Tailored Interactive Multimedia to Reduce Colorectal CA Screening Disparities

描述(由申请人提供)：交互式多媒体计算机程序(IMCP)作为一种传递个人定制(PT)信息的方式显示出希望，以增强健康行为的认知中介并改善患者结果。然而，目前还不清楚初级保健办公室是否可以部署PT IMCP，以增加癌症筛查的接受率，并通过以每个用户的首选语言提供PT信息来消除吸收方面的种族差异。目的/假设：我们将比较IMCP PT在结直肠癌筛查认知中介(自我效能、感知障碍和准备情况)和吸收方面的变化，以增强关键认知中介并针对患者的自我认同种族--与非定制的电子传单对照IMCP产生的变化。试验性和控制性IMCP将分别提供英语和西班牙语版本。我们假设，与适当的控制条件(英语、西班牙语或两者兼而有之)相比：(1)英文版PT IMCP将增强讲英语的西班牙裔和非西班牙裔的CRC筛查行为的认知中介；(2)对于使用西班牙语版PT IMCP的西班牙裔，这些中介也将出现类似的有利变化；(3)PT IMCP的部署将通过其对这些群体中认知中介的相对影响，为消除西班牙裔和非西班牙裔之间的结直肠癌筛查差异提供证据；(4)PT IMCP(英语和西班牙语合并)将通过认知中介的变化增加拉美裔和非拉美裔(分开考虑)对结直肠癌的筛查能力。方法：2组随机对照试验，比较在初级保健办公室就诊前提供的英语和西班牙语版本的PT(与认知介体)结直肠癌筛查IMCP与同样提供英语和西班牙语版本的非定制的“电子小册子”结直肠癌筛查IMCP(对照)。有针对性的筛查方法将是粪便潜血测试、柔性乙状结肠镜检查和结肠镜检查。主要结果将是结直肠癌筛查接受度、自我效能、感知障碍和就绪性。结论：我们的研究结果将决定IMCP是否能激活不同种族的患者接受结直肠癌筛查。他们还可能提出一种有前景的、便携的方法，以减少西班牙裔和非西班牙裔个体之间结直肠癌(和其他)筛查吸收的差异。公共卫生相关性：我们的发现将决定一个交互式多媒体计算机程序是否可以激活不同种族的患者接受结直肠癌筛查。该程序是为筛查行为的认知中介量身定做的，并在先前安排的访问之前部署在初级保健办公室。他们还可能提出一种有前景的、便携的方法，以减少西班牙裔和非西班牙裔个人之间结直肠癌(和其他)筛查吸收的差异。

DESCRIPTION (provided by applicant): Interactive multimedia computer programs (IMCPs) show promise as a way of delivering personally tailored (PT) information to enhance cognitive mediators of health behavior and improve patient outcomes. However, it is unclear whether PT IMCPs can be deployed in primary care offices to increase cancer screening uptake and eliminate ethnic disparities in uptake by providing PT information in each user's preferred language. Aims/Hypotheses: We will compare changes in CRC screening cognitive mediators (self- efficacy, perceived barriers, and readiness) and uptake resulting from an IMCP PT to enhance the key cognitive mediators and targeted to patients' self-identified ethnicity - with changes resulting from a non- tailored "electronic leaflet" control IMCP. The experimental and control IMCPs will each be offered in English and Spanish versions. We hypothesize that, compared with the appropriate control condition (English, Spanish, or both combined): (1) the English version of the PT IMCP will enhance the cognitive mediators of CRC screening behavior for English-speaking Hispanics and non-Hispanics; (2) there will be similarly favorable changes in these mediators for Hispanics using the Spanish version of the PT IMCP; (3) deployment of the PT IMCP will provide evidence of elimination of disparities in CRC screening between Hispanic and non-Hispanic subjects via its relative impact on the cognitive mediators in these groups; and (4) the PT IMCP (English and Spanish combined) will increase CRC screening uptake in Hispanics and non-Hispanics (considered separately) via changes in the cognitive mediators. Methods: Randomized controlled trial of 2 groups, comparing a PT (to the cognitive mediators) CRC screening IMCP offered in both English and Spanish versions and deployed before a primary care office visit with a non-tailored "electronic leaflet" CRC screening IMCP (control) also offered in both English and Spanish. Screening methods targeted will be fecal occult blood testing, flexible sigmoidoscopy, and colonoscopy. Primary outcomes will be CRC screening uptake, self- efficacy, perceived barriers, and readiness. Implications: Our findings will determine whether an IMCP that is PT to cognitive mediators of screening behavior and deployed in primary care offices prior to previously scheduled visits can activate patients of various ethnicities to undergo CRC screening. They may also suggest a promising, portable method of reducing disparities in CRC (and other) screening uptake between Hispanic and non-Hispanic individuals. PUBLIC HEALTH RELEVANCE: Our findings will determine whether an interactive multimedia computer program that is personally-tailored to cognitive mediators of screening behavior and deployed in primary care offices prior to previously scheduled visits can activate patients of various ethnicities to undergo colorectal cancer screening. They may also suggest a promising, portable method of reducing disparities in colorectal cancer (and other) screening uptake between Hispanic and non-Hispanic individuals.