Empowering Latinas to Obtain Guideline-Concordant Breast Cancer Screenings

摘要 拉丁裔人在晚期乳腺癌(BC)诊断和诊断后病情恶化方面的患病率不成比例 相对于非拉丁裔白人(NLW)的生活质量，部分原因是指南一致性较低。 教育+导航(教育)方法提供了拉丁裔社区教育来解决 心理社会障碍(例如，恐惧)和引导拉丁裔人获得免费/低成本乳腺癌护理。我们的 跨学科团队开发了一种前景看好的赋能+导航(Empower)方法，该方法可能 导致在拉丁裔网络中进行更多的BC筛查。在赋权方法中，不信奉的拉丁裔 到美国预防服务工作组(USPSTF)指南了解BC；导航到免费/低成本 乳癌护理；并获得沟通技能，在其网络中推广乳腺癌筛查。 我们的前提是，赋予非拉丁信徒作为乳房保健剂的权力可能会导致更大的BC 在未依附的拉丁裔及其网络中进行筛查而不是将未依附的拉丁裔视为被动 接受教育的人。目前的提案测试了我们的假设，并确定了 增强方法的能力。 在目标1中，我们将在联邦合格的健康中心进行一项个人随机对照试验(RCT) (FQHC)。这项试验将建立在我们团队目前的服务项目的基础上，在 FQHC，包括利用其与致力于领导的社区组织的关系 拉丁裔的发展。在非拉丁裔中，我们将比较赋权和 根据USPSTF指南，对初次和重复的BC筛查方法进行培训。 在目标2中，我们进行了一项观察性的社会网络研究。我们将通过非政府组织招募网络成员 拉丁信徒参加了我们的RCT。在网络成员中，我们将比较赋权和 在四年内对初次和重复的BC筛查方法进行培训。 在目标3中，我们将探索可能有助于干预差异的理论变化机制 BC放映。对于非拉丁裔的BC筛查，我们将研究大BC的中介作用 知识和动力，成为健康的榜样。对于网络成员的BC筛选，我们将审查 未依附的拉丁裔增强了促进BC筛查的能力的中介作用。具体地说，我们将测试 志愿服务在社区BC倡议中的独立作用，潜在地为网络成员搭建桥梁 具有正式的变革推动者(例如，社区卫生工作者、导航员)、推广BC的可接受性、可行性 推广BC，并向网络会员推广BC。 我们的创新、强大的方法对加快有前途的社区的翻译具有直接影响 将干预付诸实践。

ABSTRACT Latinas suffer disproportionately from late stage breast cancer (BC) diagnoses and worse post-diagnosis quality of life relative to non-Latina Whites (NLWs), in part due to lower guideline-concordant screening. Education+navigation (educate) approaches have offered Latinas community education to address psychosocial barriers (e.g., fear) and navigated Latinas to free/low-cost breast cancer care. Our transdisciplinary team has developed a promising empowerment+navigation (empower) approach that may lead to greater BC screening among Latino networks. In the empower approach, Latinas who are non-adherent to US Preventive Services Task Force (USPSTF) guidelines learn about BC; are navigated to free/low cost breast cancer care; and gain communication skills to promote BC screening throughout their networks. Our premise is that empowering non-adherent Latinas as breast health agents may lead to greater BC screening among non-adherent Latinas and their networks than treating non-adherent Latinas as passive recipients of education. The current proposal tests our premise and identifies “active ingredients” of the empower approach. In Aim 1, we will conduct an individual randomized controlled trial (RCT) in a federally qualified health center (FQHC). This trial will build on our team’s current service projects to provide free/low-cost BC screening in the FQHC, including leveraging its relationship with a community organization committed to leadership development among Latinas. Among non-adherent Latinas, we will compare the effects of empower and educate approaches on initial and repeat BC screening, in line with USPSTF guidelines. In Aim 2, we conduct an observational social network study. We will recruit network members through non- adherent Latinas enrolled in our RCT. Among network members, we will compare the effects of empower and educate approaches on initial and repeat BC screening across four years. In Aim 3, we will explore theoretical mechanisms of change that could contribute to intervention differences in BC screening. For non-adherent Latinas’ BC screening, we will examine the mediating roles of greater BC knowledge and motivation to be healthy role model. For network members’ BC screening, we will examine the mediating role of non-adherent Latinas’ enhanced capacity to promote BC screening. Specifically, we will test the independent effects of volunteerism in community BC initiatives, potential to “bridge” network members with formal change agents (e.g., community health workers, navigators), acceptability to promote BC, feasibility to promote BC, and BC promotion to network members. Our innovative, robust approach has direct implications for expediting the translation of promising community interventions into practice.