Efficacy-to-Effectiveness Transition of an Educational Program to Increase Colore

描述（由申请人提供）：非洲裔美国人的发病率和死亡率最高，并且比白人更不可能进行结直肠癌（CRC）筛查。我们最近完成了一项为期五年的随机对照社区干预试验，该试验证明了小团体教育干预（现称为EPICS或增加结直肠癌筛查的教育计划）的有效性，与对照组相比，它使结直肠癌筛查率增加了一倍。EPICS随后与当地卫生部门合作实施，同样有效。我们现在正在整个乔治亚州传播干预措施。在此应用中，我们提出了一项全国性的推广与实施研究。我们建议使用罗杰斯的创新扩散理论和格拉斯哥的RE-AIM （Reach, Effectiveness, Adoption, Implementation, Maintenance）评估框架来实现以下具体目标：1)测试传播EPICS的被动和主动方法，以提高非洲裔美国人的结直肠癌筛查率；2)衡量EPICS被社区联盟接受的程度以及在各种环境下实施的保真度；3)估计EPICS的潜在可翻译性和公共卫生影响。创新的传播理论将指导史诗的传播过程，RE-AIM将用于评估这种传播及其影响。在这项研究中，我们建议对来自美国各地的20个社区联盟进行集群随机对照试验，分配给四个条件之一：(1)被动地在没有技术援助（TA）的情况下通过网络获取促进者培训材料和工具包；（2，被动）与1相同，但带有TA；(3)积极地亲自访问引导者培训材料和工具包

DESCRIPTION (provided by applicant): African Americans have the highest incidence and mortality and are less likely than whites to have screening for colorectal cancer (CRC). We recently completed a five-year randomized controlled community intervention trial that demonstrated the efficacy of a small group education intervention (now named EPICS or Educational Program to Increase Colorectal Cancer Screening) that doubled the CRC screening rate compared to the control group rate. EPICS was then put into practice in partnership with the local health department and was equally effective. We are now disseminating the intervention across the state of Georgia. In this application we propose a national dissemination and implementation study. We propose using Rogers' Diffusion of Innovation Theory and Glasgow's RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation framework to pursue the following specific aims: 1) test passive and active approaches to disseminating EPICS to increase screening rates for colorectal cancer among African Americans; 2) measure the extent to which EPICS is accepted by community coalitions and the fidelity of implementation in various settings and 3) estimate the potential translatability and public health impact of EPICS. Diffusion of Innovations Theory will guide the process of EPICS dissemination and RE-AIM will be used to assess this dissemination and its impact. For this study we propose a cluster randomized controlled trial of 20 community coalitions from across the United States, assigned to one of four conditions: (1, passive) web-based access to facilitator training materials and toolkits without technical assistance (TA); (2, passive) the sam as 1, but with TA; (3, active) in-person access (IP) to facilitator training materials and toolkits without TA and (4, active) IP access to facilitator training materials and toolkits with TA. Each community coalition will partner with three settings for implementation: a church, clinic and community site. African Americans, 50-74 years of age, who are not current on CRC screening are eligible for study participation (n=7,200 or n=360 eligible individuals per community coalition). This assumes a sample size of 1800 per study arm, a significance level of 5% (i.e. alpha = 0.05), and a two-sided two-group chi-square test of proportions. Assuming that we observe in our study an increase in screening rates of colorectal cancer among participants in active arms compared to screening rates among participants in the passive arms, we will have greater than 99% power to detect statistically significant differences in the proportions. All statistical tests proposed for this study will be two-sided and will be performed using a significance level of 5% (i.e., alpha=0.05).