Reducing Urban Cervical Cancer Disparities Using a Tailored mHealth Intervention to Enhance Colposcopy Attendance

项目摘要/摘要 宫颈癌是最可预防的癌症之一，如果及早诊断和适当治疗， 存活的可能性接近100%。然而，不参加不正常的后续预约的人数达到 63%在城市、服务不足的少数族裔妇女中。宫颈癌的预防和及时诊断要求 随着时间的推移，对患者进行监测。现有的促进出席率的干预方案具有重要意义 由于对城市、服务不足的少数族裔妇女的关注有限，以及资源的可持续性降低-- 有限的设置。为了填补这一空白，我们提出了一种量身定制的mHealth干预方案，有英语和西班牙语两种版本 对3个以低血症为主的城市诊所进行异常检测反馈的针对性随访 收入较低的少数族裔妇女。我们提出了一种混合型1有效性实施试验，从理论上讲- 在认知-社会健康信息处理模型的指导下， 实施和可持续执行框架，以运作和评估 健康促进资源系统(HERS)干预。她的目标是增加患者在术后的随访 通过短信为女性提供障碍咨询和补充电话的异常检测结果- 为错过预约的女性提供健康指导。使用顺序的、多个分配， 随机试验(SMART)设计和利益相关者参与的方法我们的目标是：(1)进行随机试验 使用智能设计评估HERS疗效的对照试验(RCT)；(2)定性评估 影响她的环境因素(患者因素、医疗团队资源和组织因素) 实施结果和可伸缩性和可持续性的潜力；以及(3)探索患者级别的主持人 她的干预与参加阴道镜检查预约之间的关系。女人 (n=546)计划在检查结果异常后进行首次或重复阴道镜检查的患者将被招募，并 随机到两种情况之一(她的短信或护理标准)，并通过智能设计， 将留在分配给他们的小组中或重新随机分配到她或她的+健康指导，取决于最初 预约出席率。主要结果是参加基线阴道镜检查的人数和次要检查人数 结果是12个月的长期随访。其他研究问题将评估最佳的初始 干预(例如，护理标准或HERS)，以增加基线和12个月随访的出勤率 预约。与医疗保健利益相关者的深入访谈和与患者的离职访谈将评估 团队和医疗保健系统环境对HIS实施的影响。最后，探索性分析寻求 确定干预效果的调节因素(例如，种族/民族、西班牙语或英语、健康素养) 评估哪些患者应该接受HERS干预的基线和12个月的随访预约 作为一线干预，而不是护理标准。

PROJECT SUMMARY/ABSTRACT Cervical cancer is one of the most preventable cancers and when diagnosed early and appropriately treated, the likelihood of survival is close to 100%. However, nonattendance at abnormal follow-up appointments reaches 63% among urban, underserved minority women. Cervical cancer prevention and timely diagnosis requires that patients be monitored over time. Existing intervention protocols to promote attendance have significant limitations given a limited focus on urban, underserved minority women and reduced sustainability in resource- limited settings. To fill this void, we propose a tailored mHealth intervention available in both English and Spanish targeting follow-up attendance for abnormal test feedback at 3 urban clinic sites serving predominately low- income minority women. We propose a hybrid Type 1 effectiveness-implementation trial that is theoretically- guided by the Cognitive-Social Health Information Processing model and the Exploration, Planning, Implementation and Sustainment Implementation Framework to operationalize and assess the efficacy of the Health Enhancement Resource System (HERS) intervention. HERS aims to increase patient follow-up after abnormal test results through text message-based barriers counseling for women and supplemental telephone- based Health Coaching for women who miss their appointment. Using a sequential, multiple assignment, randomized trial (SMART) design and stakeholder-engaged approach our aims are to: (1) conduct a randomized control trial (RCT) using the SMART design to evaluate the efficacy of HERS; (2) qualitatively assess the contextual factors (patient factors, healthcare team resources, and organizational factors) affecting HERS implementation outcomes and potential for scalability and sustainability; and (3) explore patient-level moderators of the relationship between the HERS intervention and attendance at the colposcopy appointment. Women (N=546) scheduled for initial or repeat colposcopy following an abnormal test result will be recruited and randomized to one of 2 conditions (HERS text messages or Standard of Care) and, through the SMART design, will remain in their assigned group or re-randomized to HERS or HERS + Health Coaching, depending on initial appointment attendance. The primary outcome is attendance at the baseline colposcopy and the secondary outcome is long-term follow-up at 12-months. Additional research questions will evaluate the best initial intervention (e.g., Standard of Care or HERS) for increasing attendance at the baseline and 12-month follow-up appointments. In-depth interviews with healthcare stakeholders and exit interviews with patients will assess the impact of team and healthcare system context on the HERS implementation. Finally, exploratory analyses seek to identify moderators of intervention effect (e.g., race/ethnicity, Spanish or English language, health literacy) at baseline and 12-month follow-up appointments to evaluate which patients should receive the HERS intervention as a first-line intervention rather than Standard of Care.