Project 3-Community Health workers United to Reduce Colorectal cancer and CVD among people at Higher risk (CHURCH)

项目摘要/摘要 非洲裔美国人(AA)成年人比任何其他人更容易感染和死于结直肠癌(CRC) 在美国AAS中，种族群体接受CRC筛查的可能性最小，患有结直肠癌前病变 切除息肉，并在早期阶段检测到结直肠癌，以便进行根治性切除。较低的筛查率 与结构性种族主义和其他社会生态因素的下游影响有关。虽然减少了 结直肠癌的死亡率最好通过筛查，令人信服的证据与炎症性饮食和 其他心血管疾病(CVD)危险因素导致结直肠癌风险增加。黑人教堂是中心 AA社区中的机构，可以帮助增加获得CRC筛查的机会，并解决心血管疾病风险因素。 社区卫生工作者(CHW)是来自目标社区的受信任的辅助专业人员，他们可能是 能够通过教会干预在结直肠癌筛查和心血管疾病风险因素之间架起桥梁 送货。因此，这项研究的总体目标是发展一个全面的、根据文化定制的社区- 基于CRC预防模型，双重强调降低CRC风险及其CVD风险因素。这个 研究干预包括两个组成部分：筛查、简短干预和转诊治疗(SBIRT) 解决CRC筛查和一个名为“活着！”的网络生活方式项目应对与以下因素相关的心血管疾病风险因素 CRC。C.H.U.R.C.H.试验(社区卫生工作者联合减少结直肠癌和 高危人群中的心血管疾病)有四个具体目标：(1)比较 CHW主导的SBIRT(干预)转诊为照常转诊(RAU)(通常护理)符合指南的结直肠癌 筛选摄取；(2)评估文化适应的CHW连锁活体的效果！(CACA)计划 纳入干预组对膳食炎症评分(DIS)的影响；(3)评价CACA的疗效 关于生活简单-7(LS7)分数的变化；以及(4)考察多层次的语境机制和 影响CHW有效性、覆盖范围和实施结直肠癌筛查和CACA的因素 通过混合方法的过程评估开展活动。鉴于布莱克的广泛影响和影响力 这项研究的结果可以用来为未来扩大这一多管齐下的干预措施提供信息。

PROJECT ABSTRACT/SUMMARY African American (AA) adults are more likely to contract and die from Colorectal Cancer (CRC) than any other racial group in the U.S. AAs are the least likely to undergo CRC screening, have precancerous colorectal polys removed, and have CRC detected at stages early enough for curative excision. Lower screening rates are linked to the downstream effects of structural racism and other socio-ecological factors. Although reducing the mortality from CRC is best accomplished by screening, compelling evidence links inflammatory diets and other cardiovascular disease (CVD) risk factors to increased risk of CRC. Black churches are central institutions in AA communities that can help increase access to CRC screening and address CVD risk factors. Community Health Workers (CHWs), who are trusted paraprofessionals from the target community, may be able to bridge the connection between CRC screening and CVD risk factors through church-based intervention delivery. Thus, the overall goal of this study is to develop a comprehensive, culturally tailored community- based CRC prevention model with a dual emphasis on reducing CRC risk along with its CVD risk factors. The study intervention has two components: Screening, Brief Intervention, and Referral to Treatment (SBIRT) to address CRC screening and a web-based lifestyle program called “Alive!” to address CVD risk factors linked to CRC. The C.H.U.R.C.H. Trial (Community Health workers United to Reduce Colorectal cancer and cardiovascular disease among people at Higher risk) has four specific aims: (1) to compare the effect of a CHW-Led SBIRT (Intervention) to Referral As Usual (RAU) (Usual Care) on guideline-concordant CRC screening uptake; (2) to evaluate the effect of a Culturally Adapted CHW-linked Alive! (CACA) program incorporated into the intervention arm on dietary inflammatory score (DIS); (3) to evaluate the effect of CACA on changes in Life Simple-7 (LS7) scores; and (4) to examine the multi-level contextual mechanisms and factors influencing CHW effectiveness, reach, and implementation of CRC screening uptake and CACA activities through a mixed-methods process evaluation. Given the broad reach and influence of Black churches, results from this study can be used to inform future scale up of this multi-pronged intervention.