Research Project

联合首席研究员：Micah Park牧师，Young Sang Church 项目摘要 结直肠癌（CRC）是亚裔美国人第二大最常见的癌症，也是第三大死亡原因。尽管一般人群中CRC的发病率有所下降，但其在韩国社区的发病率却在上升。与非西班牙裔白色男性相比，韩国男性CRC的发病率和死亡率排名第二。在韩国女性中，CRC是第二大最常见的癌症。虽然常规和及时筛查的有效性已被证明是预防疾病发展的可行措施，但各种研究表明，韩国人的CRC筛查率极低，每种类型的CRC筛查，当获得筛查时，更有可能揭示疾病的晚期和5年生存率的不良预后。我们对宾夕法尼亚州和新泽西州的韩国社区的研究表明，CRC筛查率一直很低（韩国人为13%至17%，而普通人群为52%），并且存在多种医疗保健障碍。我们所服务的韩国人中约有80%是医疗服务不足和低收入，缺乏对CRC风险，筛查福利和卫生系统的了解，并且有限或无法获得文化和语言适当的医疗保健。缺乏适合韩国人需要的CRC筛查干预方案。拟议的项目将通过评估一个多方面和文化上适当的韩国教会为基础的 采用基于社区的参与性研究（CBPR）方法进行干预，以显著改善PA和NJ的韩国教会（30个教会地点）医疗服务不足的成员中的CRC筛查。该项目将建立在社区-学术-临床伙伴关系的长期基础设施之上，该伙伴关系已成功地在韩国和其他亚洲社区开展了多个CBPR指导项目，并在韩国人中开展了一项CBPR CRC干预试点。该研究的总体目标是使用CBPR方法保持和确保可持续的伙伴关系，通过减少服务不足的韩国人的医疗保健准入障碍来增加CRC筛查。具体而言，该研究旨在研究文化上适当的CBPR CRC干预是否更有效地增加筛查，CRC的知识，感知风险和易感性以及筛查的益处，以及减少卫生系统对筛查的障碍。 CBPR原则和逻辑模型将用于指导研究的所有阶段，包括制定和实施项目计划、程序、干预、评估和传播。研究设计是一项2组随机试验，包括基线和干预后评估以及12个月随访。总共30个韩国教会将被随机分配到即时干预组或对照组（一般癌症教育加延迟干预）。建议的干预，健康信念模型和社会认知理论的综合框架的指导下，解决个人和医疗系统的障碍，通过多方面的创新方法。主要组件包括：（1）由受过培训的双语社区卫生教育工作者和教会卫生工作者进行小组教育;（2）由社区卫生教育工作者（CHE）和社区卫生工作者（CHW）进行患者导航;（3）让社区双语医生参与CRC筛查和转诊。预计该研究将产生关于国际影响的重要和新的数据。如果这种CBPR CRC干预措施被证明是有效的，它可以作为一个模型计划，在韩国和其他亚洲社区具有潜在的可移植性和可持续性，从而为减少健康差距做出重大贡献。

Co-Principal Investigator: Rev. Micah Park, Young Sang Church PROJECT SUMMARY Colorectal cancer (CRC) is the second most commonly diagnosed cancer and the third highest cause of mortality in Asian Americans. Despite a decline in the incidence of CRC in the general population, its incidence in the Korean community is rising. Korean men ranked the second highest in incidence and mortality from CRC compared with those of non-Hispanic White men. Among Korean women, CRC is the second most commonly diagnosed cancer. Although the efficacy of routine and timely screening has been demonstrated as a viable preventive measure against the development of the disease, various studies have shown that CRC screening rates among Koreans are extremely low for every type of CRC screening, and when screening is obtained, it is more likely to reveal a late stage of the disease and poor prognosis for 5-year survival. Our studies ofthe Korean community in PA and NJ indicated consistently low rates of CRC screening (13% to 17%, in Koreans vs 52% in general populations) and multiple barriers to health care. About 80% Koreans we serve are medically underserved and low income, lack of knowledge about CRC risks, screening benefits and health system, and have limited or no access to culturally and linguistically appropriate health care. There is a lack of CRC screening intervention program tailored to the needs of Koreans. The proposed project will address this gap by evaluating the effectiveness of a multifaceted and culturally appropriate Korean church-based intervention using community-based participatory research (CBPR) approach to significantly improve CRC screening among medically underserved members of Korean churches (30 church sites) in PA and NJ. The project will be built on an established long-standing infrastructure of community-academic-clinical partnership that has collaborated successfully on several CBPR guided projects in Korean and other Asian communities, as well as a pilot CBPR CRC intervention among Koreans. The overall goal of the study is to maintain and ensure sustainable partnerships using CBPR approach to increase CRC screening by reducing healthcare access barriers for underserved Koreans. Specifically, the study aims to examine whether a culturally appropriate CBPR CRC intervention is more effective in increasing screening, knowledge of, perceived risks of and susceptibility to CRC and benefits of screening, as well as reducing health system barriers to screening. CBPR principles and logic model will be used to guide all phases of the study in developing and implementing project plans, procedures, intervention, evaluation and dissemination. The study design is a 2-arm group randomized trial with baseline and post-intervention assessment and a 12-month follow-up. A total of 30 Korean churches will be randomized to either an immediate intervention or control group (general cancer education plus delayed intervention). The proposed intervention, guided by an integrative framework of Health Belief Model and Social Cognitive Theory, addresses both individual and healthcare system barriers through multifaceted innovative approaches. Key components include: (1) group education by trained bilingual community health educators and church health workers; (2) patient navigation by Community Health Educators (CHEs) and Community Health Workers (CHWs); and (3) engaging community bilingual physicians in CRC screening and referral. The proposed study is expected to yield important and new data on the inten/ention effects. If this CBPR CRC intervention proves effective, it can be used as a model program that has potential transportability to and sustainability in Korean and other Asian communities nationally, hence make a substantial contribution toward reducing health disparities.