An Appalachian Cervical Cancer Prevention Project

描述（由申请人提供）：尽管它几乎是可以预防的，但每年仍有13，000例新的浸润性宫颈癌病例被诊断出来，其中4，600例死亡。虽然在全国范围内，妇女在过去50年中宫颈癌死亡率下降了75%，但阿巴拉契亚农村妇女的巴氏试验率仍然很低，宫颈癌发病率不成比例地高。为了减少中年和老年阿巴拉契亚妇女所经历的宫颈癌负担，我们建议开展一项社区参与式的、量身定制的、基于信仰的干预措施，名为“信仰移山”。“虽然大量文献已经建立了农村文化与宗教信仰之间的联系，但除了涉及非裔美国人教堂的项目之外，令人惊讶的是，很少有基于科学的干预措施将疾病预防活动定位在阿巴拉契亚农村值得信赖的、可持续的农村宗教机构内。为了解决这个错失的机会，本项目将随机分层抽样50个教会，600名参与者，以：（1）检查因素（包括障碍和资产），影响巴氏试验的使用;（2）管理一个基于信仰的外行健康顾问干预，是社区参与，理论上知情，文化上一致;（3）采用分组随机实验设计评价干预效果。这三个目标对应于三个阶段，一个发展，民族志为导向的阶段;一个社区参与干预阶段;和一个定性和定量评估阶段。通过一个由社会科学家、社区领导人、医生和癌症控制专家组成的多学科小组，拟议项目的成果将使研究人员和社区能够更好地解决阻碍农村妇女接受巴氏试验和建议的后续护理的障碍;利用当地社区资产促进巴氏试验的使用;并建立一个以社区为基础的模式，可以推广到其他农村，服务不足的社区预防癌症。

DESCRIPTION (provided by applicant): Despite its nearly preventable status, 13,000 new cases of invasive cervical cancer are diagnosed each year, with 4,600 deaths. While nationally, women have experienced a 75% reduction in cervical cancer mortality in the past 5 decades, rural Appalachian women continue to sustain low rates of Pap testing and disproportionately high cervical cancer rates. To reduce this cervical cancer burden experienced by middle aged and older Appalachian women, we propose to undertake a community participatory, tailored, faith based intervention entitled "Faith Moves Mountains." While extensive literature has established the association between rural culture and religiosity, aside from programs involving African-American churches, surprisingly few scientifically based interventions have located disease prevention activities within the trusted, sustainable, rural religious institutions of rural Appalachia. To address this missed opportunity, this project will develop a random, stratified sample of 50 congregations with 600 participants to: (1) Examine the factors (both barriers and assets) that influence the use of Pap tests; (2) Administer a faith-based lay health advisor intervention that is community-participatory, theoretically informed, and culturally consistent; (3) Evaluate the efficacy of the intervention in a group-randomized experimental design. These 3 aims correspond to 3 phases, a developmental, ethnographically oriented phase; a community-participatory intervention phase; and a qualitative and quantitative evaluation phase. With a multidisciplinary team of social scientists, community leaders, physicians, and cancer control experts, the results from the proposed project will enable researchers and communities to better address the barriers that prevent rural women from receiving Pap tests and recommended follow-up care; draw on local community assets to promote the use of Pap tests; and establish a community-based model that can be extrapolated to other rural, underserved communities for cancer prevention.