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：
10666423
负责人：
Samantha L. Leaf
金额：
$ 2.66万
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 2024-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10666423
关键词：
Address Adherence Adoption Adult African American African American population Age Algorithms Behavior Belief Benchmarking Black Populations Black race Breast Cancer Detection Cancer Etiology Caring Cellular Phone Cervical Cancer Screening 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 Institution Instruction Intervention Knowledge Language Link Malignant Neoplasms Measures Medical Meta-Analysis Modeling Online Systems Participant Patients Persons Phase Positioning Attribute Poverty Precancerous Polyp Preventive service Provider Public Health Race Randomized Recommendation Recording of previous events Reporting Research Resources Screening for cancer Services Site Socioeconomic Status Survival Rate Testing Text Text Messaging Underinsured Underserved Population Uninsured United States black men cancer health disparity cancer invasiveness care providers colorectal cancer screening community based care cost design effectiveness evaluation follow-up group intervention health assessment health belief health care settings health disparity high school improved low health literacy low socioeconomic status mHealth male medically underserved men mortality non-compliance outreach patient-level barriers peer personalized intervention preference prevent primary care patient primary care setting programs prototype racial disparity racism screening screening guidelines skill acquisition systematic review telephone based text messaging intervention 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.

项目摘要/摘要贫困对健康有无数的有害影响，包括大多数人的发病率和死亡率更高癌症的形式。结直肠癌（CRC）是癌症死亡的第二个主要原因，也不例外。在社会经济地位（SES）中，CRC被诊断出40％的频率高40％。在美国，种族和 SES are inextricably linked, leading to profound health disparities.确实，CRC特别繁重黑人，最著名的是非裔美国人。黑人的CRC发病率高20％死亡率高52％的白人。在所有CRC阶段，非裔美国人的存活率最低。筛查（例如结肠镜检查，基于凳子的测试）可以防止大多数侵入性CRC病例。但是，吸收是不足，特别是在低SES非裔美国人中。确实，CRC中的种族差异的40％ incidence and 20% of mortality differences can be attributed to lack of screening.是黑人，男性和低美国的SES相交，形成一组复杂的机构，提供商和患者级别的障碍，导致差异筛选率。增加该组中CRC筛查的大多数努力都利用面对面或电话 - 基于教育和导航。尽管有效，但这些方法是资源密集的，限制了他们的为低SES黑人服务的组织采用，例如联邦合格的保健中心（FQHC）。解决有效，负担得起且可扩展的策略以增加CRC筛查的需求在医学上服务不足的非裔美国人，该项目将开发移动结直肠癌筛查该组的干预（M-CRCSI）。 M-CRCSI将基于健康信念模型（HBM）并交付通过手机。它将包括旨在改善CRC知识和健康信念的短信。一些短信将包括指向三种视频之一的链接：教育教学，脚本化小插曲和无脚本的同伴叙述。计划内容将减少健康素养障碍并促进CRC筛查坚持。最后，它将通过将HBM结构与健康信念的上下文相关化，从而在文化上成为目标与低SES黑人有关，并通过整合性别和种族的形象，语言和价值观。 A prototype m-CRCSi was developed in Phase I. This development was informed by formative research 与社区的护理提供者和目标最终用户。第一阶段的结果远远超过了提出的结果基准并强烈支持干预的可用性，可接受性和潜在有效性。在第二阶段，我们将完成M-CRCSI的开发。然后，与家人合作医疗咨询服务（我们的合作伙伴FQHC），我们将研究M-CRCSI增加的有效性非裔美国人的CRC筛查。参与者将被随机分配给干预措施条件或匹配的控制条件。 Secondary measures will assess health beliefs, medical mistrust, 癌症宿命论，患者提供的互动和知识。