Better Breast and Cervical Cancer Control for Korean American Women

描述(申请人提供)：尽管在过去的20年里，美国在癌症控制方面取得了长足的进步，但某些少数族裔群体仍然面临着巨大的健康差距。韩裔美国人(KA)女性的乳腺癌和宫颈癌筛查率远远低于国家目标，也低于其他种族的报告筛查率。因此，KA妇女通常在癌症的后期被诊断出来，这可能会导致不良的预后、高死亡率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深远的主要障碍，特别是在非英语移民人口中。本研究以KA社区为例，针对语言和/或社会上与世隔绝的少数民族社区的癌症控制干预研究中的关键知识空白问题，制定了本研究应用程序。这些问题是：(1)采用以社区为基础的参与性研究(CBPR)程序的以健康素养为重点的干预措施是否将有效地促进健康素养，并提高KA妇女的乳腺癌和宫颈癌筛查率；以及(2)由社区卫生工作者(CHW)提供的量身定制的干预措施是否将在这样的社区有效。这项拟议的研究是一项以社区为基础的、整群随机的临床试验，有两个平行的手臂，具有延迟干预。纵向重复测量设计将使我们能够确定由CHWS提供的拟议的以健康素养为重点的定制癌症控制干预措施的有效性。共有480名克族妇女将参加这项研究。这项研究的主要结果将是坚持乳腺癌和宫颈癌筛查。我们假设，与对照组(延迟干预)中的KA女性相比，接受我们以识字为重点的定制CHW干预的KA女性将表现出对乳腺癌和宫颈癌筛查的更高水平的坚持。通过实施这些研究活动，我们希望建立一个机制，为这类人群传播重要的健康信息，并加强社区网络，以促进社区获得乳癌和宫颈癌筛查的机会。虽然这项研究项目的重点是促进KA女性的健康素养以及乳腺癌和宫颈癌筛查，但这种干预的核心原则和方法可以为制定有效的、对文化敏感的健康素养计划提供见解，以满足全美癌症控制不足、社会和/或语言上孤立的少数群体的需求。公共卫生意义：韩裔美国人(KA)女性的宫颈癌发病率在全国排名第二，乳腺癌发病率正在快速上升。获取、处理和了解基本健康信息和服务以作出适当健康决定的能力有限(即健康素养有限)是克雅族妇女早期发现癌症的主要障碍。这项研究建议测试以社区为基础的参与性研究过程以健康素养为重点的干预措施是否将有效地促进健康素养，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量身定制的干预措施是否在这样的社区有效。

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.