Reducing Health Disparities in Maryland Along the National Capital Border

描述（由申请人提供）：癌症是亚裔美国人和太平洋岛民（AAPI）的主要死因，结直肠癌（CRC）死亡率在AAPI癌症死亡中排名第三。然而，亚裔美国人的CRC筛查率明显低于其他种族/族裔群体。考虑到CRC筛查可将死亡率降低高达79%，因此在过去十年中，华裔和韩裔美国人的CRC死亡率并未降低，这并不奇怪，这与其他种族/族裔群体不同，在其他种族/族裔群体中观察到了下降趋势。有强烈的需要了解CRC筛查行为，特别是关于CRC筛查的障碍和促进因素，以及在中国和韩国美国人中增加CRC筛查的策略。很少有研究探讨与中国和韩国美国人CRC筛查相关的因素。这些研究大多数使用封闭式调查收集数据。因此，关于筛选决定背后的因素的更深入的数据有限。 为了解决文献中的这一显著差距，我们建议进行一项研究，以更好地了解CRC筛查的障碍和促进因素，使用混合方法。将探讨的潜在因素将基于健康信念模型和社会生态模型的概念。具体而言，我们提出了以下两个目标：第一，通过进行20个关键的知情人访谈，初步了解50岁及以上的中国和韩国美国人中CRC筛查的障碍和促进因素。根据这些调查结果，我们将最终确定或告知我们的焦点小组指南草案。第二，通过以下方式了解这一人群中CRC筛查的障碍和促进因素：进行12个焦点小组，120名参与者按华裔和韩裔美国人种族划分;对焦点小组参与者进行调查，以获得定量数据;并使用三角测量方法汇总关键知情人访谈、焦点小组和调查响应的结果，以探索主要发现。考虑到中国人和韩裔美国人人群中持续的CRC死亡率和CRC筛查率低，这项两阶段混合方法研究的结果将有助于加深对CRC筛查障碍和促进因素的理解。此外，研究结果将为未来干预措施的制定提供信息，这些干预措施将文化和语言上适当的战略纳入沟通信息，社区推广和教育，以及环境和系统，以提高亚裔美国人的筛查率。此外，拟议的研究将解决2020年健康人的总体目标，以减少健康差距，以及减少新的CRC病例和死亡人数。

DESCRIPTION (provided by applicant): Cancer is the leading cause of death among Asian American and Pacific Islanders (AAPIs), and mortality from colorectal cancer (CRC) is ranked as the third most common in cancer deaths among AAPIs. However, CRC screening rates among Asian Americans are significantly lower than in other racial/ethnic groups. Considering that CRC screening reduces mortality by up to 79%, it is not surprising that CRC mortality has not been reduced among Chinese- and Korean Americans during last decade unlike in other racial/ethnic groups where a decreasing trend has been observed. There is a strong need to understand CRC screening behaviors particularly regarding barriers to and facilitators of CRC screening and strategies to increase CRC screening among Chinese- and Korean Americans. Few studies have examined the factors associated with CRC screening among Chinese- and Korean Americans. The majority of these studies collected data using closed-ended surveys. Therefore, more in-depth data on the factors underlying screening decisions have been limited. To address this notable gap in the literature, we propose to conduct a study to better understand the barriers to and facilitators of CRC screening, using a mixed methods approach. Potential factors to be explored will be based on concepts from the Health Belief Model and the Social Ecological Model. Specifically, we propose the following two aims: First, gain a preliminary understanding of barriers to and facilitators of CRC screening among Chinese- and Korean Americans age 50 and older by conducting 20 key informant interviews. Based on these findings, we will then finalize or inform the draft of our focus group guide. Second, provide understanding of barriers to and facilitators of CRC screening among this population by: conducting 12 focus groups with 120 participants that are segmented by Chinese- and Korean American ethnicity; conducting surveys with focus group participants to obtain quantitative data; and using a triangulation approach to converge results from the key informant interviews, focus groups, and survey responses to explore major findings. Considering the sustained CRC mortality and low CRC screening rates in this understudied Chinese- and Korean American population, findings from this two-stage mixed methods study will help enhance the understanding of the barriers to and facilitators of CRC screening. Moreover, the findings will inform the development of future interventions that incorporate culturally and linguistically appropriate strategies into communication messages, community outreach and education, and environmental and system to increase screening rates within the Asian American population. Furthermore, the proposed study will address the overarching Healthy People 2020 objective to reduce health disparities, as well as to reduce the number of new CRC cases and deaths.