Korean Immigrants & Mammography-Culture-Specific Health Intervention (KIM-CHI)

描述（由申请人提供）：乳腺癌是韩裔美国女性中最常见的癌症和最常见的癌症死亡原因，但韩裔美国女性的乳房x光检查使用率仍然不理想。大多数针对朝鲜族妇女的乳腺癌筛查研究都是描述性和相关性的，但在这个为期4年的项目中，我们将测试韩国移民和乳房x光检查-文化特异性健康干预（KIM-CHI）对依从推荐的乳腺癌筛查方案的影响。具体目的是：(1)比较接受KIM-CHI治疗的组与注意对照组的乳房x光检查结果，包括获得的乳房x光检查次数（0、1或2），如果获得，在15个月时获得第一次乳房x光检查的时间长度（使用生存分析）；(2)采用重复测量多变量方差分析比较两组在健康信念、知识、自我效能、配偶支持和乳房自我检查实践的中介变量在2周和15个月的差异；(3)采用结构方程模型，确定健康信念、知识、自我效能、配偶支持和2周BSE实践对15个月乳房x光检查获得结果的中介作用。我们已经测试了针对KA妇女的KIM-CHI计划的可行性，通过结合文化特定策略来改变(1)对乳腺癌和筛查的信念，(2)对乳腺癌和癌症筛查的知识，以及(3)获得乳房x光检查和要求医生转诊乳房x光检查的自我效能。在韩国教会随机分配干预或对照条件下，400名40岁以上过去2年没有做过乳房x光检查的KA妇女和她们的丈夫将作为单独的一组，参加包括教育DVD、BSE技能练习、同伴讨论和夫妇在家中讨论的小组会议。将在基线、基线后2周和15个月收集乳房x光检查程度和中介变量的数据。该建议的一个优势是测试了一种成本保守的方案，使用韩国榜样、母语、男性医生认证以及包括配偶在内的一致健康行为信息的群体传递，以提高KA妇女的乳房x光检查成绩。

DESCRIPTION (provided by applicant): Breast cancer is the most commonly occurring cancer and most common cause of cancer mortality among Korean American (KA) women, but mammography utilization among KA women remains suboptimal. Most breast cancer screening studies with KA women have been descriptive and correlational, but in this 4-year project we will test the effects of Korean Immigrants & Mammography-Culture-Specific Health Intervention (KIM-CHI) on adherence to recommended breast cancer screening protocols. The specific aims are to: (1) compare the group receiving KIM-CHI with an attention control group on mammogram attainment outcomes including number of mammograms obtained (0, 1, or 2) and if obtained, length of time to obtain the first mammogram, at 15 months using survival analysis; (2) compare the two groups on the mediating variables of health beliefs, knowledge, self-efficacy, spousal support and breast self-examination (BSE) practice at 2 weeks and 15 months using repeated measures multivariate analysis of variance; and (3) identify the mediating effects of health beliefs, knowledge, self-efficacy, spousal support, and BSE practice at 2 weeks on mammogram attainment outcomes at 15 months, using structural equation modeling. We have tested the feasibility of the KIM-CHI program targeting KA women by incorporating culture-specific strategies for changing (1) beliefs about breast cancer and screening, (2) knowledge of breast cancer and cancer screening, and (3) self-efficacy for obtaining a mammogram and requesting a referral for a mammogram from a physician. Using Korean churches randomly assigned to intervention or control conditions, a total sample of 400 KA women 40 years of age or older who have not had a mammogram within the past 2 years, along with their husbands in a separate group, will participate in a group session incorporating an educational DVD, BSE skill practice, peer discussion, and an assignment for the couple to have a discussion afterwards at home. Data on mammography attainment and the mediating variables will be collected at baseline and at 2-weeks and 15-months post-baseline. A strength of this proposal is the testing of a cost- conservative protocol with group delivery of consistent health behavior information using Korean role models, native Korean language, and male physician authentication as well inclusion of spouses for improving KA women's mammography attainment.