Comparative Effectiveness of Interventions to Improve Screening Among Rural Women

 描述（由申请人提供）：2014年，美国约有310，030名女性（美国）将被诊断患有乳腺癌（BC），宫颈癌（CC）或结直肠癌（CRC），68，060名女性将死于这些癌症。这三种癌症占美国女性癌症负担的39%和癌症死亡率的25%，尽管有效的筛查测试广泛适用于所有三种癌症，但许多女性不遵守筛查指南。此外，这些癌症的负担在某些人口群体和区域中更高。俄亥俄州西北部和印第安纳州东北部的32个农村县有着相似的社会经济服务不足的人口，主要是（96.2%）白色妇女，这些妇女具有较高的BC、CRC和CC死亡率，以及较低的乳腺X线摄影、巴氏试验和粪便潜血试验或结肠镜检查筛查率。没有已知的干预措施可以同时提高这三种主要女性癌症的筛查率，尽管多种健康行为改变研究正在成为一种新的模式，可以改变干预措施的包装方式。拟议的项目使用一个整体的理论框架来理解健康差异，其中包括个人，社会和社区层面的变量，以及使用多行为理论方法的干预的概念模型，所有这些都证明了在改善对单一筛查测试行为的依从性方面的有效性，以及其他预防性健康行为。本提案的目的是测试通过DVD（TIDVD）与TIDVD +基于电话的患者导航（PN）干预（TNI）与泌尿系护理（UC）提供的定制交互式计算机程序的比较有效性，以提高居住在俄亥俄州和印第安纳州农村县的50至74岁女性中基于指南的BC、CC和CRC筛查率。具体目标是：1）在生活在俄亥俄州西北部和印第安纳州东北部农村的1058名50至74岁的女性中，比较定制和交互式DVD（TIDVD）与TIDVD +基于电话的PN干预（TNI）与UC在随机化后12个月时提高基于指南的BC、CC和CRC癌症筛查率的有效性;和2）比较TIDVD和TIDVD + TNI干预与UC的成本效益，以坚持每个筛选结果或筛选试验的组合。作为探索性目标，我们将确定理论变量（社区，社会和个人）和筛查结果之间的关联，包括与干预措施的相互作用。如果发现具有成本效益，其中一种或两种干预措施都有可能立即推广，以提高BC、CC和CRC筛查率，并最终减少服务不足的农村妇女的癌症差异。

 DESCRIPTION (provided by applicant): In 2014 approximately 310,030 women in the United States (U.S.) will be diagnosed with breast cancer (BC), cervical cancer (CC), or colorectal cancer (CRC), and 68,060 women will die from these cancers. These three cancers account for 39% of the cancer burden and 25% of the cancer mortality among women in the U.S. Although effective screening tests are widely available for all three cancers, many women do not adhere to screening guidelines. Furthermore, the burden of these cancers is higher among some population groups and regions. Thirty-two rural counties in northwest Ohio and northeast Indiana share similar socioeconomically underserved populations of predominately (96.2%) white women who have elevated BC, CRC, and CC mortality rates, and lower screening rates with mammography, Pap tests, and fecal occult blood testing or colonoscopy. No known intervention has addressed improving screening rates for these three main female cancers simultaneously, even though multiple health behavior change research is emerging as a new model to change the way in which interventions can be packaged. The proposed project uses an overall theoretical framework to understand health disparities which includes individual, social and community level variables, and a conceptual model for the intervention which uses a multiple behavior theoretical approach, all of which have demonstrated efficacy in improving adherence to single screening test behaviors, as well as other preventive health behaviors. The goal of this proposal is to test the comparative effectiveness of a tailored interactive computer program delivered via DVD (TIDVD) vs. a TIDVD + telephone-based patient navigation (PN) intervention (TNI) vs. Usual Care (UC) to increase guideline-based screening rates for BC, CC, and CRC among women age 50 to 74 living in these rural counties of Ohio and Indiana. Specific aims are to: 1) compare the effectiveness of a tailored and interactive DVD (TIDVD) vs. TIDVD + telephone-based PN intervention (TNI) vs. UC, to increase guideline-based cancer screening rates at 12 months post randomization for BC, CC, and CRC among 1058 women age 50 to 74 living in rural northwest Ohio and northeast Indiana; and 2) compare the cost effectiveness of the TIDVD and the TIDVD + TNI intervention vs. UC, for adherence to each screening outcome or combination of screening tests. As an Exploratory Aim, we will identify associations between theoretical variables (community, social, and individual) and screening outcomes, including interactions with the interventions. If found to be cost effective, either or both interventions hae the potential to be immediately disseminated to increase BC, CC, and CRC screening rates and ultimately reduce cancer disparities for underserved rural women.