Joy Luck Academy: A Culturally Sensitive Social Support Intervention

描述（由申请人提供）：尽管亚裔美国人的人口规模越来越大（1730万），乳腺癌的发病率也越来越高，但很少有人关注亚裔美国人（AA）乳腺癌幸存者的信息和心理需求。更值得注意的是，我们没有找到在这一人群中进行的随机对照试验，以解决这一研究不足和服务不足的人群的未满足需求。由于他们的社会、文化和语言障碍，在很大程度上无法获得具有文化能力的精神卫生保健。缺乏文化上合适的精神卫生保健和研究，以确定和解决亚裔美国癌症幸存者的身体、情感和社会需求，构成了癌症护理中不必要和可避免的差异。在美国约1730万亚裔美国人中，华裔美国人占最大的群体（24%）。我们的研究和社区合作伙伴团队设计了一个文化敏感的社会支持干预，称为“喜福学院（JLA）”，为华裔美国乳腺癌幸存者（BCS）提供教育和同伴导师支持。我们团队最近完成的一项单臂试点研究表明，JLA受到参与者的高度重视，并与华裔美国人BCS的生活质量有关。本研究提出了一项随机对照试验（RCT）来测试JLA计划的健康效益，并使用基于社区的参与性研究（CBPR）方法以及混合演绎和归纳方法来确定JLA计划的工作对象和原因。完成初级治疗的美籍华裔乳腺癌幸存者（N=210）将被随机分配到JLA组或对照组，在等待JLA的同时接受强化的常规护理。在基线、干预后立即以及1个月和4个月随访时评估健康结果。我们将使用演绎定量方法来测试健康结果、理论化的中介因素和基线个体差异。我们使用归纳和演绎定性方法来探索和理解解释干预益处的机制，并加强对定量数据的解释。针对不同种族群体的经过测试的社会心理干预措施很少。其中一个主要的假设障碍是缺乏对乳腺癌含义和适当的情感和社会反应的独特文化差异的理解。更少的研究测试了以证据为基础的项目在有色人种社区的可行性、适用性和可持续性。现有的社区努力往往是在没有理论指导和缺乏科学依据的情况下反复试验的结果

DESCRIPTION (provided by applicant): Despite the increasing size of the Asian American population (17.3 million) and their growing rate of breast cancer, little attention is focused on Asian American (AA) breast cancer survivors' informational and psychological needs. More notably, we have located no randomized controlled trial conducted in this population to address the unmet needs of this understudied and underserved population. Due to their social, cultural, and linguistic barriers, culturally competent mental health care is largely unavailable. The lack o both the availability of culturally competent mental health care and studies to identify and address the physical, emotional, and social needs of Asian American cancer survivors' constitute unnecessary and avoidable disparities in cancer care. Chinese Americans comprise the largest subgroup (24 percent) among the estimated 17.3 million Asian Americans in the U.S. Our research and community partner team have designed a culturally sensitive social support intervention called the "Joy Luck Academy (JLA)" that provide education and peer mentor support for Chinese American breast cancer survivors (BCS). A single-arm pilot study recently completed by our team has shown that the JLA is highly valued by participants and is associated with better quality of life among Chinese American BCS. This study proposes a randomized controlled trial (RCT) to test the health benefits of the JLA program and to identify for whom and why the JLA works using a community based participatory research (CBPR) approach, and mixed deductive and inductive methods. Chinese American breast cancer survivors who have completed primary treatment (N=210) will be randomly assigned to either the JLA group or a control group to receive enhanced usual care while waiting for the JLA. Health outcomes are assessed at baseline, immediately post intervention, and 1 and 4 months follow-ups. We will use deductive quantitative methods to test health outcomes, theorized mediators, and baseline individual differences. We use inductive and deductive qualitative methods to explore and understand mechanisms explaining the benefits of the intervention and to enhance the interpretation of the quantitative data. Few tested psychosocial interventions exist for diverse ethnic groups. One of the major hypothesized barriers is the lack of understanding of unique cultural differences in the meaning of and appropriate emotional and social responses to breast cancer. Even fewer studies have tested evidence-based programs for their feasibility, applicability, and sustainability in communities of color. Existing communit efforts are often the result of trial and error without theoretical guidance and lack of scientific rigor. This proposed study is the first RCT social support intervention among AA BCSs. The intervention is innovative as it is culturally relevant to an AA group, using a theoretically grounded and CBPR approach, and mixed methods design. We expect that the proposed research guided by both theory and methods with an underserved and understudied population will inspire new directions in future research to address these scientific and practical needs in health disparities research.