Doctoral Dissertation Research: Integrating Geographic Information Science and Community Engagement to Evaluate Colorectal Cancer Spatial Patterns

这项研究探索了社区如何将他们对空间和地点的知识与观察到的疾病空间模式联系起来，以提高他们理解产生这些模式的潜在过程并实施有效干预的能力。总体而言，关于地理科学、社区参与和健康的交集的研究令人惊讶地少之又少。这项研究的重点是结直肠癌，这是癌症预防和控制努力的重点，因为早期诊断极大地改善了预后。然而，筛查率仍然很低，筛查率的差异与种族、民族和地理等因素有关。使用向爱荷华州健康注册中心报告的结直肠癌发病率，这项研究将使用自适应空间过滤的方法创建结直肠癌发病率、晚期、死亡率和筛查的地图，作为连续变化的表面，即在研究区域上方铺设网格，并使用重叠的圆形过滤器计算每个网格点的比率，这些重叠的圆形过滤器展开，直到它们获得足够的信息来计算稳定的比率。统计分析将确认利率高于预期的位置。这些地图将为社区关于结直肠癌的讨论提供背景。将邀请社区居民生成有关社区结直肠癌经验以及筛查和治疗障碍的信息。参与者和研究人员将确定焦点问题，例如“为什么暴风湖的晚期结直肠癌发病率高？”然后生成对这个问题的答复，将答复分类，并根据重要性对其进行评级。这项研究的结果将有助于更好地了解健康差距。此外，研究人员将让社区参与讨论为什么地方癌症负担存在差异，以及他们可以做些什么来降低当地的癌症负担。这项研究可以促进地理学中关于定量和定性数据的相对优点和整合潜力的长期辩论，探索不同类型的空间和地点知识的价值以及整合这些类型的知识的潜力，以更多地讲述导致健康差距的故事。这项研究对翻译研究这一正在发展中的研究领域也将是重要的，因为它在地理学中还处于起步阶段，因此将有助于在未来几年增加卫生地理学作为一个子学科的相关性。通过整合经验的、定量的空间数据和定性的、社区生成的知识来提高地理信息的质量，这项研究将推动社会不仅对差距的根源有更细微的理解，而且朝着更有效的战略来对抗差距。作为博士论文研究改进奖，该奖项还将提供支持，使有前途的学生建立一个强大的独立研究生涯。

This research explores ways in which communities can connect their knowledge of space and place with observed spatial patterns of disease to increase their abilities to both understand underlying processes that create these patterns and to implement effective interventions. Overall, there is surprisingly little research on the intersection of GIScience, community engagement, and health. This research focuses on colorectal cancer, a focus of cancer prevention and control efforts because early diagnosis greatly improves prognosis. However, screening rates remain low and differences in screening rates are associated with race, ethnicity and geography, among other factors. Using colorectal cancer incidences reported to the Iowa Health Registry, the research will create maps of colorectal cancer incidence, late-stage, mortality and screening as continuously varying surfaces using the method of adaptive spatial filtering, whereby a grid is laid over the study area and rates are computed for each grid point using overlapping circular filters that expand until they have pulled in enough information to calculate a stable rate. Statistical analyses will confirm the locations of higher than expected rates. These maps will provide context for community discussions of colorectal cancer. Community residents will be invited to generate information about the community's colorectal cancer experiences and barriers to screening and treatment. Participants and researchers will determine focal questions, such as "why are late-stage colorectal cancer rates high in Storm Lake?" and then generate responses to this question, sort the responses into categories, and rate them according to importance. The results of this study will contribute to a better understanding of health disparities. In addition, the researchers will engage communities in discussions of why local differences in cancer burdens are occurring and what they can do to lower the burden in their local areas. This research can contribute to a long-standing debate in geography about the relative merits, and the potential for integration, of quantitative and qualitative data, exploring the value of different types of space and place knowledge and the potential for integrating these types of knowledge to tell more of the story that contributes to health disparities. This research also will be important to the developing research area of translational research, which is just in its infancy in the discipline of geography, and will thereby contribute to increasing the relevance of health geography as a sub-discipline in the years to come. By improving the quality of geographic information through integration of empirical, quantitative spatial data and qualitative, community-generated knowledge, this research will move society toward not only a more nuanced understanding of the roots of disparity, but also toward more effective strategies to combat disparity. As a Doctoral Dissertation Research Improvement award, this award also will provide support to enable a promising student to establish a strong independent research career.