FIBER ADHERENCE AND MARKER DEVELOPMENT IN BLACK CHURCHES

这项以社区为基础的患者结局研究的目的是实施 45-75岁南方黑人成年人的护理干预 较低至较高的中间SES，然后评估遵守结果和 开发一种复合黏附标记物。记号笔是一种声音， 相对非侵入性依从性测量的护理干预。这个 干预是一种经过检验的基于健康的依从性促进策略 癌症预防模式中的行为。它鼓励食用13.5克 标记为50毫克的补充膳食小麦麸皮(不溶性)纤维 核黄素/服务。参与者有患结肠癌的年龄风险 将从南方黑人教堂和周围地区招募 社区。一个由100名男性和女性(至少三分之一的男性)组成的有目的的样本将 接受遵守干预，每个人都充当自己的控制者。 对为期一个月的护理干预的坚持程度将通过以下方式进行衡量 多种生物-心理-社会模式：自我报告(按日历遵守 完成)、血液测量和尿核黄素。不同的 遵守措施将单独和合并进行比较 以尿核黄素为标记物的多模式复合黏附标志物 纤维摄入量的标准测量(“黄金标准”)。复合体 将测试遵守标记的适当性(对 参与者、文化相关性和成本效益)；敏感性， 特异度和预测值；效度和可靠性。探索性的 将使用判别函数和Logistic回归进行分析 制定综合指数形成的决策规则，同时 评估敏感性和特异性。两个变量之间的相关性 用核黄素水平、t检验和方差分析进行个体依从性测量 将标记与年龄、性别和SES进行事后比较(p< 超过0.01)；并将使用内容分析来解决 目标。这项探索性研究扩展了该团队正在进行的 对另一个群体的研究，即具有较低到中等SES的黑人 总部设在南方教堂，并开发了遵守标记指数。 主要结果包括：验证南方黑色衣服的标记 人口，以及与护理干预相关的饮食变化 对结肠癌有潜在的保护作用。其他结果包括高 风险人群受过更好的癌症知识教育，这是结肠癌的一种组成部分 (护理干预)添加到现有的基于教会的健康计划中 (减少心血管疾病风险部分)在黑人社区， 以及确定遵守战略的障碍和好处 参与者。整个研究计划的最终目标是 通过增加纤维摄入量对结肠癌的一级预防。

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.