Colorectal screening fear-reduction and racially-targeted norm messaging entreaties to increase colorectal cancer screening rates among African Americans

摘要 结直肠癌（CRC）是美国和非洲癌症死亡率的主要原因之一。 与欧洲裔美国人相比，美国人（AfAms）在CRC发病率和死亡率方面仍然更差 提高非洲艾滋病患者CRC筛查率的干预措施有助于解决 CRC发病率和死亡率的差异。尽管文献表明，AfAms的恐惧（例如，结肠镜 程序或癌症诊断）作为CRC筛查的障碍，没有干预措施使用理论指导 直接针对基于恐惧的信念的方法。此外，没有研究调查种族歧视的程度。 身份缓和了种族针对性消息的影响，尽管使用针对性健康的无处不在， 在少数群体中传递信息。这一点尤其重要，因为我们的工作表明，种族- 有针对性的筛查请求增加了AfAms中的CRC筛查意愿， 但在那些更强烈认同自己种族群体的AfAms中，这些意图受到了抑制。缺乏 关注其他突出的CRC筛查障碍可能会让高度认同的非洲裔美国人感到不快。 我们建议研究是否结合恐惧减少和种族有针对性的规范为基础的信息 将增加所有非洲裔美国人在家中基于粪便的CRC筛查的接受性和吸收率， 种族认同的程度。鉴于家庭筛查工具包的退货率较低，我们还将探讨是否 明确承诺归还筛查工具包与工具包归还量的增加有关。 目标1：制定和完善以计划行为理论为指导的减少恐惧干预措施， 出版的文献，与非洲妇女协会社区专家一起。 目的2：检查减少恐惧的恳求是否会增加对家庭的接受和吸收 CRC筛查与针对种族的基于规范的信息相结合。 目的3：研究种族认同和感知的CRC风险对恐惧影响的调节作用- 减少和种族针对性的规范为基础的信息恳求。 目标4：我们将探讨明确承诺返还FIT套件的参与者是否会返还FIT套件 与那些没有做出这种承诺的人相比，他们的比率更高。 这项拟议的研究是重要的，因为它直接解决了记录的CRC筛查缺陷 在一个服务不足的人口，是创新的，因为它的设计，以理论为基础， 采取知情干预措施，以解决以前未解决的非洲援助妇女在进行儿童权利委员会筛查方面的障碍。

Summary Abstract Colorectal cancer (CRC) is one of the leading causes of cancer mortality in the United States, and African Americans (AfAms) still fare worse in CRC incidence and mortality compared to European Americans (EuAms).Interventions to increase CRC screening rates among AfAms are instrumental to address the disparities in CRC incidence and mortality. Despite literature indicating that AfAms’ fears (e.g., of colonoscopy procedures or cancer diagnosis) serve as barriers to CRC screening, no interventions have used theory-guided methods to directly target fear-based beliefs. Additionally, no research has examined the extent to which racial identity moderates the effects of racially targeted messaging, despite the ubiquity of using targeted health messaging entreaties among minority groups. This is particularly relevant given our work showing that racially- targeted screening entreaties increased CRC screening intentions among AfAms who identified less strongly, but depressed those intentions among AfAms who identified more strongly with their racial group. Lack of focus on other salient CRC screening barriers may have been off-putting to highly identified African Americans. We propose to examine whether combining both fear-reduction and racially-targeted norm-based messages will increase at-home stool-based CRC screening receptivity and uptake for all African American regardless of level of racial identity. Given low return rates of at-home screening kits, we will also explore whether making an explicit commitment to return screening kits is associated with increased kit returns. Aim 1: To develop and refine a fear-reduction intervention guided by the theory of planned behavior and by published literature, in conjunction with AfAm community experts. Aim 2: To examine whether the fear-reduction entreaty increases receptivity to, and uptake of at-home CRC screening when coupled with racially-targeted norm-based messages. Aim 3: To examine the moderating roles of racial identity and perceived CRC risk on the effects of fear- reduction and racially-targeted norm-based messaging entreaties. Aim 4: We will explore whether participants who make explicit commitments to return FIT Kits return them at a higher rate compared to those who do not make such commitments. This proposed study is significant because it directly addresses documented CRC screening deficits among an underserved population, and is innovative given its design of a theory-based and literature informed intervention to address previously unaddressed barriers to CRC screening among AfAms.