Testing Approaches to Promote Breast Cancer Screening in Rural Ghana

促进加纳农村地区乳腺癌筛查的测试方法

• 批准号: 10645446
• 负责人: Yubraj Acharya
• 金额: $ 22.65万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-21 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10645446
• 关键词: Address; Advisory Committees; Affect; Africa South of the Sahara; Age; Attitude; Awareness; Behavior Therapy; Belief; Breast Cancer Detection; Breast Cancer Education; Bundling; Clinic; Consult; Country; Data Collection; Decision Making; Diabetes Mellitus; Diagnosis; Disease; Early Diagnosis; Economics; Education; Educational Curriculum; Educational Materials; Effectiveness of Interventions; Enrollment; Evaluation; Family; Family Planning; Feasibility Studies; Future; Gender; Generations; Ghana; Goals; Government; Head; Health; Health behavior; Health care facility; Health system; Household; Incidence; Income; Intervention; Interview; Low income; Malignant Neoplasms; Maternal and Child Health; Measures; Methods; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Participant; Personal Satisfaction; Process; Protocols documentation; Randomized, Controlled Trials; Religion; Research; Risk Factors; Rural; Sample Size; Scientist; Self-Examination; Side; Site; Social support; Surveys; Survival Rate; Testing; Time; Transportation; Travel; Visit; Woman; Women' s Health; arm; combat; cost; design; diabetes education; effectiveness testing; gender behavior; high reward; improved; innovation; insight; instrument; intervention effect; male; malignant breast neoplasm; men; multidisciplinary; novel; programs; prototype; recruit; routine screening; screening; screening program; social; social culture; social stigma; uptake; young woman

Project Summary Breast cancer (BC) is the most common cancer among women worldwide and has profound implications for the well-being of women and their families. In sub-Saharan Africa, BC incidence is rising, late presentation is common, younger women are disproportionately affected, and survival rates are low. One of the Government of Ghana’s top strategies to combat BC is early detection through routine screening, yet screening rates are low. Our multidisciplinary team has designed two interventions to surmount three key sociocultural and economic barriers and increase the utilization of BC screening, including (1) time and transportation costs, (2) cultural beliefs and stigma, and (3) male dominance in decision-making and lack of social support for women. The BUNDLING intervention offers women BC and diabetes education followed by BC and type II diabetes screenings during the same visit to the local clinic. Provision of simultaneous (bundled) screenings is hypothesized to increase BC screening through several mechanisms, including reducing time/transportation costs and diluting the stigma of seeking BC screening on its own. The MEGH (Male Engagement in Gender and Health) Program offers BC education to women and their male partners, invites partners to 7 weekly discussion group sessions (5 men-only and 2 women and men), and subsequently offers women BC screening at the local clinic. The MEGH Program is hypothesized to increase BC screening through several mechanisms, including changing men’s gender attitudes, increasing women’s control over decision-making, and increasing men’s social support. Our long-term goal is to test the effectiveness of these interventions in a future clustered RCT. The overall goal of the proposed R21 project is to finalize the design and implementation aspects for the future RCT in a feasibility study. The specific aims are: (1) Refine study materials (education materials, MEGH Program curriculum, data collection instruments) for cultural relevance and implementation. We consult with an expert advisory committee and a local committee in an iterative process. (2) Determine the feasibility of the two interventions using sequential mixed methods. We assess the interventions in three clinic zones (2 interventions + a control) with women age 20+ (and male partners in the MEGH group). We conduct baseline and endline surveys, followed by qualitative in-depth interviews. (2A) Establish feasibility based on recruitment, retention, and acceptability. (2B) Assess initial evidence of efficacy and intervention fidelity, and clarify these findings through participants’ insights from follow-on in-depth interviews. We assess the strengths and weaknesses of the interventions, challenges to intervention fidelity, and implementation approaches. (2C) Examine initial evidence of the effect of interventions on the mechanisms, and clarify these findings through participants’ insights. (2D) Finalize the protocol for the future clustered RCT using study findings. These new interventions tackle key barriers to improving a critical health behavior—BC screening—for women. The study will generate a prototype for addressing the high incidence of BC in low-income settings.

项目摘要 乳腺癌（BC）是全世界女性中最常见的癌症，对女性健康有着深远的影响。 妇女及其家庭的福祉。在撒哈拉以南非洲，BC发病率正在上升，迟发性 年轻妇女普遍受到不成比例的影响，存活率很低。之一 加纳政府抗击BC的最高战略是通过常规筛查进行早期发现， 筛查率低。我们的多学科团队设计了两种干预措施，以克服三个关键 社会文化和经济障碍，增加BC筛查的利用率，包括（1）时间和 交通费用，（2）文化信仰和耻辱，（3）男性在决策中的主导地位和缺乏 对妇女的社会支持。捆绑干预为妇女提供BC和糖尿病教育 BC和II型糖尿病筛查在同一次访问当地诊所。提供同声 假设（捆绑）筛查通过几种机制增加BC筛查，包括 减少时间/运输成本，并淡化自行寻求BC筛查的耻辱。MEGH (Male参与性别与健康）方案向妇女及其男性伴侣提供不列颠哥伦比亚教育， 邀请合作伙伴参加7次每周一次的小组讨论会（5名男子和2名妇女和男子）， 随后在当地诊所为妇女提供BC筛查。据推测，MEGH计划将增加 通过多种机制进行BC筛查，包括改变男性的性别态度，提高女性的 控制决策，增加男性的社会支持。我们的长期目标是测试 这些干预措施的有效性，在未来的集群随机对照试验。拟议的R21项目的总体目标 是在可行性研究中完成未来随机对照试验的设计和实施方面。具体 目的是：（1）完善研究材料（教育材料，MEGH计划课程，数据收集 文化相关性和执行的文书。我们咨询专家咨询委员会和 在一个迭代过程中的地方委员会。(2)使用序贯方法确定两种干预措施的可行性 混合方法。我们评估了三个诊所区的干预措施（2项干预措施+一项对照）， 年龄20岁以上（和MEGH组的男性伴侣）。我们进行基线和底线调查， 定性深入访谈。(2A)基于招聘、保留和可接受性建立可行性。 (2B)评估疗效和干预保真度的初步证据，并通过以下方式澄清这些发现： 参与者从后续深入访谈中获得的见解。我们评估的长处和短处， 干预措施，干预措施的保真度的挑战，以及实施方法。(2C)检查初始 干预措施对机制的影响的证据，并通过参与者的 见解. (2D)使用研究结果最终确定未来聚类RCT的方案。这些新 干预措施解决了改善妇女关键健康行为-BC筛查-的主要障碍。的 这项研究将产生一个解决低收入环境中BC高发问题的原型。