Adapting patient navigation to promote cancer screening in Chicagos Chinatown

描述(由申请人提供)：尽管芝加哥有五个主要的学术医疗中心、一个大型县医院和两个NCI指定的综合性癌症中心，但芝加哥的收入群体之间的癌症差距是美国最严重的。在语言和文化上与世隔绝的移民方面，这一负担更加突出，他们传统上既不受益于研究，也不参与研究。特别是，在芝加哥，华裔女性的乳腺癌和宫颈癌筛查率低得令人无法接受，仅为白人女性的一半。这项申请是芝加哥唐人街社区领导人表达的担忧的直接结果，他们担心有必要对低收入中国女性进行癌症预防和控制方面的教育和赋权。患者导航器(PN)已经在非裔美国人、拉丁裔和白人人群中进行了研究。然而，PN研究主要集中在对癌症或发现异常的患者的随访上，很少有提高筛查率的研究。我们寻求通过实施量身定制的PN干预措施来研究PN行为健康服务干预的传播，重点是增加乳腺癌和宫颈癌的筛查以及对唐人街以移民为主的低收入女性人口的随访。我们建议的研究建立在NIH资助的两项PN研究、我们的唐人街RC4研究基础设施赠款活动(包括一个社区数据资源中心)以及我们与唐人街主要安全网提供商Mercy Medical Center的长期社区参与性研究(CBPR)合作伙伴关系的基础上。在CBPR方法中使用混合方法，我们的目标是在我们的社区研究伙伴华人美国服务联盟的赞助下，评估PN适应和推广到癌症控制教育和筛查中的有效性。我们将研究以最佳方式调整干预措施所需的基本机制，这些干预措施侧重于文化和语言上孤立的移民人口。拟议的项目旨在扩大PNS的作用，了解更多关于PNS作为健康教育者的有效性的决定因素，如何鼓励乳腺癌和宫颈癌筛查，以及PNS如何成为值得信赖和尊重的社区卫生工作者和倡导者，为芝加哥唐人街的低收入妇女提供社区和医疗保健系统之间的必要联系。这项研究将评估中国女性如何通过PN团队与健康信息和资源互动，以做出健康决策和获得医疗保健系统。妇女在其家庭和社区的卫生工作者、卫生消费者和卫生决策者中占最大比例，但在亚洲移民人口中获得适当卫生服务的比例较低。一旦女性被赋予权力，成为知情的健康消费者，她们就成为社会变革的催化剂。 公共卫生相关性：这个拟议的项目旨在将迅速增长的患者导航现象转变为更广泛的努力，利用社区卫生工作者进行具有文化能力的癌症控制和预防。我们的CBPR方法植根于我们的社区组织和安全网提供商合作伙伴的长期声誉，提供了关闭社区定义的健康问题和获得当地医疗保健系统之间的循环的机会。由于伊利诺伊州的许多女性已经为癌症筛查和随访提供了公共保险，但没有利用这一资源，因此，一旦实施更广泛的医疗改革法律，这项提案对未来增加弱势群体获得医疗服务的努力具有重大意义。

DESCRIPTION (provided by applicant): Despite the presence of five major academic medical centers, a large county hospital, and two NCI designated comprehensive cancer centers, Chicago has some of the worst cancer disparities between income groups in the US. This burden is accentuated with respect to linguistically and culturally isolated immigrants who do not traditionally benefit from nor participate in research. In particular, Chinese women in Chicago, a significantly understudied population, have unacceptably low breast and cervical cancer screening rates which are only half the rates of white women. This application is a direct outgrowth of concerns expressed by leaders of Chicago's Chinatown community about the need to educate and empower low income Chinese women about cancer prevention and control. Patient navigators (PN) have been studied in African American, Latino, and white populations. However, PN research has largely focused on follow-up of patients with cancer or abnormal findings, rarely to improve screening rates. We seek to study the dissemination of PN behavioral health services interventions by implementing a tailored PN intervention with a focus on increasing breast and cervical cancer screening as well as follow-up for the largely immigrant population of low income women in Chinatown. Our proposed research builds on two NIH funded PN studies, our Chinatown RC4 research infrastructure grant activities, including a community data resource center, and our long-standing community based participatory research (CBPR) partnership with Chinatown's major safety net provider, Mercy Medical Center. Using mixed methods within a CBPR approach, we aim to evaluate the effectiveness of PN adaptation and extension to cancer control education and screening under the auspices of our community research partner, the Chinese American Service League. We will study the fundamental mechanisms required to optimally adapt interventions focused on immigrant populations that are culturally and linguistically isolated. The proposed project seeks to expand the role of PNs, to learn more about what determines the effectiveness of PNs as health educators, how to encourage breast and cervical cancer screening, and how PNs can become trusted and respected community health workers and advocates that provide essential links between the community and the health care system for low income women in Chicago's Chinatown. This research will assess how Chinese women interact with health information and resources via a PN team to make health decisions and access the health care system. Women comprise the largest segment of health workers, health consumers, and health decision makers for their families and communities, but are underrepresented accessing appropriate health services among Asian immigrant populations. Once women are empowered, informed health consumers, they become catalysts for social change. PUBLIC HEALTH RELEVANCE: This proposed project aims to adapt the rapidly growing phenomenon of patient navigation into a broader effort to use community health workers for culturally competent cancer control and prevention. Our CBPR approach, grounded in the long-standing prestige of our community organization and safety net provider partners, offers the opportunity to close the loop between community-defined health problems and access to the local health care system. Because many women in Illinois already have public insurance coverage for cancer screening and follow-up but do not take advantage of this resource, this proposal has major relevance for future efforts to increase access for vulnerable populations once broader health reform laws are implemented.