Better Breast and Cervical Cancer Control for Korean American Women

描述（由申请人提供）：尽管过去20年来美国癌症控制取得了相当大的进展，但某些少数族裔群体的健康状况仍然存在显着差异。韩裔美国人（KA）妇女的乳腺癌和宫颈癌筛查率远远低于国家目标，也低于其他族裔群体的报告率。因此，KA女性通常在癌症的后期被诊断出来，这可能导致预后不良，死亡率高，以及随后的情感和经济负担。有限的健康素养正在成为癌症预防行为的一个影响深远的主要障碍，特别是在非英语移民人群中。该研究应用程序旨在回答以KA社区为例，针对语言和/或社会孤立的少数民族社区的癌症控制干预研究中的关键知识差距的研究问题。这些问题是：（1）使用基于社区的参与性研究（CBPR）过程的健康素养为重点的干预措施是否能有效促进健康素养，提高KA妇女的乳腺癌和宫颈癌筛查率;（2）由社区卫生工作者（CHW）提供的定制干预措施是否能在这样的社区中有效。该研究是一项以社区为基础的随机分组临床试验，有两个平行组，延迟干预。纵向重复测量设计将使我们能够确定建议的健康素养为重点的定制癌症控制干预CHW提供的有效性。共有480名KA女性将参与这项研究。本研究的主要结局将是乳腺癌和宫颈癌筛查的依从性。我们假设，与对照组（延迟干预）中的KA女性相比，接受我们以扫盲为重点的定制CHW干预的KA女性将表现出更高水平的乳腺癌和宫颈癌筛查依从性。透过进行这些研究活动，我们预期可建立一个机制，向这类人士发放重要的健康资讯，并加强社区网络，方便市民接受乳癌和子宫颈癌检查。虽然本研究项目的重点是健康素养的促进和乳腺癌和宫颈癌筛查KA妇女，这种干预的核心原则和方法可以提供见解发展有效的，文化敏感的健康素养计划，以满足社会和/或语言孤立的少数群体的需要与癌症控制不足，在整个美国。公共卫生意义：韩裔美国人（KA）妇女宫颈癌发病率在全国排名第二，乳腺癌发病率正在迅速增加。获得、处理和理解基本健康信息和服务以做出适当健康决策的能力有限（即，健康知识有限）是KA妇女早期发现癌症的主要障碍。本研究旨在测试使用基于社区的参与性研究过程的以健康素养为重点的干预措施是否能有效促进健康素养并提高KA妇女的乳腺癌和宫颈癌筛查率;以及（2）由训练有素的社区卫生工作者提供的定制干预措施是否能在这样的社区中有效。

DESCRIPTION (provided by applicant): Despite considerable progress made in U.S. cancer control during the past 20 years, certain ethnic minority groups continue to experience significant health disparities. Breast and cervical cancer screening rates for Korean American (KA) women are far below the national goal, and below rates reported for other ethnic groups. As a result, KA women are often diagnosed at a later stage of cancer which can lead to a poor prognosis, high mortality, and subsequent emotional and financial burdens. Limited health literacy is emerging as a far-reaching, major barrier to cancer prevention behaviors, particularly among non-English speaking immigrant populations. This research application is formulated to answer research questions that address critical knowledge gaps in cancer control intervention research for linguistically and/or socially isolated ethnic minority communities using the KA community as an example. These questions are: (1) whether a health literacy-focused intervention using a community-based participatory research (CBPR) process will be effective in promoting health literacy and increasing breast and cervical cancer screening rates among KA women; and (2) whether a tailored intervention delivered by community health workers (CHWs) will be effective in such a community. The proposed study is a community-based, cluster-randomized clinical trial with two parallel arms, with a delayed intervention. A longitudinal repeated measures design will allow us to determine the effectiveness of the proposed health literacy-focused tailored cancer control intervention delivered by CHWs. A total of 480 KA women will participate in the study. The primary outcome of this study will be adherence to breast and cervical cancer screening. We hypothesize that, as compared to KA women in the control (delayed intervention) group, KA women who receive our literacy-focused tailored CHW intervention will demonstrate higher levels of adherence to screening for breast and cervical cancer. Through implementation of these research activities, we expect to establish a mechanism for disseminating critical health information for this population and to enhance a community network which will facilitate community access to breast and cervical cancer screening. While the focus of this research project is health literacy promotion and breast and cervical cancer screening among KA women, the core principles and methodology of this intervention can provide insights toward development of effective, culturally sensitive health literacy programs to meet the needs of socially and/or linguistically isolated minority groups with inadequate cancer control throughout the United States. PUBLIC HEALTH SIGNIFICANCE: Korean American (KA) women have the second highest incidence of cervical cancer nationally and are experiencing rapid increases in breast cancer incidence. Limited capacity to obtain, process, and understand basic health information and services to make appropriate health decisions (i.e., limited health literacy) is a major barrier to early detection of cancer among KA women. This study proposes to test if a health literacy-focused intervention using a community- based participatory research process will be effective in promoting health literacy and increasing breast and cervical cancer screening rates among KA women; and (2) whether a tailored intervention delivered by trained community health workers will be effective in such a community.