CRC Screening in Primary Care Settings: Factors for Low Income Urban Hispanics

描述（由申请人提供）：结直肠癌（CRC）是西班牙裔女性癌症死亡的第三大原因，与前列腺癌并列，是西班牙裔男性癌症死亡的第二大原因。提高拉美裔人群的CRC筛查率和早期检出率是降低拉美裔人群CRC死亡率的一个关键和可改变的方法。不幸的是，大多数拉美裔人没有接受筛查。更令人不安的是，对于那些寻求常规医疗护理的人来说，CRC的筛查率甚至很低。在制定干预措施以增加西班牙裔人群的结直肠癌筛查之前，需要确定西班牙裔人群筛查的障碍和促进因素。为此，拟议的R21将确定在三个主要诊所接受治疗的城市西班牙裔人群中进行结直肠癌筛查的障碍和促进因素，涉及位于纽约东哈莱姆的35多名全职医生。该提案直接解决了NCI确定的结直肠癌社会、行为和健康服务研究的优先事项。该提案侧重于行为模型，可以指导干预措施，以增加城市西班牙裔人的CRC筛查使用，文化考虑是贯穿始终的主题，研究团队是跨学科的。具体目的是：1)确定在初级保健实践中接受内镜下结直肠癌筛查的城市西班牙裔（多米尼加人、墨西哥人和波多黎各人）的障碍和促进因素；2)调查与西班牙裔相关的卫生保健、健康促进和文化因素：a)接受内镜下结直肠癌筛查的准备阶段；b)内镜下CRC筛查依从性。该研究还将探讨是否存在西班牙内部差异（即多米尼加人、墨西哥人和波多黎各人之间的差异），以及与内镜下结直肠癌筛查的准备阶段和内镜下结直肠癌筛查依从性相关的因素。这项研究将分为两个阶段。这两个研究阶段中的每一个都将使用不同的方法来收集和分析数据。第一阶段将采用焦点小组方法，由六个焦点小组组成，每组最多10名拉美裔人。焦点小组数据的定性分析将确定西班牙裔人群中CRC筛查的障碍和促进因素，并提出将用于第二种研究方法的调查修订建议。第二阶段将对300名西班牙裔男性和女性进行横断面调查，年龄在50岁以上，患结直肠癌的平均风险。本研究的横断面调查数据的定量分析结果将表明卫生保健、健康促进和文化因素与西班牙裔人接受内镜下结直肠癌筛查的准备阶段和内镜下结直肠癌筛查的依从性相关。第二种研究方法的结果也将表明，在被确定为CRC筛查障碍和促进因素的因素中，是否存在西班牙裔内部差异。摘要：本研究旨在调查西班牙裔人群进行结直肠癌筛查的障碍和促进因素。该研究结果将导致干预材料的发展，以根据与他们最相关的因素增加不同西班牙裔人群的CRC筛查。在这个快速增长的少数群体中增加CRC筛查的干预措施可以提高他们的CRC筛查率，从而降低他们的CRC死亡率。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the 3rd leading cause of cancer death among Hispanic women and ties with prostate cancer as the 2nd deadliest cancer among Hispanic men. A key and modifiable way to decrease mortality from CRC among Hispanics is to increase their rates of CRC screening and early detection of CRC. Unfortunately, the majority of Hispanics do not get screened. All the more troubling is that CRC screening rates are even low for individuals who seek routine medical care. Prior to developing interventions to increase CRC screening in Hispanics, the factors that are barriers and facilitators to screening among Hispanics need to be identified. To that end, the proposed R21 will identify barriers and facilitators to CRC screening among urban Hispanics treated in three primary practice settings, involving over 35 full-time physicians, located in East Harlem, New York. This proposal directly addresses the priorities identified by NCI for social, behavioral, and health services research in colorectal cancer. The proposal focuses on behavioral models that can guide interventions to increase the use of CRC screening in urban Hispanics, cultural considerations are a theme throughout, and the research team is interdisciplinary. The specific aims are: 1) To identify barriers and facilitators to endoscopic CRC screening in urban Hispanics (Dominicans, Mexicans and Puerto Ricans) treated in a primary care practice and 2) To investigate health care, health promotion, and cultural factors associated with Hispanics': a) stage of readiness to undergo endoscopic CRC screening; and b) endoscopic CRC screening adherence. The study will also explore if there are intra-Hispanic differences (i.e., differences among Dominicans, Mexicans, and Puerto Ricans), for the factors associated with stage of readiness to undergo endoscopic CRC screening and endoscopic CRC screening adherence. There will be two phases to the study. Each of the two study phases will use a different approach to data collection and analysis. The first phase will use focus group methodology with six focus groups comprised of up to 10 Hispanics in each group. Qualitative analyses of the data from the focus groups will identify barriers and facilitators of CRC screening among Hispanics and suggest revisions to the survey that will be used for the 2nd study approach. The second phase will use a cross-sectional survey of 300 Hispanics men and women), over the age of 50 at average risk for CRC. The results of the quantitative analyses with the data from the study's cross-sectional survey will indicate health care, health promotion, and cultural factors associated with Hispanics' stage of readiness to undergo endoscopic CRC screening and endoscopic CRC screening adherence. The results from this second study approach will also suggest if there are intra-Hispanic differences in the factors identified as barriers and facilitators to CRC screening. Lay Summary: The proposed study seeks to investigate the barriers and facilitators of CRC screening among Hispanics. The study results will lead to the development of intervention materials to increase CRC screening among diverse Hispanics based on the factors that are most relevant to them. Interventions to increase CRC screening in this rapidly growing minority group could increase their rates of CRC screening and thereby decreased their mortality from CRC.