Enhancing the Effectiveness of Community Health Workers to Reduce Cervical Cancer Disparities in African American Women

提高社区卫生工作者的有效性，减少非裔美国妇女的宫颈癌差异

• 批准号: 10710217
• 负责人: DOUGLAS W BILLINGS
• 金额: $ 70.94万
• 依托单位: ISA ASSOCIATES, INC.
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-23 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10710217
• 关键词: Adherence; African American; African American population; Age; Attention; Behavior Therapy; Benchmarking; Breast Cancer Prevention; Caring; Case Management; Cellular Phone; Cervical; Cervical Cancer Screening; Communication; Communities; Community Health Aides; Complex; Computer software; Consultations; Data; Development; Devices; Diagnosis; Diagnostic; Disease; Disparity; Effectiveness; Electronic Health Record; Emotional; Funding; Goals; Health Personnel; Health Promotion and Education; Health education; Hispanic; Hysterectomy; Incidence; Insurance; Intervention; Interview; Knowledge; Lesion; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Marketing; Measures; Medical; Morbidity - disease rate; National Cancer Institute; Not Hispanic or Latino; Online Systems; Participant; Patients; Performance; Phase; Pilot Projects; Provider; Public Health; Randomized; Research; Resolution; Risk Assessment; Screening for cancer; Self Efficacy; Services; Testing; Text Messaging; Time; Transportation; Trust; Tumor stage; Underserved Population; Uninsured; Woman; Work; black patient; black women; cancer care; cancer health disparity; cancer prevention; dashboard; design; effectiveness evaluation; follow-up; health literacy; improved; member; mortality; mortality disparity; outreach; patient navigation; premalignant; product development; programs; prototype; screening; screening disparities; screening guidelines; skills; socioeconomic disadvantage; success; tool; treatment as usual; video delivery

PROJECT SUMMARY/ABSTRACT The hysterectomy-corrected incidence of cervical cancer (CC) is more than 40% higher among African American women than white women. Black women are also twice as likely to die from CC. It does not have to be this way. Widespread screening and proper follow-up would eliminate most new cases of CC because the natural progression of precancerous cervical lesions is slow, allowing for treatment and cure. The best evidence indicates that this is not happening. Adherence to screening guidelines is too low among Black women. One promising solution to this problem is patient navigation (PN). PN was originally developed to help socioeconomically disadvantaged Black women overcome the systemic, provider, and personal barriers to timely cancer prevention and care using community members as lay navigators. Recently, however, there has been a general shift away from navigating poor and uninsured patients, towards higher SES patients in better funded, more comprehensive cancer care centers. While nearly all can benefit from PN, if not targeted to those most in need, delivering these services to more privileged patients can exacerbate disparities. In previous pilot work, we developed and tested a prototype, mobile PN intervention for both African American women (mNav) and lay navigators (mNav-D) to reduce CC health disparities. These products are front-ends to the same server-based program, and thus fully integrated. For patients, mNav includes an integrated web-based risk assessment that allows our SMS software app to select and deliver videos and text messages specific to each woman’s particular cervical screening challenges. Pilot work with 42 African American women ages 21 to 65 informed the development of this product. For lay navigators, mNav-D provides an “at a glance” overview of key performance metrics while also supporting easy entry of encounter- level patient data. Development of this product was informed by formative research with 16 PNs working in a range of settings. We also interviewed 12 participants who either had upstream or downstream touch points with electronic health record (EHR) workflows. The data across these pilot studies strongly supports the feasibility and potential effectiveness of these products, far exceeding the proposed benchmarks. During Phase II we will complete development of mNav and mNav-D in consultation with our three content experts. We will then examine the effectiveness of mNav and mNav-D to increase adherence to cervical screening guidelines via medical review among nonadherent African American women. Participants will be randomly assigned to either the intervention condition (PN + mNav/mNav-D) or to usual care (PN only). Secondary measures will assess cancer screening knowledge, benefits and barriers of cancer screening, and intentions.

项目总结/摘要 子宫颈癌（CC）的子宫颈切除术矫正的发病率在非洲高出40%以上。 美国女人比白色女人。黑人女性死于CC的可能性也是女性的两倍。它不必 就这样。广泛的筛查和适当的随访将消除大多数新的CC病例，因为 宫颈癌前期病变的自然进展缓慢，可以治疗和治愈。最好的证据 表明这并没有发生。黑人妇女对筛查指南的遵守率太低。 解决这个问题的一个有前途的解决方案是患者导航（PN）。PN最初是为了帮助 在社会经济上处于不利地位的黑人妇女克服了系统性、提供者和个人障碍， 及时的癌症预防和护理，利用社区成员作为外行导航员。然而，最近， 从引导穷人和没有保险的病人，到更好的社会经济地位更高的病人， 更全面的癌症护理中心。虽然几乎所有人都可以从PN中受益，但如果不是针对那些 最需要的是，向较有特权的病人提供这些服务可能会加剧不平等。 在以前的试点工作中，我们开发并测试了一个原型，移动的PN干预， 美国妇女（mNav）和外行导航员（mNav-D），以减少CC健康差距。这些产品 前端到相同的基于服务器的程序，从而完全集成。对于患者，mNav包括 集成的基于网络的风险评估，允许我们的短信软件应用程序选择和提供视频和文本 针对每个妇女的子宫颈检查挑战的具体信息。与42个非洲国家开展试点工作 21至65岁的美国女性告知了该产品的开发。对于外行导航员，mNav-D 提供关键绩效指标的“概览”，同时还支持轻松输入遇到的问题- 患者数据水平。该产品的开发是通过对16名PN进行的形成性研究得出的 设置范围。我们还采访了12名参与者，他们要么有上游接触点，要么有下游接触点 电子健康记录（EHR）工作流程。这些试点研究的数据强烈支持 这些产品的可行性和潜在有效性，远远超过拟议的基准。 在第二阶段，我们将与我们的三个合作伙伴协商，完成mNav和mNav-D的开发。 内容专家然后，我们将检查mNav和mNav-D增加宫颈癌患者依从性的有效性。 通过医学审查筛选指南在非依从性非裔美国妇女。参与者将被 随机分配至干预条件（PN + mNav/mNav-D）或常规护理（仅PN）。 次要措施将评估癌症筛查知识、癌症筛查的益处和障碍，以及 intentions.