Colorectal Cancer Screening in Southwestern Hispanics and Native Americans

西南部西班牙裔和美洲原住民的结直肠癌筛查

• 批准号: 7547056
• 负责人: Robert L. Rhyne
• 金额: $ 14.18万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-02-01 至 2011-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7547056
• 关键词: Address; Age; American Indians; Behavior; Behavioral; Cancer Etiology; Caring; Cells; Cessation of life; Colorectal Cancer; Community Health; Community Health Centers; Data; Decision Making; Disease; Eligibility Determination; Endoscopy; Ethnic Origin; Focus Groups; Funding; Goals; Health Services Research; Hispanic Americans; Hispanics; Incidence; Intervention; Intervention Studies; Interview; Knowledge; Literature; Low income; Malignant Neoplasms; Measures; Mexico; Minority; Modeling; Native Americans; New Mexico; Newly Diagnosed; Not Hispanic or Latino; Outpatients; Participant; Patients; Pattern; Perception; Physicians; Population; Primary Health Care; Process; Provider; Public Health; Qualitative Methods; Recording of previous events; Research; Research Design; Research Personnel; Rural; Sample Size; Sampling; Screening procedure; Second Primary Cancers; Services; Social Environment; Structure; Surveys; Transcript; Underrepresented Minority; Underserved Population; United States; United States Indian Health Service; Vulnerable Populations; base; cancer diagnosis; colorectal cancer screening; design; experience; knowledge base; medically underserved population; member; mortality; population based; practice-based research network

DESCRIPTION (provided by applicant): In 2005, colorectal cancer (CRC) was the second leading cause of cancer deaths in the United States. Nationally the age-adjusted incidence rate of CRC has steadily decreased since 1975, at a rate of 0.8% per year; the US Hispanic rates have been relatively steady; and American Indians have had a steeper decline of 1.8% annually. The opposite is found in New Mexico (NM), where the annual incidence rates for Hispanics and American Indians have increased at alarming rates of 3.6% and 4.7%, respectively, for the same period. The CRC screening rates for these NM minorities are 30-50% lower than the national rates for FOBT and endoscopy. The long range goal is to increase CRC screening rates in NM; however, before an intervention to accomplish this can be designed, the reasons why screening rates are so low in these unique populations must be explored and understood. Very little information exists on these populations regarding CRC screening. Two specific aims will be addressed in this study: 1) To determine which patient and provider factors in the CRC orous qualitative analysis, and 2) To develop, pilot, and finalize a survey instrument for quantitatively measuring the components of the patient decision making process that are barriers to CRC screening, among New Mexico Hispanic and American Indian populations. Qualitative focus groups and semi-structured interviews will be conducted through RIOS Net; a primary care practice-based research network formed specifically to conduct research of direct relevance to the Southwest's rural, culturally diverse and underserved populations. A conceptual model of 10 constructs that determines CRC screening behavior forms the basis of the study, and will be explored in-depth in physicians and community health worker (CHW) semi-structured interviews and patient focus groups. Sampling will be based on type of practice setting, Community Health Center or Indian Health Service, which is reflective of ethnicity of service population. Sample size will be determined by points of data saturation within each sampling cell, and it is estimated that 14 randomly selected physicians, 14 CHWs, and 42 patient focus groups with 336 participants will be required to reach data saturation. Patient eligibility criteria include ethnicity (Hispanic or American Indian), age (e50 years), and no prior history of CRC. A rigorous analysis of interview and focus group transcript data will be conducted by researchers experienced in qualitative methods. The unique aspects of each construct that contribute to CRC screening behavior will be identified. The new information developed by this project will expand the knowledge base of the conceptual model in new populations, will be used to design a survey that can quantitatively measure the screening behaviors in Hispanics and Native Americans, and will be used to design a culturally sensitive RO1 intervention study designed to increase CRC screening rates among NM Hispanics and American Indians. While the rates for colorectal cancer in the US are decreasing, the rates for New Mexico Hispanics and American Indians are increasing; this represents a worsening public health problem in two US minority populations. The reasons why disease rates are increasing are unknown, but a contributing factor is very low screening rates in these populations. This qualitative study will explore the reasons why screening rates are low and this new knowledge will contribute to the design of culturally sensitive interventions to increase screening rates, which has the potential to reverse this public health problem by decreasing the colorectal cancer disease rates in these vulnerable populations.

描述（由申请人提供）：2005年，结直肠癌（CRC）是美国癌症死亡的第二大原因。在全国范围内，自1975年以来，CRC的年龄调整发病率稳步下降，每年下降0.8%;美国西班牙裔发病率相对稳定;美国印第安人的发病率下降幅度更大，每年下降1.8%。相反的是在新墨西哥州（NM），西班牙裔和美洲印第安人的年发病率在同一时期分别以惊人的3.6%和4.7%的速度增长。这些NM少数民族的CRC筛查率比全国FOBT和内窥镜检查率低30-50%。长期目标是提高NM的CRC筛查率;然而，在设计实现这一目标的干预措施之前，必须探索和理解这些独特人群中筛查率如此之低的原因。关于这些人群的CRC筛查信息非常少。本研究的两个具体目标是：1）确定CRC或定性分析中的患者和提供者因素，2）开发、试点和最终确定一种调查工具，用于定量测量新墨西哥州西班牙裔和美洲印第安人人群中CRC筛查障碍患者决策过程的组成部分。定性焦点小组和半结构化访谈将通过RIOS网进行;一个以初级保健实践为基础的研究网络，专门用于开展与西南部农村，文化多样性和服务不足人口直接相关的研究。确定CRC筛查行为的10个结构的概念模型构成了研究的基础，并将在医生和社区卫生工作者（CHW）半结构化访谈和患者焦点小组中深入探讨。抽样将基于实践环境的类型，社区卫生中心或印度卫生服务，这反映了服务人群的种族。样本量将由每个采样单元内的数据饱和点确定，估计需要14名随机选择的医生、14名CHW和42个患者焦点组（336名参与者）才能达到数据饱和。患者合格性标准包括种族（西班牙裔或美洲印第安人）、年龄（e50岁）和既往无CRC病史。访谈和焦点小组成绩单数据的严格分析将由定性方法经验丰富的研究人员进行。将确定有助于CRC筛选行为的每个构建体的独特方面。该项目开发的新信息将扩大新人群中概念模型的知识基础，将用于设计一项调查，可以定量测量西班牙裔和美洲原住民的筛查行为，并将用于设计一项文化敏感的RO 1干预研究，旨在提高NM西班牙裔和美洲印第安人的CRC筛查率。 虽然美国结直肠癌的发病率正在下降，但新墨西哥州西班牙裔和美洲印第安人的发病率正在上升;这代表了美国两个少数民族人群中日益恶化的公共卫生问题。患病率上升的原因尚不清楚，但一个促成因素是这些人群的筛查率非常低。这项定性研究将探讨筛查率低的原因，这一新知识将有助于设计文化敏感的干预措施，以提高筛查率，这有可能通过降低这些弱势人群的结直肠癌发病率来扭转这一公共卫生问题。