Addressing Cervical Cancer Disparity in South Florida CBPR in Action

描述(由申请人提供)：南佛罗里达减少癌症差异中心，也被称为SUCCESS，支持迈阿密大都市区的许多校园-社区合作伙伴关系或社区咨询小组(CAGs)。这种伙伴关系是本着基于社区的参与性研究(CBPR)的精神构思的，并促进大学调查人员和社区利益攸关方在处理健康差距问题方面进行有意义的合作。拟议的项目重点关注宫颈癌，这是Success服务的三个社区的一个重大健康问题：小海地、Hialeah和West Perine。与美国其他以少数族裔为主的低收入社区一样，这些社区导致宫颈癌发病率和死亡率过高，这主要是因为无法进行常规的巴氏涂片筛查，也无法及时跟进发现的异常情况。Success旨在解决这一差距。在过去的三年里，我们一直在进行一项社区试验，比较两种疾病预防的创新模式：导航到当地联邦合格卫生中心(FQHC)的巴氏涂片筛查与基于家庭的人类乳头瘤病毒(HPV)自我采样，HPV是宫颈癌的主要原因。在这两个方面，社区卫生工作者(CHW)在提供干预服务方面都发挥着关键作用。然而，我们的初步数据表明，CHW的参与可能没有筛查方法本身那么重要。在所有三个社区中，随机进行自我抽样的女性的筛查接受率明显更高，这可能是因为基于家庭的筛查的易用性和参与者的偏好，这绕过了护理的结构和文化障碍。这项拟议的研究将通过比较CHW提供的自我抽样和邮寄提供的自我抽样来正式测试CHW参与的重要性。我们将对来自我们三个目标社区的700名女性进行一项双臂研究，CHW-自身抽样干预作为我们的对照组，或ARM。我们的主要目标是1)确定哪种自我抽样方法可以使更多的女性接受筛查。次要结果包括：a)关于宫颈癌的知识、态度和信念，以及早期发现疾病的重要性；b)获得护理的机会(医疗保险、通常的护理来源、6个月内去看医生)，特别是在筛查异常并需要医疗干预的妇女中；c)两种干预策略的相对成本。与CBPR的原则一致，这类工作的重点和范围由小海地、Hialeah和West Perine的成功CAG提供了信息。通过争取社区在研究概念化方面的领导，我们确保我们能够成功地实现我们的预期目标，在那些对疾病发病率和死亡率造成不成比例的影响的妇女中确定预防宫颈癌的最优策略。

DESCRIPTION (provided by applicant): The South Florida Center for Reducing Cancer Disparities, also known as SUCCESS, supports a number of campus-community partnerships, or Community Advisory Groups (CAGs), throughout the Miami metropolitan area. Such partnerships were conceived in the spirit of Community-based Participatory Research (CBPR) and facilitate meaningful collaboration between University investigators and community stakeholders in addressing issues of health disparity. The proposed project focuses on cervical cancer, a topic of significant health concern for three communities served by SUCCESS: Little Haiti, Hialeah, and West Perrine. Like other predominately minority, low-income neighborhoods across the United States, these communities contribute to excess cervical cancer incidence and mortality, largely due to lack of access to routine Pap smear screening and timely follow up for detected abnormalities. SUCCESS aims to address this disparity. For the past three years, we have been engaged in a community trial comparing two innovative modalities for disease prevention: navigation to Pap smear screening at local Federally-Qualified Health Centers (FQHC) vs. home-based self-sampling for Human Papillomavirus (HPV), the principal cause of cervical cancer. In both arms, Community Health Workers (CHWs) play a critical role in intervention delivery. However, our preliminary data indicate that CHW involvement may matter less than the method of screening itself. Screening uptake is significantly higher among women randomized to self-sampling in all three communities, likely given the ease of use and participant preference for home-based screening, which circumvents structural and cultural barriers to care. The proposed study will formally test the significance of CHW participation by comparing self-sampling provided by a CHW with self-sampling provided by mail. We will implement a two-arm study of 700 women from across our three target communities, with the CHW-self sampling intervention serving as our control group, or arm. Our primary aim is 1) to determine which method of self-sampling results in a greater proportion of women screened. Secondary outcomes include comparisons of a) knowledge, attitudes and beliefs about cervical cancer and the importance of early detection of disease~ b) access to care (health insurance, having a usual source of care, and visit to provider in six months), particularly among women having abnormal screens and requiring medical intervention~ and the c) relative cost of the two intervention strategies. Consistent with the tenets of CBPR, the focus and scope of such work was informed by the SUCCESS CAGs in Little Haiti, Hialeah, and West Perrine. By enlisting community leadership in study conceptualization, we ensure that we can successfully achieve our intended goal, to identify the most optimal strategy for cervical cancer prevention among women who disproportionately contribute to disease incidence and mortality.