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（IMCPs）有望作为一种提供个人定制（PT）信息的方式，增强健康行为的认知中介，改善患者的治疗效果。然而，目前尚不清楚PT imcp是否可以在初级保健办公室部署，以提高癌症筛查的接受程度，并通过以每个用户首选的语言提供PT信息来消除接受方面的种族差异。目的/假设：我们将比较CRC筛查认知介质（自我效能、感知障碍和准备程度）的变化，以及IMCP PT增强关键认知介质并针对患者自我认同的种族所产生的变化，以及非定制的“电子传单”控制IMCP所产生的变化。试验性和控制性imcp将分别以英文和西班牙文提供。我们假设，与适当的对照条件（英语、西班牙语或两者结合）相比：(1)英文版PT IMCP将增强说英语的西班牙裔和非西班牙裔人群CRC筛查行为的认知调节因子；(2)使用西班牙语版PT IMCP的拉美裔人在这些中介因素上也有类似的有利变化；(3) PT IMCP的部署将通过其对这些群体中认知介质的相对影响，为消除西班牙裔和非西班牙裔受试者之间的CRC筛查差异提供证据；(4) PT IMCP（英语和西班牙语结合）将通过认知介质的改变增加西班牙裔和非西班牙裔（单独考虑）的CRC筛查。方法：两组随机对照试验，比较英语和西班牙语版本的PT（认知介质）CRC筛查IMCP和非定制的“电子宣传单”CRC筛查IMCP（对照）（也提供英语和西班牙语版本）。筛查方法主要包括粪便隐血检查、乙状结肠镜检查和结肠镜检查。主要结果将是CRC筛查的接受程度、自我效能、感知障碍和准备程度。意义：我们的研究结果将确定在初级保健办公室预先安排的就诊之前，是否对筛查行为的认知介质具有PT作用的IMCP可以激活不同种族的患者进行CRC筛查。他们也可能提出一种有希望的、便携的方法，减少西班牙裔和非西班牙裔个体在CRC（和其他）筛查方面的差异。公共卫生相关性：我们的研究结果将确定一个针对筛查行为的认知媒介量身定制的交互式多媒体计算机程序，并在初级保健办公室预先安排的就诊之前部署，是否可以激活不同种族的患者进行结直肠癌筛查。他们也可能提出一种很有前途的便携方法，减少西班牙裔和非西班牙裔人群在结肠直肠癌（和其他）筛查方面的差异。

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.