Development of a culturally targeted patient navigation curriculum for LGBT adult

为 LGBT 成人开发具有文化针对性的患者导航课程

• 批准号: 7897934
• 负责人: Alicia K Matthews
• 金额: $ 18.79万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-22 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7897934
• 关键词: Accounting; Address; Adult; Age; Age at First Live Birth; Alcohol consumption; American; Attitude; Behavior; Behavioral; Behavioral Risk Factor Surveillance System; Belief; Bisexual; Breast; Cancer Burden; Cancer Prevention Trial; Caring; Cervical; Cessation of life; Characteristics; Clinical; Colon; Colon Carcinoma; Colorectal; Communication; Communities; Data; Development; Diagnosis; Early Diagnosis; Educational Curriculum; Effectiveness; Emotional; Evaluation; Evidence based practice; Face; Fright; Gays; General Population; Genus Cola; Goals; Guidelines; Health; Health Educators; Health Personnel; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Healthy People 2010; Heterosexuals; Income; Individual; Insurance; Intervention; Interview; Knowledge; Lesbian; Life; Malignant Neoplasms; Measures; Medial; Mediating; Medical center; Methods; Morbidity - disease rate; Newly Diagnosed; Obesity; Oral Contraceptives; Outcome; Patient Education; Patients; Performance; Persons; Physicians; Preventive; Preventive Health Services; Program Acceptability; Protocols documentation; Provider; Qualitative Research; Research; Risk; Role; Screening for cancer; Screening procedure; Services; Sex Behavior; Sex Orientation; Simulate; Smoking; System; Testing; Training; Transportation; Vulnerable Populations; Work; base; cancer care; cancer health disparity; cohort; colorectal cancer screening; compliance behavior; cost; experience; falls; follow-up; health care quality; innovation; mortality; parity; patient population; peer; programs; psychosocial; public health priorities; public health relevance; randomized trial; reproductive; satisfaction; skills; social; social stigma; transgender

DESCRIPTION (provided by applicant): The overall study objective is to develop a culturally targeted patient navigation training curriculum aimed at increasing breast, cervical and colorectal cancer screening behaviors in lesbian, gay, bisexual and transgendered (LGBT) persons. We propose a rigorous plan of formative research (qualitative interviews and learner verification trials) with key stakeholders (non-adherent LGBT adults, health care providers and medical center directors) to identify general and unique sociocultural (social stigma, mistrust, provider bias, concealment and identity and health), provider (appropriateness, cultural competency, quality of providers, patient adherences and communication) and system level (availability, costs, transportation, organization) barriers to cancer screening experienced by LGBT individuals. The obtained information will serve as a basis for adapting and culturally targeting an existing Health System Navigation curriculum that will guide patient navigators in the reduction of barriers to appropriate cancer screening and follow-up care among non-adherent LGBT individual. A secondary goal is to pilot test the adapted cancer screening Health System Navigation (CS- HSN) training curriculum with a cohort of LGBT health educators and lay PN. Pilot testing the CS-HSN training methods and curriculum will help to establish the feasibility of training protocols, the acceptability of the curriculum and materials and performance outcomes based on the curriculum as measured during simulated clinical encounters with standardized patients. Specific aims are: Aim 1a: To determine using in-depth interviews with key stakeholders (non-adherent LGBT, medial providers and medical center directors) barriers to cancer screening (sociocultural, provider and system) for LGBT who are non-adherent to age-appropriate cancer screening guidelines (breast, cervical, and colon). Aim 1b: To use the interview data as a basis for adapting the Health System Navigation curriculum and training protocol for use in reducing barriers to cancer screening in LGBT persons and finalizing the Cancer Screening-Health System Navigation curriculum (CS-HSN). Aim 2: To use the generated CS-HSN curriculum, to pilot test the training of a cohort of health educators (N=6) and lay patient navigators (N=10) and to systematically evaluate feasibility (recruitment and retention), acceptability (program satisfaction), and performance outcomes (knowledge, interviewing skills, patient navigation roles) as measured by simulated clinical with standardized patients. PUBLIC HEALTH RELEVANCE: This study will be one of the first attempts to systematically develop a targeted patient navigation (PN) training curriculum aimed at reducing cancer screening disparities in Lesbian, Gay, Bisexual, and Transgender (LGBT) persons. Anticipated outcomes from the current project, including the identification of LGBT specific barriers to cancer screening, the development of a new patient navigation targeting cancer screening, experience training health educators and PN using the curriculum, and the evaluation of the health system barriers to providing cancer screening at 7 LGBT medical centers will provide the preliminary data necessary to conduct a full randomized trial testing the cancer screening patient navigation program.

描述（由申请人提供）：总体研究目标是开发针对文化的患者导航培训课程，旨在增加女同性恋、男同性恋、双性恋和变性人 (LGBT) 的乳腺癌、宫颈癌和结直肠癌筛查行为。我们提出了一项严格的形成性研究计划（定性访谈和学习者验证试验），与主要利益相关者（非依从性 LGBT 成年人、医疗保健提供者和医疗中心主任）合作，以确定一般和独特的社会文化（社会耻辱、不信任、提供者偏见、隐瞒和身份与健康）、提供者（适当性、文化能力、提供者质量、患者依从性和沟通）和系统水平 （可用性、成本、交通、组织）LGBT 人群在癌症筛查方面遇到的障碍。所获得的信息将作为调整现有卫生系统导航课程并在文化上定位的基础，该课程将指导患者导航员减少对非依从性 LGBT 个体进行适当癌症筛查和后续护理的障碍。第二个目标是与一群 LGBT 健康教育者和非专业 PN 一起试点测试改编后的癌症筛查健康系统导航 (CS-HSN) 培训课程。 CS-HSN 培训方法和课程的试点测试将有助于确定培训方案的可行性、课程和材料的可接受性以及基于在与标准化患者的模拟临床接触过程中测量的课程的绩效结果。具体目标是： 目标 1a：通过与关键利益相关者（不遵守 LGBT、医疗服务提供者和医疗中心主任）的深入访谈，确定不遵守适龄癌症筛查指南（乳腺癌、宫颈癌和结肠癌）的 LGBT 人群癌症筛查（社会文化、提供者和系统）的障碍。目标 1b：以访谈数据为基础，调整卫生系统导航课程和培训方案，以减少 LGBT 人群癌症筛查的障碍，并最终确定癌症筛查-卫生系统导航课程 (CS-HSN)。目标 2：使用生成的 CS-HSN 课程，对一组健康教育者 (N=6) 和非专业患者导航员 (N=10) 的培训进行试点测试，并通过标准化患者的模拟临床来系统地评估可行性（招募和保留）、可接受性（项目满意度）和绩效结果（知识、访谈技巧、患者导航角色）。公共健康相关性：本研究将是系统开发有针对性的患者导航 (PN) 培训课程的首批尝试之一，旨在减少女同性恋、男同性恋、双性恋和跨性别者 (LGBT) 人群的癌症筛查差异。当前项目的预期成果，包括确定 LGBT 癌症筛查的具体障碍、开发针对癌症筛查的新患者导航、使用课程培训健康教育者和 PN 的经验，以及评估 7 个 LGBT 医疗中心提供癌症筛查的卫生系统障碍，将为测试癌症筛查患者导航计划进行全面随机试验提供必要的初步数据。