Reducing disparities in colorectal cancer screening in Vietnamese Americans

描述(申请人提供)：越南裔美国人的结直肠癌(CRC)筛查率低于非西班牙裔白人。根据我们降低结直肠癌发病率和死亡率的长期目标，我们建议在媒体运动(MEDIA)的支持下，传播一项以证据为基础的业外卫生工作者(LHW)干预，以增加对这一贫困和医疗服务不足的人群的CRC筛查。我们将使用路径框架、基于社区的参与性研究过程和创新扩散理论来指导我们的干预、社区参与和传播方法。这项研究的具体目的是：1)评估CRC LHW媒体干预在50至74岁从未接受过CRC筛查测试的越南裔美国人中增加CRC筛查的有效性；2)确定CRC筛查的预测因素；以及3)评估社区参与的过程。在使用认知测试方法进行形成性研究以开发适合文化和语言的健康教育材料和调查工具后，我们将在加利福尼亚州圣克拉拉县的50-74岁越南裔美国人中进行整群随机试验，他们在招募之前从未接受过CRC筛查测试。我们将跟踪两个纵向队列，其中将对参与者关于结直肠癌筛查的知识、意图和行为进行干预前调查；在试验组实施结直肠癌筛查教育课程；在对照组实施营养教育课程；以及进行干预后调查。两个队列中的每一个将包括150名男性和150名女性，总样本量为600人。媒体干预部分将通过印刷和电子媒体分发越南语健康教育材料。我们将通过比较干预前和干预后调查的筛查频率来评估干预的有效性。为了检验我们关于干预对筛查活动的影响的主要假设，我们将使用Z检验。我们还将使用Logistic回归模型来测试干预的效果，并确定结直肠癌筛查的预测因素。此外，我们还将对干预和社区参与进行过程评估。如果这种干预被发现是有效的，这个LHW模型可以应用于健康促进项目，以进一步减少越南裔美国人在结直肠癌筛查方面的差异，并在其他行为目标和环境中进行评估，以减少其他贫困和服务不足人群的健康差异。公共卫生相关性：越南裔美国人的结直肠癌(CRC)筛查率低于非西班牙裔白人。与非西语裔白人相比，越南裔美国人更贫穷，医疗服务也更差，他们有与癌症筛查相关的特殊语言和文化问题，这些问题无法通过针对普通人群的干预措施来解决。根据我们降低结直肠癌发病率和死亡率的长期目标，我们建议在媒体运动(MEDIA)的支持下，传播一项以证据为基础的业外卫生工作者(LHW)干预，以增加对这一贫困和医疗服务不足的人群的CRC筛查。如果这种干预被发现是有效的，它可以应用于美国各地的其他健康促进计划，以进一步减少越南裔美国人在结直肠癌筛查方面的差距。此外，该LHW模型可以在其他人群中进行评估，如其他种族和民族、贫困或移民社区；其他行为目标，如其他形式的癌症、心血管健康或烟草、糖尿病和肥胖症控制；以及其他环境，如社区卫生诊所和医院。公共卫生相关性：越南裔美国人的结直肠癌(CRC)筛查率低于非西班牙裔白人。与非西班牙裔白人相比，越南裔美国人更贫穷，医疗服务也更差，而且有特殊的语言和文化 与癌症筛查有关的问题不能通过针对普通人群的干预措施来解决。根据我们降低结直肠癌发病率和死亡率的长期目标，我们建议在媒体运动(MEDIA)的支持下，传播一项以证据为基础的业外卫生工作者(LHW)干预，以增加对这一贫困和医疗服务不足的人群的CRC筛查。如果这种干预被发现是有效的，它可以应用于美国各地的其他健康促进计划，以进一步减少越南人在结直肠癌筛查方面的差距 美国人。此外，该LHW模型可以在其他人群中进行评估，如其他种族和民族、贫困或移民社区；其他行为目标，如其他形式的癌症、心血管健康或烟草、糖尿病和肥胖症控制；以及其他环境，如社区卫生诊所和医院。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) screening rates in Vietnamese Americans are lower than those in non-Hispanic whites. Consistent with our long-term goal of reducing morbidity and mortality caused by colorectal cancer, we propose to disseminate an evidence-based lay health worker (LHW) intervention supported by a media campaign (Media) to increase CRC screening in this poor and medically underserved population. We will use the Pathways Framework, Community-Based Participatory Research process, and Diffusion of Innovations Theory to guide our approach to the intervention, community participation, and dissemination. The specific aims of this study are to: 1) evaluate the effectiveness of a CRC LHW + Media intervention in increasing CRC screening among Vietnamese Americans aged 50 to 74 who have never had a CRC screening test, 2) identify predictors of CRC screening, and 3) evaluate the process of community participation. Following formative research using a cognitive testing approach to develop culturally and linguistically appropriate health education materials and survey instruments, we will conduct a cluster randomized trial among Vietnamese Americans aged 50-74 in Santa Clara County California, who have never had a CRC screening test prior to recruitment. We will follow two longitudinal cohorts among whom we will conduct a pre-intervention survey of participants' knowledge, intention, and behavior as regards CRC screening; implement CRC screening educational sessions in an experimental group and nutrition educational sessions in a comparison group; and conduct a post-intervention survey. Each of the two cohorts will include 150 men and 150 women to have a total sample size of 600. The media intervention component will distribute Vietnamese-language health education materials through print and electronic media. We will evaluate the effectiveness of the intervention by comparing the frequency of screening using pre- and post-intervention surveys. To test our primary hypothesis regarding the effects of the intervention on screening activity, we will use Z-tests. We will also employ logistic regression models to test the effects of the intervention and to identify predictors for CRC screening. In addition, we will conduct process evaluation of the intervention and community participation. If this intervention is found to be effective, this LHW model could be applied in health promotion programs to further reduce disparities in CRC screening in Vietnamese Americans and evaluated in other behavioral objectives and settings to reduce health disparities in other poor and underserved populations. PUBLIC HEALTH RELEVANCE: Colorectal cancer (CRC) screening rates in Vietnamese Americans are lower than those in non-Hispanic whites. Relative to non-Hispanic whites, Vietnamese Americans are both poorer and less well medically served and have special language and cultural issues related to cancer screening that cannot be addressed though interventions aimed at the general population. Consistent with our long-term goal of reducing morbidity and mortality caused by colorectal cancer, we propose to disseminate an evidence-based lay health worker (LHW) intervention supported by a media campaign (Media) to increase CRC screening in this poor and medically underserved population. If this intervention is found to be effective, it could be applied in other health promotion programs throughout the United States to further reduce disparities in CRC screening in Vietnamese Americans. In addition, this LHW model could be evaluated in other populations, such as other racial and ethnic, poor, or immigrant communities; in other behavioral objectives, such as other forms of cancer, cardiovascular health, or tobacco, diabetes and obesity control; and in other settings, such as community health clinics and hospitals. Public Health Relevance: Colorectal cancer (CRC) screening rates in Vietnamese Americans are lower than those in non-Hispanic whites. Relative to non-Hispanic whites, Vietnamese Americans are both poorer and less well medically served and have special language and cultural issues related to cancer screening that cannot be addressed though interventions aimed at the general population. Consistent with our long-term goal of reducing morbidity and mortality caused by colorectal cancer, we propose to disseminate an evidence-based lay health worker (LHW) intervention supported by a media campaign (Media) to increase CRC screening in this poor and medically underserved population. If this intervention is found to be effective, it could be applied in other health promotion programs throughout the United States to further reduce disparities in CRC screening in Vietnamese Americans. In addition, this LHW model could be evaluated in other populations, such as other racial and ethnic, poor, or immigrant communities; in other behavioral objectives, such as other forms of cancer, cardiovascular health, or tobacco, diabetes and obesity control; and in other settings, such as community health clinics and hospitals.