Developing and evaluating scalable and culturally relevant interventions to improve breast cancer screening among White Mountain Apache women

制定和评估可扩展且与文化相关的干预措施，以改善白山阿帕奇妇女的乳腺癌筛查

• 批准号: 10494075
• 负责人: Mary Allison Barlow
• 金额: $ 27.98万
• 依托单位: WHITE MOUNTAIN APACHE TRIBE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10494075
• 关键词: Address; Age; Alaska Native; American Indians; Apache; Arizona; Breast Cancer Detection; Breast Cancer Early Detection; Breast Cancer Patient; Breast Cancer Risk Factor; COVID screening; COVID-19; COVID-19 pandemic; Caring; Clinic; Communities; Community Healthcare; Continuity of Patient Care; Data Collection; Diagnosis; Disease; Distant; Education; Educational Curriculum; Eligibility Determination; Epidemiology; Ethnic Origin; Family; Focus Groups; Funding; Goals; Grant; Health; Healthy People 2020; Individual; Intervention; Interview; Learning; Learning Module; Localized Disease; Mammography; Morbidity - disease rate; Motivation; Names; Native American Research Center for Health; Outpatients; Physical activity; Population; Process; Provider; Race; Randomized; Readiness; Recording of previous events; Research; Resources; Rural Population; Schedule; Stress; Survival Rate; System; Tablets; Testing; Time; Transportation; Visit; Voice; White Mountain Apache; Woman; Women' s Health; Work; aged; arm; behavior change; breast cancer survival; cancer care; community based participatory research; coronavirus disease; design; efficacy evaluation; evidence base; experience; improved; learning community; mHealth; malignant breast neoplasm; mortality; nutrition; obesity risk; patient navigator; peer; screening; telephone coaching; tool; tribal community; tribal lands; tribal leader; uptake

PROJECT SUMMARY White Mountain Apache (WMA) leaders have voiced an urgent need to prioritize breast cancer screening research in NARCH XI due to concern about low screening rates. As of 2018, screening rates among eligible WMA women were more than 2 times lower than the Healthy People 2020 target, 39.1% compared to 81.1%, and substantially lower than screening rates among AI/AN women nationally. In Arizona (AZ), where the WMA tribal lands are located, 32% of AI women are diagnosed at later stage disease (i.e., either regional or distant vs. local disease) compared to 25% of AZ women overall. There is a great need for culturally appropriate interventions to improve screening rates and reduce mortality and morbidity from breast cancer in the WMAT population. This project will support the WMA-JHU partners and our established cancer care Community Advisory Board to design two motivational tools based on findings regarding barriers and facilitators to breast screening among Apache women, and he shortage of providers’ time and resources to provide clinic- based education. The first tool will be delivered on a tablet in the clinic with highly graphic, culturally congruent breast-cancer screening information. It is named Tablet-based Education to improve Acceptance of Mammography” or “TEAM.” The second tool will be an Individual-based one-to-one peer-educational module delivered by a paraprofessional Apache women’s health coach, called “COACH,” to address individuals’ personal barriers and facilitators to breast cancer and screening concerns and provide one-to-one support for scheduling, transportation and completing a mammogram. We will evaluate these intervention tools through an RCT with n= 500 women aged 50+ who receive a mammography referral after a local outpatient visit. Women will be stratified by prior history of mammography (never or ever) and age (<65 or 65+), and then randomized 1:1 to receive either TEAM alone or TEAM+Coach. The WMA-JHU partners bring extensive experience building and evaluating motivational behavior change curricula delivered one-on-one and with mobile health tools that have now been scaled to >140 tribal communities across 21 states.

项目摘要 白山阿帕奇（WMA）领导人迫切需要优先考虑乳腺癌筛查 由于担心较低的筛查率，对Narch XI的研究。截至2018年，筛选率 合格的WMA妇女比2020年健康人低2倍以上，39.1％ 相比之下为81.1％，在全国范围内的AI/A妇女中的筛查率大大低于筛查率。在 WMA部落土地所在的亚利桑那州（AZ），在后期诊断出32％的AI妇女 疾病（即区域或远处与当地疾病），而总体上的AZ妇女中有25％。有 非常需要在文化上适当的干预措施来提高筛查率并降低死亡率和 WMAT人群中乳腺癌的发病率。 该项目将支持WMA-JHU合作伙伴和我们既定的癌症护理社区咨询 董事会根据有关障碍和促进因子的乳房的发现设计两个动机工具 在Apache妇女中进行筛查，以及他缺乏提供者的时间和资源来提供诊所 基于教育。第一个工具将在诊所的平板电脑上运送，具有高度图形的文化 一致的乳腺癌筛查信息。它被称为基于平板电脑的教育以改善 接受乳房X线摄影”或“团队”。第二个工具将是基于个人的一对一 由Apache妇女健康教练提供的同行教育模块称为 “教练”，以针对个人的个人障碍和促进者，以应对乳腺癌和筛查 关注并为安排，运输和完成乳房X线照片提供一对一的支持。 我们将通过RCT评估这些干预工具，n = 500名50岁以上的女性 当地门诊后乳房X线摄影转介。妇女将按照先前的历史进行分层 乳房X线摄影（从未或以往）和年龄（<65或65岁以上），然后随机1：1接收任一支团队 单独或团队+教练。 WMA-JHU合作伙伴带来了广泛的经验建设和评估 动机行为改变课程提供了一对一和移动健康工具的交付 被缩放到21个州的140个部落社区。