Colorectal Cancer Screening in Primary Care Practice

描述（由申请人提供）：背景：关于拉丁裔人群对结直肠癌（CRC）筛查的知识、态度和信念，以及在该人群中促进筛查的方法，我们知之甚少。目的：比较社区健康顾问提供的强化行为干预与患者信息分发、“最小干预”或常规护理对参与结直肠癌筛查的效果。第二个主要目标是开发一种文化敏感的干预措施，以增加知识，改变文化观念，并赋予患者参与三种公认的结直肠癌筛查策略中的任何一种的决策能力。该研究的次要目的是：1)确定低收入拉丁裔人群中结直肠癌筛查的障碍；2)在社区卫生中心内建立具有文化敏感性和有效的癌症筛查教育计划。

DESCRIPTION (provided by applicant): Background: Little is known about the Latino population's knowledge, attitudes and beliefs on colorectal cancer (CRC) screening, or on methods to promote screening in this population. Objective: To compare the effectiveness of an intensive Community Health Advisor - delivered behavioral intervention on participation in CRC screening with a patient information handout, a "minimal intervention", or usual care. A second primary aim is to develop a culturally sensitive intervention that will increase knowledge, modify culturebound beliefs, and empower patients with the decision-making ability to participate in any 1 of 3 accepted screening strategies for CRC. Secondary aims of the study are to: 1) Identify barriers to CRC screening in a low-income Latino population; and 2) institutionalize within a community health center a culturally sensitive and effective cancer screening education program. Methods: In this prospective randomized controlled study, trained bilingual research personnel will invite 600 eligible patients who present for routine care at a large Community Health Center to participate in the study. Patients from one facility will be randomized into one of three intervention groups: (1) Community Health Advisor; (2) Patient information pamphlet; or (3) Healthy diet brochure. These participants will complete a baseline survey on colorectal cancer and screening issues and on constructs related to a combined Health Belief Model / Theory of Reasoned Action conceptual model. The survey will further draw from validated instruments reported in the literature. Subjects will again complete the survey after participation in their study group. Control subjects will be recruited from a satellite facility and asked to complete a baseline survey on general health and cancer screening issues, and will receive an information brochure on healthy diet. At 4-month follow-up from the time of randomization and for all four groups, the outcome variable of participation in any CRC screening will be assessed by chart review. Data analysis: Data will include a combination of quantitative and qualitative endpoints. All data will be entered into a computer and descriptive statistics will be generated when appropriate. A 2x3 contingency table for compliance with CRC screening and the intervention group membership will be computed. The chi-square test will be applied to assess whether there is an overall difference of the compliance index in the three study arms. Post hoc pairwise comparison will be used to compare all groups using a Bonferroni adjustment of significance level (0.05/4=0.0125). Multivariate analysis will be conducted to investigate variables from our HBM/TRA model as predictors of compliance.