Reducing Colorectal Cancer Health Disparities: An mHealth Intervention to Improve Screening among African American Men

项目总结/摘要 贫穷对健康有无数的有害影响，包括对大多数人来说， 癌症的形式。结直肠癌（CRC）是癌症死亡的第二大原因，也不例外。 CRC在社会经济地位较低的人群中的诊断率高出40%。在美国，种族和 社会经济地位不可避免地联系在一起，导致了深刻的健康差距。事实上，《儿童权利公约》对以下方面造成的负担尤其沉重： 黑人，尤其是非洲裔美国人。黑人男性的CRC发病率比男性高20%， 白色男性的死亡率高出52%。非裔美国人在所有CRC阶段的存活率最低。 筛选（例如，结肠镜检查，粪便检测）可以预防大多数侵袭性CRC病例。然而，摄取量是 特别是在低社会经济地位的非洲裔美国人中。事实上，《儿童权利公约》中40%的种族差异 发病率和20%的死亡率差异可归因于缺乏筛查。作为黑人，男性，和低 SES在美国交叉形成一套复杂的机构、提供者和患者层面的障碍，导致 差别筛查率。在这一组中增加CRC筛查的大多数努力都是通过亲自或电话进行的， 基于教育和导航。虽然有效，但这些方法是资源密集型的，限制了它们的应用。 为社会经济地位较低的黑人男性提供服务的组织（例如联邦合格医疗中心（FQHC））采用。 为了满足对有效，负担得起和可扩展的战略的需求，以增加CRC筛查， 医疗服务不足的非洲裔美国人，该项目将开发一个移动的结肠直肠癌筛查 干预（m-CRCSI）。m-CRCSI将基于健康信念模型（HBM）， 通过移动的电话。它将包括旨在提高CRC知识和健康信念的短信。一些 文本信息将包括三种类型视频之一的链接：教育说明，脚本小插曲， 没有剧本的同伴叙述计划内容将减少健康素养障碍，促进CRC筛查 坚持。最后，它将通过将HBM结构与健康信念最 与低社会经济地位的黑人男性相关，并通过整合性别和种族一致的形象，语言和价值观。 在第I阶段开发了原型m-CRCSi。这一发展是由形成性研究提供信息的 与社区护理提供者和目标最终用户合作。第一阶段的成果远远超过拟议的 基准，并强烈支持干预的可用性，可接受性和潜在有效性。 在第二阶段，我们将完成m-CRCSi的开发。与家人合作， 医疗咨询服务（我们的合作伙伴CIMHC），我们将检查m-CRCSi的有效性，以增加 非裔美国男性的CRC筛查。参与者将被随机分配到干预措施中， 条件或匹配的对照条件。次要措施将评估健康信念，医疗不信任， 癌症宿命论、医患互动和知识。

PROJECT SUMMARY/ABSTRACT Poverty has a myriad of pernicious effects on health, including higher incidence and mortality for most forms of cancer. Colorectal cancer (CRC), the second overall leading cause of cancer death, is no exception. CRC is diagnosed 40% more often in those lower in socioeconomic status (SES). In the United States, race and SES are inextricably linked, leading to profound health disparities. Indeed, CRC is particularly burdensome for Black people, most notably African American men. CRC incidence is 20% higher in Black men as compared to white men with death rates 52% higher. African American men have the lowest survival rates at all CRC stages. Screening (e.g., colonoscopy, stool-based tests) can prevent most cases of invasive CRC. However, uptake is inadequate, especially among low SES African American men. Indeed, 40% of the racial disparity in CRC incidence and 20% of mortality differences can be attributed to lack of screening. Being Black, male, and low SES in the U.S. intersect to form a complex set of institutional, provider, and patient-level barriers that lead to differential screening rates. Most efforts to increase CRC screening in this group utilize in-person or telephone- based education and navigation. While effective, these approaches are resource intensive, limiting their adoption by organizations that serve low SES Black men, such as Federally Qualified Health Centers (FQHCs). To address the need for an effective, affordable, and scalable strategy to increase CRC screening among medically underserved African American men, this project will develop a mobile colorectal cancer screening intervention (m-CRCSI) for this group. m-CRCSI will be based on the health belief model (HBM) and delivered via mobile phone. It will include text messages designed to improve CRC knowledge and health beliefs. Some text messages will include links to one of three types of videos: educational instruction, scripted vignettes, and unscripted peer narratives. Program content will reduce health literacy barriers and promote CRC screening adherence. Finally, it will be culturally targeted by contextualizing HBM constructs with the health beliefs most relevant to low SES Black men and by integrating gender- and race-congruent imagery, language, and values. A prototype m-CRCSi was developed in Phase I. This development was informed by formative research with community-based care providers and target end-users. The results of Phase I far exceeded the proposed benchmarks and strongly support the usability, acceptability, and potential effectiveness of the intervention. During Phase II we will complete development of the m-CRCSi. Then, in collaboration with Family and Medical Counseling Service (our partner FQHC), we will examine the effectiveness of the m-CRCSi to increase CRC screening in African American men. Participants will be randomly assigned to either the intervention condition or to a matched control condition. Secondary measures will assess health beliefs, medical mistrust, cancer fatalism, patient-provider interaction, and knowledge.