Native Navigation across the Cancer Continuum in Comanche Nation

描述（由申请人提供）：南部平原（俄克拉荷马州、得克萨斯州和堪萨斯）美洲原住民（NAs）的癌症发病率和死亡率过高。尽管教育策略的实施已经成功地达到了许多种族/族裔群体在美国，以减少癌症的发病率和死亡率，这是不是在NA人生活在南部平原的情况。拟议的项目旨在满足美国国立卫生研究院的使命，以消除少数群体之间的健康差距，并了解人类行为在癌症连续体中的作用。患者导航是一种新兴的策略，雇用训练有素的个人来帮助他人导航医疗保健系统，以接受所需的教育和服务。这是一个过程，通过这个过程，一个人-一个病人导航器-提供外展和教育， 确保获得筛查检查，并指导可疑发现的患者通过复杂的癌症护理系统中的障碍，以帮助确保及时诊断和治疗。 拟议的多学科项目（护理，公共卫生和统计）采用基于社区的参与性方法，使用混合方法来检查使用土著导航员作为科曼奇族的干预措施。将与每个本地导航员一对一地实施基于目标实现缩放（GAS）原则的目标设置，以促进培训。它还将用于社区癌症教育研讨会的NA参与者，作为帮助NA实现癌症相关行为改变的一种手段。该项目的目标是测试GAS，以帮助科曼奇国家完善，扩展和调整目前在其他NA社区使用的各种导航模型，以满足社区和患者在癌症护理连续体中的需求。预期的结果是开发一个特定于站点（量身定制）的本地导航员癌症教育计划，该计划解决了科曼奇族癌症护理的完整连续性，促进了参与者与癌症相关的行为变化。具体目标是：1。确定在何种程度上土著导航发起的美洲原住民社区教育研讨会将提高有关癌症预防，筛查和治疗美洲原住民参与者的知识。2.确定参加本地导航员发起的社区教育研讨会的NA参与者的年龄，教育程度和家庭年收入等人口统计学变量是否与为NA开发的癌症相关知识项目的前和后测试分数相关。3.确定基于GAS的目标设定是否有助于本地导航员的培训。4.确定基于GAS的目标设定是否是社区癌症教育参与者在癌症相关行为改变方面取得进展的有效方法。 公共卫生相关性：拟议的研究的相关性是双重的：1）测试使用本地导航员提供社区癌症教育在科曼奇民族的结果可能会导致知识，可应用于解决癌症健康的差距，不仅在科曼奇民族，但可能在其他部落社区具有类似的特点;和2）将目标实现设定应用于土著导航员培训的结果，以及参加社区教育讲习班的美洲土著参与者在癌症相关行为变化方面的进展，这可能会减少美国原住民之间的癌症健康差异。

DESCRIPTION (provided by applicant): The Southern Plains (Oklahoma, Texas, and Kansas) Native Americans (NAs) have excessive cancer incidence and mortality rates. Despite the implementation of educational strategies that have successfully reached many racial/ethnic groups in the United States to decrease cancer incidence and mortality, this is not the case among NA people living in the Southern Plains. The proposed project seeks to meet National Institutes of Health missions to eliminate health disparities among a minority population, and to understand the role of human behavior across the cancer continuum. Patient navigation is an emerging strategy of employing trained individuals to assist others to navigate the health care system to receive needed education and services. It is a process by which an individual-a patient navigator-provides outreach and education, ensures access to screening examinations, and guides patients with a suspicious finding through and around barriers in the complex cancer care system to help ensure timely diagnosis and treatment. The proposed multidisciplinary project (nursing, public health, and statistics) employs a community-based participatory approach using mixed methods to examine use of Native navigators as an intervention in the Comanche Nation. Goal setting based on principles of Goal Attainment Scaling (GAS) will be implemented one-on-one with each Native Navigator in order to facilitate training. It will also be used with NA participants in community cancer education workshops as a means of assisting NAs to make progress towards achieving cancer-related behavior change. The goal of this project is to test GAS to assist the Comanche Nation in refining, expanding and adapting various navigator models currently used in other NA communities to address the community's and patients' needs across the continuum of cancer care. The expected outcome is the development of a site-specific (tailored), Native Navigator cancer education program that addresses the full continuum of cancer care in the Comanche Nation that facilitates cancer-related behavioral change in participants. Specific aims are: 1. To determine to what extent Native Navigator-initiated Native American community education workshops will improve knowledge regarding cancer prevention, screening, and treatment among Native American participants. 2. To determine whether demographic variables of age, education, and annual family income in NA participants attending Native Navigator-initiated community education workshops are associated with pre- and post-test scores on cancer-related knowledge items developed for NAs. 3. To determine if goal setting based on GAS will facilitate training of Native Navigators. 4. To determine if goal setting based on GAS will be an effective method for participants in community cancer education to make progress in cancer-related behavioral change. PUBLIC HEALTH RELEVANCE: The relevance of the proposed study is twofold: 1) Findings of testing the use of Native Navigators to provide community cancer education in Comanche Nation may result in knowledge that can be applied to resolving cancer health disparities, not only in Comanche Nation, but in possibly in other tribal communities with similar characteristics; and 2) Findings of application of Goal Attainment Setting to training of Native Navigators, as well as progress towards cancer-related behavioral change in Native American participants attending community education workshops, may lead to decreased cancer health disparities among Native Americans.