CBPR Strategies to Increase Colorectal Cancer Screening in Ohio Appalachia

描述（由申请人提供）：CRC发病率和死亡率的不成比例的负担，主要是由于推荐的CRC筛查试验的利用率较低。俄亥俄州的阿巴拉契亚地区除了更高的贫困率、更低的就业率和更低的教育水平外，还遭受着这种疾病的负担。为了解决这种癌症健康差异问题，我们在俄亥俄州州立大学（OSU）的健康差异研究团队与四个阿巴拉契亚社区联盟合作，使用基于社区的参与性研究（CBPR）方法来设计和试点测试旨在提高阿巴拉契亚县CRC筛查率的两种干预措施（第一阶段）。 本申请的目的是在12个俄亥俄州阿巴拉契亚县（2期）测试这些CRC筛查干预措施，为阿巴拉契亚社区癌症网络（ACCN）内另外6个阿巴拉契亚州的全面传播试验（3期）做准备。 该第2阶段提案的具体目标是：1）利用CBPR方法来完善具体的县级媒体宣传活动和关于CRC筛查的基于诊所的信息（题为“支持你的健康！“）或注意力控制消息（一项名为“桃子”的健康饮食运动）在俄亥俄州阿巴拉契亚的12个县; 2）实施和测试，使用分组随机设计，交错县范围的干预计划，比较县特定的媒体宣传活动，包括当地CRC幸存者，诊所特定的宪章提醒系统，将6个随机选择的干预县的两种策略与6个随机选择的注意力控制县的相同运动策略相结合，使用以当地农民和教育为特色的县特定健康饮食运动。放在诊所的材料; 3）利用过程（县居民的便利样本）和结果评估（每个县居民的4项独立横断面调查）策略来评估每种策略对提高CRC筛查率的有效性;以及4）利用结果，计划在随后的3期研究中将干预措施传播到ACCN的另外6个州的36个阿巴拉契亚县。 所有具体目标将使用CBPR原则，与这四个俄亥俄州阿巴拉契亚社区为基础的癌症联盟全面合作，并将由跨理论模型的基本理论框架，结合三个行为理论相关的行为改变（社会认知理论，理性行动理论和态度可及性理论）指导。 因此，这项研究的结果将对这些阿巴拉契亚县产生直接影响，因为社区将能够将成功的战略制度化到现有的全县健康运动中。

DESCRIPTION (provided by applicant): a disproportionate burden of CRC incidence and mortality, mainly due to lower utilization of recommended CRC screening tests. The Appalachian region of Ohio suffers from this burden of disease in addition to higher poverty, lower employment, and lower educational levels. To address this cancer health disparity, our health disparities research team at The Ohio State University (OSU) in partnership with four Appalachia-based community coalitions have used community-based participatory research (CBPR) methods to design and pilot test two interventions intended to increase CRC screening rates in one Appalachian county (Phase 1). The goal of this application is to test these CRC screening interventions in 12 Ohio Appalachian counties (Phase 2) in preparation for a full-scale dissemination trial (Phase 3) in 6 additional Appalachian states within the Appalachia Community Cancer Network (ACCN). The specific aims of this Phase 2 proposal are to: 1) utilize CBPR methods to refine specific county-level media campaigns and clinic-based messages about CRC screening (entitled "Get Behind Your Health!") or an attention control message (a healthy eating campaign entitled "PEACHES") in 12 Ohio Appalachia counties; 2) implement and test, using a group-randomized design, a staggered county-wide intervention program that compares county-specific media campaigns featuring local CRC survivors, clinic-specific charter reminder systems, and a combination of the two strategies in 6 randomly selected intervention counties to the same campaign strategies in 6 randomly selected attention control counties using county specific healthy eating campaigns featuring local farmers and educational material placed in clinics; 3) utilize process (convenience samples of county residents) and outcome evaluation (4 independent cross-sectional surveys of residents of each county) strategies to assess the efficacy of each strategy on improving CRC screening rates; and 4) utilize the results, to plan the dissemination of the intervention into 36 Appalachian counties in 6 additional states of the ACCN in a subsequent Phase 3 study. All specific aims will be carried out using CBPR principles, in full partnership with these four Ohio Appalachian community-based cancer coalitions, and will be guided by an underlying theoretical framework of the Transtheoretical Model, in conjunction with three behavioral theories relevant to behavior change (Social Cognitive Theory, Theory of Reasoned Action, and Attitude Accessibility Theory). The results of this study, thus, will have immediate impact in these Appalachian counties, as the community will be able to institutionalize successful strategies into existing county-wide health campaigns.