Feasibility of a Multi-Channel Intervention to Promote Colorectal Cancer Screening among American Indians in Oklahoma

项目总结 结直肠癌是美国男性和女性癌症死亡的第二大原因。 各州。与全国平均水平相比，美国印第安人(AI)承受着不成比例的CRC负担 发病率和结直肠癌特有的死亡率。筛查是一种有效的早期发现策略，可以减少可预防的风险 与结直肠癌相关的死亡，但人工智能的结直肠癌筛查率最低。在俄克拉荷马州，只有51%的人工智能在运行 到目前为止，有资格的美国成年人中有近三分之二的人接受了筛查。努力提高筛查率 专注于增加家庭粪便筛查的机会(即粪便免疫化学测试；FIT)，一样多的人工智能 他们居住在农村社区，必须长途跋涉才能获得筛查服务。部落社区卫生 教育者(TCHE)是在人工智能社区内推广适合性筛选的有效策略 克服历史上的不信任、健康素养差距，并提供与文化相一致的教育信息。 然而，TCHE的成功受到他们的影响范围的限制，因为他们无法在后勤上接触到所有必要的人工智能 社区。虚拟人技术，它可以创建照片逼真的、交互式的虚拟TCHE(v-Tche)提供 一种可扩展的战略，以克服面对面提供健康教育所固有的后勤障碍。 因此，这项提议的总体目标是利用与印度卫生服务机构的现有关系 克林顿服务单位以及夏延人和阿拉帕霍部落研究共同开发和 作为多通道通信干预的一部分来传播V-TCHE。干预措施将是 通过两个渠道传播：(1)社交媒体(即，通过在线研究广告访问)和(2)诊所(即， 通过短信文本中的研究链接直接向患者发送消息)。在这两个渠道中，我们将检查REACH(主要 结果)干预措施及其潜在效果(关于提高CRC知识和完成FIT试剂盒) 通过随机对照试验。一旦参与者点击研究链接，他们将被随机分配为1：1 两种干预条件：(1)观看真实部落社区健康的叙事性证明视频 教育者(对照)或(2)与V-TCHE的互动。然后参与者将完成干预后的调查， 在那里，他们可以点击订购一套适合自己的装备。第一个研究目标是共同开发多渠道 俄克拉何马州与人工智能的沟通干预。第二个研究目标将决定其影响范围和潜力。 功效。该提案高度响应PA-20-272中的轨道2，因为它试图解决 人工智能人群中的CRC结果。我们研究了共同开发和传播多个 渠道沟通干预促进美国预防服务工作组建议 癌症筛查试验。如果成功，研究结果将支持一种首创的、高度可扩展的方法来克服 部落社区健康教育者面临的覆盖范围限制。未来的R01将决定 不同的v-tche在其他部落医疗系统中推广Fit筛查。

PROJECT SUMMARY Colorectal cancer (CRC) is the second-leading cause of cancer death in both men and women in the United States. Compared to national averages, American Indians (AI) endure a disproportionate burden of CRC incidence and CRC-specific mortality. Screening is an effective early detection strategy to decrease preventable CRC-related deaths, but AI have some of the lowest CRC screening rates. In Oklahoma, only 51% of AI are up to date with screening compared to nearly two-thirds of eligible US adults. Efforts to improve screening rates have focused on increasing access to home stool screening (i.e.. fecal immunochemical test; FIT), as many AI live in rural communities and must drive long distances to access screening services. Tribal community health educators (TCHE) are an effective strategy to promote FIT screening within AI communities as they can overcome historical mistrust, health literacy gaps, and provide culturally concordant educational messaging. However, success of TCHE is limited by their reach as they cannot logistically engage with all necessary AI communities. Virtual human technology, which can create photorealistic, interactive virtual TCHE (v-TCHE) offer a scalable strategy to overcome the logistical barriers inherent with in-person delivered health education. Therefore, the overall objective of this proposal is to leverage existing relationships with Indian Health Service Clinton Service Unit and the Cheyenne and Arapaho Tribes to examine the feasibility of co-developing and disseminating a v-TCHE as part of a multi-channel communication intervention. The intervention will be disseminated across two channels: (1) Social Media (i.e., accessed via online study adverts) and (2) Clinic (i.e., direct messaging to patients via a study link in a SMS text). Across both channels, we will examine reach (primary outcome) of the intervention and its potential efficacy (on improving CRC knowledge and completing a FIT kit) via a randomized controlled trial. Once participants click on the study link they will be randomized 1:1 to one of two intervention conditions: (1) watch a Narrative Testimonial Video of a real-life Tribal community health educator (control) or (2) an interaction with a v-TCHE. Participants will then complete a post-intervention survey, in which they can click to order a FIT kit afterwards. The first study aim will co-develop a multi-channel communication intervention with AI in Oklahoma. The second study aim will determine its reach and potential efficacy. This proposal is highly responsive to Track 2 in the PA-20-272 as it attempts to address inequities in CRC outcomes among AI populations. We examine the feasibility of co-developing and disseminating a multi- channel communication intervention to promote a United States Preventive Services Taskforce recommended cancer screening test. If successful, findings will support a first-of-its-kind, highly scalable approach to overcome the reach limitations that Tribal community health educators face. A future R01 will determine the efficacy of different v-TCHE to promote FIT screening across other Tribal healthcare systems.