Enhancing the Effectiveness of Community Health Workers to Reduce Cervical Cancer Disparities in African American Women

提高社区卫生工作者的有效性，减少非裔美国妇女的宫颈癌差异

• 批准号: 10603297
• 负责人: DOUGLAS W BILLINGS
• 金额: $ 85.59万
• 依托单位: ISA ASSOCIATES, INC.
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-23 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10603297
• 关键词: Adherence; African American; African American population; Age; Attention; Behavior Therapy; Benchmarking; Breast Cancer Prevention; Car Phone; Caring; Case Management; Cervical; Communication; Communities; Community Health Aides; Complex; Computer software; Consultations; Data; Development; Devices; Diagnosis; Diagnostic; Disease; Effectiveness; Electronic Health Record; Emotional; Funding; Goals; Health Personnel; Health education; Hispanic; Hysterectomy; Incidence; Insurance; Intervention; Interview; Knowledge; Lesion; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Measures; Medical; Morbidity - disease rate; National Cancer Institute; Not Hispanic or Latino; Online Systems; Participant; Patients; Performance; Phase; Pilot Projects; Provider; Public Health; Randomized; Research; Resolution; Risk Assessment; Screening for cancer; Self Efficacy; Services; Testing; Text Messaging; Time; Touch sensation; Transportation; Trust; Tumor stage; Underserved Population; Uninsured; Woman; Work; base; black patient; black women; cancer care; cancer health disparity; cancer prevention; dashboard; design; follow-up; health literacy; improved; member; mortality; mortality disparity; outreach; premalignant; product development; programs; prototype; screening; screening disparities; screening guidelines; skills; socioeconomic disadvantage; success; tool; treatment as usual; video delivery

PROJECT SUMMARY/ABSTRACT The hysterectomy-corrected incidence of cervical cancer (CC) is more than 40% higher among African American women than white women. Black women are also twice as likely to die from CC. It does not have to be this way. Widespread screening and proper follow-up would eliminate most new cases of CC because the natural progression of precancerous cervical lesions is slow, allowing for treatment and cure. The best evidence indicates that this is not happening. Adherence to screening guidelines is too low among Black women. One promising solution to this problem is patient navigation (PN). PN was originally developed to help socioeconomically disadvantaged Black women overcome the systemic, provider, and personal barriers to timely cancer prevention and care using community members as lay navigators. Recently, however, there has been a general shift away from navigating poor and uninsured patients, towards higher SES patients in better funded, more comprehensive cancer care centers. While nearly all can benefit from PN, if not targeted to those most in need, delivering these services to more privileged patients can exacerbate disparities. In previous pilot work, we developed and tested a prototype, mobile PN intervention for both African American women (mNav) and lay navigators (mNav-D) to reduce CC health disparities. These products are front-ends to the same server-based program, and thus fully integrated. For patients, mNav includes an integrated web-based risk assessment that allows our SMS software app to select and deliver videos and text messages specific to each woman’s particular cervical screening challenges. Pilot work with 42 African American women ages 21 to 65 informed the development of this product. For lay navigators, mNav-D provides an “at a glance” overview of key performance metrics while also supporting easy entry of encounter- level patient data. Development of this product was informed by formative research with 16 PNs working in a range of settings. We also interviewed 12 participants who either had upstream or downstream touch points with electronic health record (EHR) workflows. The data across these pilot studies strongly supports the feasibility and potential effectiveness of these products, far exceeding the proposed benchmarks. During Phase II we will complete development of mNav and mNav-D in consultation with our three content experts. We will then examine the effectiveness of mNav and mNav-D to increase adherence to cervical screening guidelines via medical review among nonadherent African American women. Participants will be randomly assigned to either the intervention condition (PN + mNav/mNav-D) or to usual care (PN only). Secondary measures will assess cancer screening knowledge, benefits and barriers of cancer screening, and intentions.

项目概要/摘要 非洲人经子宫切除术纠正的宫颈癌 (CC) 发病率高出 40% 以上 美国女性多于白人女性。黑人女性死于 CC 的可能性也是女性的两倍。它不必 就这样吧。广泛的筛查和适当的随访将消除大多数新的 CC 病例，因为 宫颈癌前病变的自然进展缓慢，可以进行治疗和治愈。最好的证据 表明这没有发生。黑人女性对筛查指南的遵守率太低。 解决这一问题的一个有希望的解决方案是患者导航 (PN)。 PN 最初是为了帮助 社会经济上处于不利地位的黑人妇女克服了系统性、提供者和个人的障碍 利用社区成员作为非专业导航员进行及时的癌症预防和护理。然而最近却有 这是一个普遍的转变，从引导贫困和没有保险的患者转向生活条件较好、社会经济地位较高的患者 资助的、更全面的癌症护理中心。虽然几乎所有人都可以从 PN 中受益，但如果不针对这些人 如果向最需要帮助的患者提供这些服务，可能会加剧不平等。 在之前的试点工作中，我们开发并测试了针对非洲和非洲的移动 PN 干预原型 美国女性 (mNav) 和非专业导航员 (mNav-D) 致力于减少 CC 健康差异。这些产品是 前端到相同的基于服务器的程序，从而完全集成。对于患者，mNav 包括 基于网络的集成风险评估，允许我们的 SMS 软件应用程序选择和传送视频和文本 针对每位女性特定宫颈筛查挑战的具体信息。与 42 个非洲国家开展试点工作 21 至 65 岁的美国女性了解了该产品的开发。对于非专业导航员来说，mNav-D 提供关键绩效指标的“一目了然”概述，同时还支持轻松输入遭遇- 水平患者数据。该产品的开发基于 16 名 PN 的形成性研究 设置范围。我们还采访了 12 位有上游或下游接触点的参与者 电子健康记录 (EHR) 工作流程。这些试点研究的数据有力地支持了 这些产品的可行性和潜在有效性，远远超出了建议的基准。 在第二阶段，我们将与我们的三个团队协商完成 mNav 和 mNav-D 的开发 内容专家。然后，我们将检查 mNav 和 mNav-D 提高颈椎病依从性的有效性 通过对不依从的非洲裔美国女性进行医学审查的筛查指南。参加者将是 随机分配至干预条件（PN + mNav/mNav-D）或常规护理（仅限 PN）。 次要措施将评估癌症筛查知识、癌症筛查的益处和障碍，以及 意图。