider messaging, and implementation strategies. The effectiveness of the toolkit on HPV vaccine uptake and decisional quality outcomes will be tested in a future R01.

项目摘要 与男性发生性关系（MSM）和变性妇女（TGW）的男性的风险增加 由于流行的肛门人乳头瘤病毒（HPV）感染。 MSM范围的肛门癌发病率 每100,000例37箱至131例。在一般中，大约是肛门癌率的20到80倍 人口。与MSM相比，TGW具有癌前肛门病变的风险甚至更大。 HPV疫苗接种 提供了一个独特的机会来减少MSM和TGW的肛门癌差异；但是，当前的HPV 疫苗覆盖范围不足。迫切需要进行有针对性的努力以增加HPV疫苗的摄取 合格的成人MSM和TGW。我们建议利用已经使用的现有艾滋病毒预防服务 MSM和TGW（例如，暴露前预防[PREP]）可以帮助提高HPV的范围和权益 疫苗接种。鉴于高肛门癌风险率很高，MSM/TGW对HPV疫苗的需求增加 因素。但是，HPV疫苗接种并不是当前筛查指南的一部分。长期 这项研究的目的是开发一个基于多级预科诊所的工具包，以支持共同的临床决策 预防肛门癌。该应用的目的是发展患者水平的肛门癌 针对民族不同的MSM/TGW Prep患者的预防含量。这是一种混合方法健康 与预备患者和提供者相关的沟通方法。我们将使用感知映射和 向量消息建模以创建针对HPV的文化响应式肛门癌预防信息 疫苗接种。这些方法由信息动机行为技能模型告知 相交性框架，并在健康沟通中应用最佳实践。有三个特定的目标： （1）确定PREP的MSM/TGW的肛门癌预防信息需求和消息传递策略； （2） 为PREP开发针对MSM/TGW的靶向肛门癌预防信息； （3）评估可接受性， 相关性以及肛门癌预防信息的可理解性并确定实施策略。 深入的定性访谈和与MSM/TGW有关PREP和PREP提供商的焦点小组将提供 定性证据（目标1和3）。感知映射调查和向量消息建模（AIM 2）将是 用于开发肛门癌预防工具包的内容。该项目将有助于减少癌症差异 通过改善医疗决策和有关肛门癌预防的患者沟通。 多层方法解决了国家少数民族健康与健康研究所所述的差距 差异研究框架。我们专注于个人的行为和医疗保健系统领域 人际关系水平。这项研究中开发的内容将包括在基于多级预备诊所中 工具包，提供患者教育，提供者消息传递和实施策略。有效性 HPV疫苗摄取和决策质量结果的工具包将在未来的R01中进行测试。