Improving Uptake of Cervical Cancer Prevention Services in Appalachia

项目总结--总体 该计划项目的目标是解决阿巴拉契亚地区宫颈癌发病率和死亡率的负担 通过提供以临床为基础的综合预防计划，重点关注宫颈疾病的主要原因 癌症(吸烟、人乳头瘤病毒(HPV)感染和缺乏宫颈癌筛查) 旨在针对个人、社会和社区、卫生系统和更广泛的背景层面相关障碍 宫颈癌的负担。建立在我们长期合作研究和社区的基础上 作为伙伴关系，该方案将测试以烟草为重点的卫生系统干预措施的有效性 使用，HPV疫苗接种和宫颈癌筛查(巴氏试验和/或自我检测，阳性检测的后续行动)， 作为以临床为基础的综合宫颈癌预防计划的一部分。多层次干预(定向 到三个级别的影响-诊所、提供者和患者)将提供给符合条件的女性患者和符合年龄条件的 阿巴拉契亚四个州(俄亥俄州、肯塔基州、西弗吉尼亚州和弗吉尼亚州)的儿童和年轻人。我们的研究 这一过程是由基于健康的社会决定因素的社会生态模型--普罗科特模型--指导的 实施科学和以社区为基础的参与性研究框架。的目标是 该计划项目是：1)测试综合宫颈癌预防计划的有效性， 由三个既定的干预措施组成，旨在解决一个地区宫颈癌的三个原因 是美国宫颈癌发病率和死亡率最高的国家之一；以及2)评估 宫颈癌预防方案的影响，包括实施情况和可接受性，并注意 对诊所的短期和长期影响和可持续性。四个核心-干预和联盟， 调查和数据收集、生物统计和评估以及行政--将促进 所有项目一体化运营。本计划中项目的整合和互动在几个方面表现得很明显 方法：1)所有项目都聚焦于一个健康差距；2)参与者将从相同的卫生系统招募； 3)所有项目都在使用一套核心措施；4)所有项目都包括跨学科团队；5)所有 项目建立在我们合作研究和社区的长期历史基础上，并扩展了我们的发现 伙伴关系；6)所有项目都侧重于利用沃内克模式进行多层次评估和/或干预 一个框架，并利用Proctor等人。实施科学框架；7)所有项目都涉及互动 以某种方式与社区合作，从而加强方案的CBPR性质；以及8)评估将评估 项目和总体计划层面的实施、服务和客户成果，包括：成本、 满意度、有效性、可持续性和安全性，仅举几个例子。如果成功，此计划项目 将为一种新颖和创新的方法提供证据，以解决服务不足社区的差距 具有可持续性和传播计划，以及成本效益数据。

PROJECT SUMMARY - OVERALL The goal of this Program Project is to address the burden of cervical cancer incidence and mortality in Appalachia through the delivery of a clinic-based integrated prevention program that focuses on the major causes of cervical cancer (tobacco smoking, Human Papillomavirus (HPV) infection, and lack of cervical cancer screening) designed to target individual, social and community, health system and broader contextual-level barriers related to the burden of cervical cancer. Building upon our long history of collaborative research and community partnerships, the Program will test the effectiveness of health system-based interventions focused on tobacco use, HPV vaccination and cervical cancer screening (Pap test and/or self-testing with follow-up of positive tests), as part of an integrated clinic-based cervical cancer prevention program. The multi-level interventions (directed to three levels of influence – clinic, provider and patient) will be offered to eligible female patients and age-eligible children and young adults in four Appalachian states (Ohio, Kentucky, West Virginia and Virginia). Our research process is guided by a socio-ecological model based on the Social Determinants of Health, the Proctor Model for Implementation Science and a Community-Based Participatory Research (CBPR) framework. The aims of this Program Project are to: 1) Test the effectiveness of an integrated cervical cancer prevention program, consisting of three established interventions, designed to address three causes of cervical cancer in a region with one of the highest cervical cancer incidence and mortality rates in the United States; and 2) Evaluate the impact of the cervical cancer prevention program, including implementation, and acceptability, with attention to both short- and long-term impact and sustainability at the clinics. Four cores – Intervention and Consortium, Survey and Data Collection, Biostatistics and Evaluation, and Administrative – will facilitate the smooth and integrated operation of all projects. Integration and interaction of the projects in this Program is evident in several ways: 1) all projects focus on one health disparity; 2) participants will be recruited from the same health systems; 3) a core set of measures is being used by all projects; 4) all projects include transdisciplinary teams; 5) all projects build upon and extend findings from our long history of collaborative research and community partnerships; 6) all projects focus on multi-level assessment and/or interventions using the Warnecke model as a framework and utilize the Proctor et al. Implementation Science Framework; 7) all projects involve interaction with the community in some way, thus enhancing the CBPR nature of the Program; and 8) evaluation will assess implementation, service and client outcomes at the project and overall Program levels including: cost, satisfaction, effectiveness, sustainability, and safety, to name a few outcomes. If successful, this Program Project will provide evidence for a novel and innovative approach to address disparities in underserved communities with plans for sustainability and dissemination, as well as cost-effectiveness data.