FIBER ADHERENCE AND MARKER DEVELOPMENT IN BLACK CHURCHES

这项以社区为基础的患者结果研究的目的是实施一项

The aim of this community-based, patient outcomes study is to implement a nursing intervention among Southern black adults, 45-75 years of age with lower to upper middle SES, then to assess the adherence outcomes and develop a composite adherence marker. The marker is to be a sound, relatively non-invasive adherence measure of a nursing intervention. The intervention is a tested adherence promotion strategy based on the Health Behavior in Cancer Prevention Model. It encourages consumption of 13.5 g of supplemental dietary wheat bran (insoluble) fiber labelled with 50 mg riboflavin/serving. Participants at age risk for developing colon cancer will be recruited from Southern black churches and the surrounding community. A purposive sample of 100 men and women (at least 1/3 men) will receive the adherence intervention, each acting as their own control. Adherence to the month-long nursing intervention will be measured via multiple biopsychosocial modalities: self-report (adherence per calendar completion), blood measures, and urinary riboflavin. The separate adherence measures will be compared individually and in a combined multimodality, composite adherence marker with urinary riboflavin as the criterion measure of fiber intake ("gold standard"). The composite adherence marker will be tested for its appropriateness (acceptability to participants, cultural relevance, and cost effectiveness); sensitivity, specificity and predictive value; validity and reliability. Exploratory analyses with discriminant function and logistic regression will be used to develop decision rules for composite marker index formation, while assessing sensitivity and specificity. Bivariate correlations among the individual adherence measures with riboflavin levels, t-tests and ANOVA with post hoc comparisons of markers with age, gender, and SES (p less than 0.01); and content analysis will be used to address the rest of the aims. This exploratory study extends the team's ongoing program of research to another population, i.e., blacks with lower to middle SES based in a Southern church and by developing the adherence marker index. Primary outcomes include: validation of markers in a Southern black population, and change in diet related to a nursing intervention which is potentially protective from colon cancer. Other outcomes include high risk people who are better educated about cancer, a colon cancer component (nursing intervention) added to an existing church-based health program (cardiovascular disease risk reduction component) in a black community, and identification of barriers and benefits of the adherence strategy for participants. The ultimate goal of the whole program of research is primary prevention of colon cancer via increased fiber intake.