Better Breast and Cervical Cancer Control for Korean American Women

描述（由申请人提供）：尽管在过去的20年里，美国在癌症控制方面取得了相当大的进展，但某些少数民族群体仍然经历着显著的健康差距。韩裔美国人（KA）妇女的乳腺癌和宫颈癌筛查率远低于国家目标，也低于其他族裔的报告率。因此，KA妇女往往在癌症晚期才被诊断出来，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影响深远的癌症预防行为的主要障碍，特别是在非英语移民人群中。本研究应用程序旨在回答研究问题，以KA社区为例，解决语言和/或社会孤立的少数民族社区癌症控制干预研究中的关键知识空白。这些问题是：(1)使用基于社区的参与性研究（CBPR）过程的以健康素养为重点的干预措施是否能有效促进KA妇女的健康素养并提高乳腺癌和宫颈癌筛查率；(2)由社区卫生工作者提供的有针对性的干预措施在该社区是否有效。拟议的研究是一项基于社区的、双平行组的集群随机临床试验，采用延迟干预。一项纵向重复测量设计将使我们能够确定拟议的以健康素养为重点的由保健工作者提供的量身定制的癌症控制干预措施的有效性。共有480名KA妇女将参与这项研究。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妇女相比，接受我们以识字为重点的量身定制的CHW干预的KA妇女将表现出更高水平的乳腺癌和宫颈癌筛查依从性。通过实施这些研究活动，我们期望建立一个向这一人口传播重要健康信息的机制，并加强社区网络，促进社区获得乳腺癌和宫颈癌筛查。虽然这个研究项目的重点是在KA妇女中促进健康素养和乳腺癌和宫颈癌筛查，但这项干预的核心原则和方法可以为制定有效的、文化上敏感的健康素养计划提供见解，以满足美国各地在社会和/或语言上孤立的少数群体的需求，这些群体的癌症控制不足。公共卫生意义：韩裔美国妇女的宫颈癌发病率在全国排名第二，乳腺癌发病率也在迅速上升。获取、处理和了解基本卫生信息和服务以作出适当卫生决定的能力有限（即卫生知识有限）是早期发现KA妇女癌症的主要障碍。本研究建议测试以健康素养为重点的干预措施，使用基于社区的参与性研究过程，是否能有效地促进健康素养，提高KA妇女的乳腺癌和宫颈癌筛查率；(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在这样的社区是否有效。

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.