Tailored Touchscreen Colorectal Cancer Prevention in American Indian Communities

描述(由申请人提供)：结直肠癌(CRC)死亡率对少数族裔的影响不成比例。很少有研究涉及在特定少数群体中进行筛查，如美洲印第安人(AI)。这项研究将评估一种新的定制触摸屏计算机干预的有效性，该干预基于预防采用过程模型(PAPM)和“实施意图”概念的创新集成，该概念是最近对计划行为理论的详细阐述。大多数干预将通过多媒体音频叙述和视频信息在部落诊所和低成本触摸屏电脑上的初级保健环境中提供。研究还没有测试为改善这一群体的CRC筛查而规定的“实施意图”所规定的文化定制沟通的有效性。随机设计将测试一般信息与多媒体定制干预的比较条件，多媒体定制干预具体涉及每个参与者的筛查测试方式偏好、当前的CRC筛查决策阶段(PAPM)和CRC筛查的“实施意图”(筛查的“何时”、“何处”和“如何”细节)。行为干预材料将在文化专家的帮助下开发，这是一项试点测试，来自我们先前用于评估CRC筛查AIS的关键影响的焦点小组研究中收集的数据。这项研究将对460名符合CRC筛查条件的AI患者进行，并在部落或地区安全网诊所提供护理时招募这些患者。所有参与者将接受基线触摸屏管理的评估，并根据声明的偏好，提供免疫化学粪便潜血测试(iFOBT-Insuure TM)或结肠镜检查。参与者将被随机分为C组(对照组-计算机提供的通用CRC信息)或AI2(积极干预-计算机根据个人PAPM阶段、行为结构和实施意图提供文化定制的消息)。一项简短的办公室离职调查将评估患者与提供者对结直肠癌筛查的讨论以及对计算机化信息材料的满意度。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) mortality disproportionately impacts minorities. Few studies have addressed screening among specific minority populations such as American Indians (AI). This study will assess the efficacy of a novel tailored touch screen computer intervention based on an innovative integration of the Precaution Adoption Process Model (PAPM) and the concept of "implementation intentions," a recent elaboration of the Theory of Planned Behavior. The majority of the intervention will be delivered in tribal clinics and primary care settings on low-cost touch screen computers through multimedia audio-narrative and video messages. Studies have not tested the effectiveness of culturally tailored communications specified to stated "implementation intentions" for improving CRC screening in this group. A randomized design will test a comparison condition of generic information versus a multimedia tailored intervention that specifically addresses each participant's screening test modality preference, current CRC screening decisional stage (PAPM), and CRC screening "implementation intentions" (the "when", "where" and "how" details of screening). Behavioral intervention materials will be developed with the help of cultural experts, a pilot test, and from data gathered in a prior focus group study we used to assess key influences on CRC screening for AIs. The study will be conducted with 460 AI patients eligible for CRC screening and recruited while presenting for care in tribal or regional safety-net clinics. All participants will receive a baseline touch screen administered assessment and, depending on stated preference, be offered either an immunochemical fecal occult blood test (iFOBT-InSure TM) or colonoscopy. Participants will be randomized to either C (comparison group-computer delivered generic CRC information) or AI2 (active intervention-computer delivered culturally tailored messaging based on individual PAPM stage, behavior constructs, and "Implementation Intentions"). A brief office exit survey will assess patient-provider discussions of CRC screening and satisfaction with computerized message materials.