A Collectivist Approach to Cervical Cancer Screening Among Latinos

描述(由申请人提供)：拉丁裔和其他少数民族未进行宫颈癌筛查，并因此原因分担不成比例的疾病和死亡负担。有迹象表明，社会支持可以提高筛查率，但提供这种支持的最佳方式及其作用机制尚未得到明确研究。这项K奖将提供在服务不足的人群中进行癌症筛查行为试验所需的技能培训。培训目标是：1)获得设计和分析行为干预试验的必要技能；2)进一步发展与文化相关的社会、生态和行为理论培训，以指导干预设计；3)磨练定性和定量数据分析相结合的技能。培训目标将通过课程、研究所、研讨会和指导学习来实现。根据这些目标，研究构成部分将作为获得统计技能(纵向、调解和适度分析)的培训基础，根据定性数据建立量化标尺，并对纵向分析中的不寻常(“偏离”)结果进行定性研究。拟议的研究议程将确定对被同伴招募的94名拉丁裔妇女采用集体主义方法进行筛查(“团体访问”)的可行性。最终目标是改进用于在拉丁裔和非裔美国人中测试这种方法的随机行为试验中使用的程序，我假设这将增加对筛查指南的遵守。其具体目标是：1)评估在“新增长地区”(快速增长但仍然孤立的拉丁裔社区)进行拉美裔团体访问的可行性；2)使用纵向调查评估团体访问对拉美裔癌症筛查相关结果的影响，以比较结果并得出对这些结果的点估计、变异性测量和影响大小；以及3)通过分析妇女参加巴氏试验进行癌症筛查的集体取向的心理社会基础，制订和试点关于集体主义筛查和社会支持的基于文化的调查问题，以及b)在纵向分析中阐明主要结果变量中的“异常值”结果。相关性：如果成功，团体访问方法有可能提供符合文化能力的护理，从而改善对筛查指南的遵从性，从而预防疾病和死亡，并节省医疗成本。它还将促进在癌症筛查中整合自然社会网络和家庭的知识。

DESCRIPTION (provided by applicant): Latinas and other minorities are underscreened for cervical cancer and share a disproportionate burden of disease and death due to this cause. There are indications that social support can improve screening rates, but the best way to deliver such support and the mechanism through which it acts upon have not been clearly studied. This K award will provide training in skills needed to conduct behavioral trials on cancer screening among underserved populations. The training goals are: 1) To acquire the necessary skills to design and analyze behavioral intervention trials; 2) To further develop training in culturally relevant social ecological and behavioral theories to guide intervention designs; and 3) To hone skills in the integration of qualitative and quantitative data analysis. The training goals will be achieved via courses, institutes, workshops, and directed studies. In relation to these goals, the research component will serve as training ground for acquiring statistical skills (longitudinal, mediation and moderation analyses), creating of quantitative scales based on qualitative data, and qualitatively studying unusual ("deviant") results in longitudinal analysis. The proposed research agenda will establish the feasibility of a collectivist approach to screening ("group visits") among 94 Latina women recruited by peers. The ultimate goal is to refine procedures to be used in a randomized behavioral trial to test this approach among Latinas and African Americans, which I hypothesize, will increase adherence to screening guidelines. The Specific Aims are to 1) Assess the feasibility of group visits among Latinas in "new growth areas" (fast growing but still isolated Latino communities); 2) Assess the effect of group visits on cancer screening related outcomes among Latinas using longitudinal surveys to compare outcomes and to derive point estimates, measures of variability and effect sizes on these outcomes; and 3) Explore the psychosocial basis for a collectivist orientation to cancer screening using Pap tests by analyzing women's experiences with group visits to a) develop and pilot test culturally-grounded survey questions regarding collectivist screening and social support, and b) shed light on "outlier" results in main outcome variables in longitudinal analysis. RELEVANCE: If successful, the group visit approach has the potential to deliver culturally competent care and therefore improve compliance with screening guidelines, thus preventing disease and deaths and also resulting in healthcare cost savings. It will also advance knowledge in the integration natural social networks and the family in cancer screening.