Research Project

项目总结(见说明)： 拉美裔是美国增长最快的人口。拉丁裔女性的宫颈癌发病率比非拉丁裔白人高出约70%[1]。拉丁裔女性的宫颈癌死亡率也比非拉丁裔白人高50%[1]。拉丁裔中宫颈癌的不成比例负担被认为是由于筛查率低和在异常巴氏试验后对推荐的诊断随访的坚持不力所致。拟议项目的总体目标是测试一项基于文化的诊所计划的有效性，以提高巴氏测试的利用率，并改善对华盛顿州亚基马谷拉美裔妇女样本进行异常巴氏测试后的随访依从性。该项目的主要具体目标是：1)评估两个适合文化的、量身定做的计划的相对有效性，以增加拉美裔妇女的宫颈癌筛查，这两个计划是：a)低强度计划， 其中包括：一个视频方法，用于宫颈癌筛查；和b)一个更高强度的方案，该方案包括一个视频和一个推动者--以鼓励宫颈癌筛查；2)评估这两个干预方案的成本效益。这项建议的第二个目的是：1)评估患者导航员计划在参与的诊所接受异常巴氏试验的妇女中提高依从性和减少随访时间的有效性。这一目标的组成部分是：a)对最近巴氏试验异常的20名拉丁裔妇女进行定性的一对一访谈，以确定与坚持建议的后续行动有关的显著因素；b)制定并试行符合文化的患者导航员计划，以提高遵从性并减少接受建议后续行动的时间。主要目标将通过在随机化六个月后在干预和对照组的配对比较中评估宫颈癌筛查服务的使用变化(基于自我报告和病历审查)来评估。每名接受筛查的妇女的费用将为每一支介入手臂计算。次要目标将是 通过评估干预前和干预后在巴氏试验异常后90天内接受建议随访的妇女比例的变化以及治疗时间的变化来进行评估。

PROJECT SUMMARY (See instructions): Latinos are the fastest growing population in the United States (US). The incidence of cervical cancer among Latino women is about 70% higher than that among non-Latino Whites [1]. Latino women also experience 50% higher cervical cancer mortality than non-Latino whites [1]. The disproportionate burden of cervical cancer among Latinas is thought to be attributed to both low rates of screening and poor adherence to recommended diagnostic follow-up after an abnormal Pap test. The overall goal of the proposed project is to test the efficacy of a culturallyappropriate clinic-based program to increase Pap test utilization and improve adherence to follow-up after an abnormal Pap test in a sample of Latino women in the Yakima Valley of Washington State. The primary specific aims for this project are to: 1) Assess the relative efficacy of two culturally-appropriate, tailored programs to increase cervical cancer screening among Latino women, the two programs are: a) a low-intensity program, consisting of a video approach to cervical cancer screening; and b) a higher intensity program that consists of the video plus a promotora-intervention to encourage cervical cancer screening; 2) Assess the costeffectiveness of the two intervention programs. A secondary aim ofthis proposal is to: 1) Evaluate the efficacy of a patient navigator program to improve adherence and reduce time to follow-up among women who receive abnormal Pap tests in the participating clinics. The components of this aim are to: a) conduct qualitative one one-one interviews among 20 Latino women with a recent abnormal Pap test to identify salient factors related to adherence to recommended follow-up; b) develop and pilot-test a culturally-appropriate patient navigator program to improve adherence and reduce time to receipt of recommended follow-up. The primary aims will be evaluated by assessing changes in the use of screening services for cervical cancer (based on self-report and medical record review) in pair-wise comparisons of the intervention and control arms, six months following randomization. Cost per woman screened will be calculated for each intervention arm. The secondary aim will be evaluated by assessing pre- and post-intervention changes in the proportions of women who receive recommended follow-up within 90 days of an abnormal Pap test and changes in the time to treatment.