Research Project

联合首席调查员：永生教会朴弥嘉牧师 项目总结 在亚裔美国人中，结直肠癌(CRC)是第二常见的癌症，也是第三大死亡原因。尽管结直肠癌在普通人群中的发病率有所下降，但其在韩国社区的发病率却在上升。与非西班牙裔白人男性相比，韩国男性的结直肠癌发病率和死亡率位居第二。在韩国女性中，结直肠癌是第二常见的癌症。虽然常规和及时筛查的有效性已被证明是预防疾病发展的可行措施，但各种研究表明，对于每一种类型的CRC筛查，韩国人的CRC筛查率极低，当筛查获得时，更有可能揭示疾病的晚期和5年生存的不良预后。我们对宾夕法尼亚州和新泽西州朝鲜族社区的研究表明，结直肠癌筛查率一直较低(韩国人为13%至17%，普通人群为52%)，医疗保健方面存在多重障碍。我们服务的大约80%的韩国人医疗服务不足，收入低，缺乏对结直肠癌风险、筛查福利和医疗体系的了解，获得文化和语言上适当的医疗保健的机会有限或根本无法获得。缺乏针对韩国人需求的CRC筛查干预计划。拟议的项目将通过评估多方面的和文化上合适的韩国教会的有效性来解决这一差距。 使用基于社区的参与性研究(CBPR)方法进行干预，以显著改善宾夕法尼亚州和新泽西州医疗服务不足的韩国教会成员(30个教堂地点)中的CRC筛查。该项目将建立在社区-学术-临床伙伴关系的长期基础设施的基础上，该伙伴关系已在韩国和其他亚洲社区的几个CBPR指导项目上成功合作，以及在韩国人中进行CBPR CRC干预试点。这项研究的总体目标是使用CBPR方法维持和确保可持续的伙伴关系，通过减少服务不足的韩国人获得医疗保健的障碍来增加CRC筛查。具体地说，这项研究的目的是审查在文化上适当的CBPR CRC干预措施是否更有效地增加筛查、对CRC的了解、对CRC的感知风险和易感性以及筛查的好处，以及减少卫生系统筛查的障碍。 CBPR原则和逻辑模型将用于指导研究的所有阶段，以制定和实施项目计划、程序、干预措施、评价和传播。这项研究设计为两组随机试验，包括基线和干预后评估以及12个月的随访。共有30个韩国教会将被随机分为即时干预组和对照组(一般癌症教育加延迟干预)。拟议的干预措施以健康信念模型和社会认知理论的综合框架为指导，通过多方面的创新方法解决个人和医疗保健系统的障碍。主要组成部分包括：(1)由训练有素的双语社区健康教育者和教会健康工作者进行小组教育；(2)由社区健康教育者(CHS)和社区健康工作者(CHWS)引导患者；以及(3)聘请社区双语医生进行结直肠癌筛查和转介。预计拟议的研究将产生关于强化/干预影响的重要和新的数据。如果这种CBPR CRC干预措施被证明是有效的，它可以被用作一个示范计划，具有潜在的可移植性和可持续性，在韩国和其他亚洲社区，从而为缩小健康差距做出重大贡献。

Co-Principal Investigator: Rev. Micah Park, Young Sang Church PROJECT SUMMARY Colorectal cancer (CRC) is the second most commonly diagnosed cancer and the third highest cause of mortality in Asian Americans. Despite a decline in the incidence of CRC in the general population, its incidence in the Korean community is rising. Korean men ranked the second highest in incidence and mortality from CRC compared with those of non-Hispanic White men. Among Korean women, CRC is the second most commonly diagnosed cancer. Although the efficacy of routine and timely screening has been demonstrated as a viable preventive measure against the development of the disease, various studies have shown that CRC screening rates among Koreans are extremely low for every type of CRC screening, and when screening is obtained, it is more likely to reveal a late stage of the disease and poor prognosis for 5-year survival. Our studies ofthe Korean community in PA and NJ indicated consistently low rates of CRC screening (13% to 17%, in Koreans vs 52% in general populations) and multiple barriers to health care. About 80% Koreans we serve are medically underserved and low income, lack of knowledge about CRC risks, screening benefits and health system, and have limited or no access to culturally and linguistically appropriate health care. There is a lack of CRC screening intervention program tailored to the needs of Koreans. The proposed project will address this gap by evaluating the effectiveness of a multifaceted and culturally appropriate Korean church-based intervention using community-based participatory research (CBPR) approach to significantly improve CRC screening among medically underserved members of Korean churches (30 church sites) in PA and NJ. The project will be built on an established long-standing infrastructure of community-academic-clinical partnership that has collaborated successfully on several CBPR guided projects in Korean and other Asian communities, as well as a pilot CBPR CRC intervention among Koreans. The overall goal of the study is to maintain and ensure sustainable partnerships using CBPR approach to increase CRC screening by reducing healthcare access barriers for underserved Koreans. Specifically, the study aims to examine whether a culturally appropriate CBPR CRC intervention is more effective in increasing screening, knowledge of, perceived risks of and susceptibility to CRC and benefits of screening, as well as reducing health system barriers to screening. CBPR principles and logic model will be used to guide all phases of the study in developing and implementing project plans, procedures, intervention, evaluation and dissemination. The study design is a 2-arm group randomized trial with baseline and post-intervention assessment and a 12-month follow-up. A total of 30 Korean churches will be randomized to either an immediate intervention or control group (general cancer education plus delayed intervention). The proposed intervention, guided by an integrative framework of Health Belief Model and Social Cognitive Theory, addresses both individual and healthcare system barriers through multifaceted innovative approaches. Key components include: (1) group education by trained bilingual community health educators and church health workers; (2) patient navigation by Community Health Educators (CHEs) and Community Health Workers (CHWs); and (3) engaging community bilingual physicians in CRC screening and referral. The proposed study is expected to yield important and new data on the inten/ention effects. If this CBPR CRC intervention proves effective, it can be used as a model program that has potential transportability to and sustainability in Korean and other Asian communities nationally, hence make a substantial contribution toward reducing health disparities.