An Exploration of the Determinants that Impact Breast and Cervical Cancer Control

描述（由申请人提供）： 在美洲印第安人和阿拉斯加原住民（AI/AN）社区，非专业健康顾问（LHA）干预模式越来越多地被用于解决获得和使用推荐的乳腺癌和宫颈癌早期检测检查（包括乳房X线检查和巴氏检查）方面的差异。虽然最近的研究已经证明了非专业健康顾问计划在提高AI/AN社区乳腺癌和宫颈癌筛查率方面的适度有效性，但没有研究探讨了部落非专业健康顾问本身的态度，信仰和规范，特别是针对高度污名化疾病（如癌症）的干预措施。此外，研究人员尚未探索非专业健康顾问的外部因素，例如分散的医疗保健系统和权力不平衡，这可能会影响LHA提供乳腺癌和宫颈癌特定服务的能力。因此，这些因素的调查是必不可少的，以阐明未来的能力发展和干预策略，部落奠定健康顾问计划，以最大限度地提高他们的能力，以支持乳腺癌和宫颈癌的早期发现在他们的社区。为了解决科学知识的这一关键差距，本研究项目将与部落非专业健康顾问进行深入访谈，以探索和分析影响他们将癌症控制活动纳入其服务范围的能力的关键决定因素。据推测，一系列的决定因素，而不仅仅是癌症的具体知识和教育，解释了部落LHAs的行为意图的变化，以执行这一关键的健康促进作用。本研究的具体目的是：（1）结合计划行为理论的建构，发展一个访谈表，以探讨部落地区妇女的态度、主观规范和感知行为控制，并阐明这些因素影响其向社区妇女提供针对乳腺癌和宫颈癌的健康教育和/或导航服务的行为意图的途径;（2）与至少30名部落LHA和LHA主任进行开放式的深入访谈;（3）利用扎根理论系统地分析访谈记录，并确定相关模式、主题和理论关联，这些模式、主题和理论关联解释了态度、主观规范和感知行为控制之间的联系，以及部落LHA将癌症控制活动纳入其服务范围的行为意图;（4）确定部落社区的社会、文化和政治背景的要素，这些要素可以纳入部落LHA的干预前能力发展，以最大限度地提高其在提供癌症特异性教育和导航服务方面的有效性;以及（5）确定社区和卫生保健系统的干预杠杆点，这些干预点可以与LHA干预措施的实施同时进行，改善部落社区乳腺癌和宫颈癌早期检测服务的协调和提供。这项研究将探讨和分析影响部落外行健康顾问促进乳腺癌和宫颈癌早期发现能力的因素，这两种高度污名化的疾病使美国印第安人的生存率不成比例地低。它还将告知部落非专业健康顾问的能力发展需求，以最大限度地提高他们在提供乳腺癌和宫颈癌特定教育和导航服务方面的效率。此外，这项调查将导致确定部落社区和卫生保健系统的杠杆点进行干预，这可以有针对性的同时实施部落奠定健康顾问干预，以改善协调和提供乳腺癌和宫颈癌早期检测服务在美国印第安人社区。

DESCRIPTION (provided by applicant): Lay health advisor (LHA) intervention models have been increasingly utilized in American Indian and Alaskan Native (AI/AN) communities to address disparities in access to and utilization of recommended breast and cervical cancer early detection exams, including mammograms and Pap exams. While recent studies have documented moderate effectiveness of lay health advisor programs in increasing breast and cervical cancer screening rates in AI/AN communities, no studies have explored the attitudes, beliefs, and norms of tribal lay health advisors themselves, especially in interventions that target a highly stigmatized disease such as cancer. Further, researchers have yet to explore factors external to lay health advisors, such as fragmented health care systems and power imbalances, which may affect the capacity of LHAs to provide breast and cervical cancer-specific services. An investigation of these factors is therefore essential to elucidate future capacity development and intervention strategies for tribal lay health advisor programs to maximize their ability to bolster breast and cervical cancer early detection in their communities. To address this critical gap in scientific knowledge, this research project will conduct in-depth interviews with tribal lay health advisors to explore and analyze the key determinants which impact their ability to integrate cancer control activities into their scope of services. It is hypothesized that a host of determinants, not just cancer-specific knowledge and education alone, explains the variation in behavioral intentions of tribal LHAs to perform this critical health promotion role. Specific aims of this study are to: (1) develop an interview schedule that incorporates the constructs of the Theory of Planned Behavior, to explore the attitudes, subjective norms, and perceived behavioral control of tribal LHAs, and to elucidate the pathways through which these factors impact their behavioral intentions to provide breast & cervical cancer- specific health education and/or navigational services to community women; (2) conduct open-ended, in- depth interviews with at least 30 tribal LHAs and LHA Directors; (3) utilize Grounded Theory to systematically analyze interview transcripts and identify relevant patterns, themes, and theoretical associations that explain the linkages between attitudes, subjective norms and perceived behavior control and the behavioral intentions of tribal LHAs to incorporate cancer control activities into their scope of services; (4) identify elements of the social, cultural, and political context of tribal communities that can be integrated into pre-intervention capacity development with tribal LHAs to maximize their effectiveness in providing cancer-specific educational and navigational services; and (5) identify community and health care system leverage points for intervention, which can be targeted concurrently with the implementation of LHA interventions, to improve the coordination and delivery of breast and cervical cancer early detection services in tribal communities. This study will explore and analyze the factors that impact the ability of tribal lay health advisors to promote early detection of breast and cervical cancer, two highly stigmatized diseases for which American Indian people experience disproportionately poor survival rates. It will also inform the capacity development needs of tribal lay health advisors to maximize their effectiveness in providing breast and cervical cancer-specific educational and navigational services. Moreover, this investigation will lead to the identification of tribal community and health care system leverage points for intervention, which can be targeted concurrently with the implementation of tribal lay health advisor interventions, to improve the coordination and delivery of breast and cervical cancer early detection services within American Indian communities.