A web-based tailored health behavior intervention for African American colon canc

描述(由申请者提供)：背景非裔美国人患结肠癌和直肠癌的发病率和死亡率不成比例。高水果和蔬菜的饮食，以及中等到剧烈的体力活动，都有可能显著降低结肠癌的发病率和死亡率，以及其他并发症的风险。然而，令人惊讶的是，对非裔美国人结肠癌幸存者的健康行为(饮食和体力活动)干预的经验性测试相对较少。一个原因可能与制定成功的干预措施的挑战有关，特别是对少数群体；因此，可能特别值得将在一个人口群体中证明有效的方案调整到人口的其他部分。WATCH(通过教会为非裔美国人提供健康)项目是在北卡罗来纳州12个农村教堂进行的随机试验，展示了邮寄定制印刷和视频(TPV)干预的有效性，该干预由四份单独定制的时事通讯和有针对性的录像带组成，以改善这些行为。结果显示，在水果和蔬菜消费(0.6份)和娱乐体育活动(每周2.5小时)方面有显著改善(p&lt；0.05)。在这里，我们建议进行一项试点研究(电子手表)，以调查手表定制的印刷信息和录像带是否可以有效和高效地传播给不同的非裔美国人(结肠癌幸存者)，并使用不同的传递渠道或方法(通过互联网的电子技术)。次要目标是确定这种干预措施是否能改善次级结果，特别是改善健康行为的自我效能感和社会支持；并使用过程评估措施来评估电子观察计划的可行性、可接受性和更广泛传播的潜力。方法为了实现这些目标，我们将为电子手表开发一个密码保护的网站，参与者可以通过互联网访问。符合条件的参与者将是北卡罗来纳州的非裔美国人男性和女性(n=200)，年龄在40-79岁之间，被诊断为I期或II期结肠癌，他们已经成功完成了疾病的治疗，并且在确诊后至少6个月。参与者将被随机分配到接受文化和个人定制的干预或对照条件(n=100每组)。他们将在网上完成基线调查(询问饮食、体力活动、人口统计和心理社会因素)，然后在基线数据收集后5-6个月内通过互联网收到定制的反馈和信息(包括数字化格式的录像带)。在基线后大约六个月，参与者将完成第二次调查，评估与基线相同的健康行为和心理社会因素。控制组参与者将接受“延迟”干预。干预前和干预后收集的过程和结果评估措施将评估暴露、认知处理、信息使用和可接受性。评估将测试这种利用新技术传播WATCH计划的方法是否产生与之前的随机试验结果(即WATCH项目)相类似的结果。意义这项试点研究将提供信息，了解利用互联网在非裔美国人结肠癌幸存者中提供文化和个人定制的健康行为干预的潜力，这种计划在这一人群中是否有效和可行，以及社会支持和自我效能等心理社会中介因素在多大程度上影响这一人群的干预效果。该项目还将有助于理解如何修改成功的健康促进干预措施，使之适用于不同的人口群体以及替代的提供形式(渠道)。

DESCRIPTION (provided by applicant): Background African Americans experience disproportionate morbidity and mortality from colon and rectal cancers. Diets high in fruits and vegetables and moderate to vigorous physical activity all have the potential to significantly reduce colon cancer incidence and mortality, as well as risk for other co-morbidities. However, surprisingly, there have been relatively few empirically tested health behavior (diet and physical activity) interventions in African American colon cancer survivors. One reason may relate to the challenges of developing successful interventions, particularly for minority populations; thus, it may be particularly worthwhile to adapt programs which have demonstrated effectiveness in one population group to other segments of the population. The WATCH (Wellness for African Americans Through Churches) Project was a randomized trial in 12 rural North Carolina churches that demonstrated the effectiveness of a mailed tailored print and video (TPV) intervention consisting of four individually tailored newsletters and targeted videotapes to improve these behaviors. Results showed significant improvements (p<.05) for fruit and vegetable consumption (0.6 servings) and recreational physical activity (2.5 MET hours per week). Aims Here, we propose to conduct a pilot study (e-WATCH) to investigate whether the WATCH tailored print messages and videotapes can be effectively and efficiently disseminated to a different group of African Americans (colon cancer survivors) and using a different delivery channel or method (electronic technology via the internet). Secondary aims are to determine whether this intervention results in improvements in secondary outcomes, specifically self-efficacy and social support for improving health behaviors; and to use process evaluation measures to assess the feasibility, acceptability, and potential for wider dissemination of the e- WATCH program. Methods To accomplish these objectives, we will develop a password-protected website for e-WATCH that participants will access via the internet. Eligible participants will be African American males and females in North Carolina (n=200), 40-79 years, diagnosed with either Stage I or II colon cancer who have successfully completed treatment for their disease and who are at least 6 months post-diagnosis. Participants will be randomly assigned to receive the culturally and individually tailored intervention or the control condition (n=100 per group). They will complete a baseline survey online (querying on diet, physical activity, demographics, and psychosocial factors) and then will receive the WATCH tailored feedback and information (including the videotapes in digitized format) via the internet over a 5-6 month period after baseline data collection. Approximately six months after baseline, participants will complete a second survey assessing the same health behavior and psychosocial factors as at baseline. Control participants will receive a "delayed" intervention. Process and outcome evaluation measures collected pre- and post-intervention will assess exposure, cognitive processing, use of information, and acceptability. Evaluation will test whether this method of disseminating the WATCH program utilizing new technology produces comparable results to the previous randomized trial findings (i.e., the WATCH project). Significance This pilot study would inform on the potential to use the internet to deliver a culturally and individually tailored health behavior intervention in African American colon cancer survivors and whether such a program can be efficacious and feasible in this population, as well as on the extent to which psychosocial mediators such as social support and self-efficacy affect intervention effectiveness in this population. This project would also contribute to the understanding of how successful health promotion interventions can be modified for use in different segments of the population and for alternative forms (channels) of delivery.