A Primary Care Multilevel mHealth Colorectal Cancer Screening (mCRC) Intervention

描述(由申请人提供)：结直肠癌(CRC)筛查挽救了生命，但在美国仍未得到充分利用，大约三分之一的符合条件的美国人仍未接受筛查。先前的研究记录了结直肠癌筛查的许多障碍，包括患者因素(即缺乏对筛查选择的认识、消极的态度和信念、低健康素养)和提供者/系统因素(即缺乏医生时间、日程安排 障碍、缺乏探视后患者支持)。以前增加结直肠癌筛查的尝试通常是针对患者或提供者/系统障碍，效果不大。为了实现尽可能高的筛查率，迫切需要一种省时、易于实施、适合不同识字水平的多层次干预措施。用户友好的移动设备的日益流行使mHealth或使用移动技术来加强患者护理成为一个有吸引力的选择。我们设计了一种创新的低成本干预措施，通过利用移动技术在患者进行初级保健访问之前、期间和之后通知、激活和支持患者，从而增加结直肠癌筛查的接受率。我们的干预措施可以很容易地在初级保健实践中传播和实施，适合所有识字水平的患者。该项目将评估我们创新的多水平mHealth CRC筛查干预(MCRC)的效果。MCRC系统的概念框架基于强调互惠决定论的社会认知模型，即人、行为和环境的动态相互作用。MCRC系统包括：1)平板电脑CRC筛查决策助手，它将收集患者信息，传递筛查消息，并允许患者做出筛查决定；2)“自助”协议，使工作人员能够订购患者要求的筛查测试；以及3)通过自动和交互式文本消息为患者提供决策后后续支持。我们将在一项随机对照试验中测试mCRC系统，该试验是在以社区为基础的初级保健实践中进行的，服务于种族和社会经济多样化的人口。患者将被随机分配到mCRC系统或关于健康生活方式习惯的平板教育计划。该试验将评估：1)mcrc系统增加接收 2)mCRC系统促进筛查的潜在机制(即，患者形成筛查决定的能力、患者的态度和信念、患者的自我效能、患者的意图， 患者-提供者CRC筛查讨论的发生)；以及3)每个筛查患者的mCRC系统的额外成本，重点是工作人员时间和技术的系统成本。在我们的研究完成后，我们将免费提供mCRC系统，以帮助增加CRC筛查和改善公众健康。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) screening saves lives yet remains underutilized in the United States, with approximately 1 in 3 eligible Americans remaining unscreened. Prior research has documented numerous barriers to CRC screening, including patient factors (i.e., lack of awareness of screening options, negative attitudes and beliefs, low health literacy) and provider/system factors (i.e., lack of physician time, scheduling barriers, absence of after-visit patient support). Prior attempts to increase CRC screening have generally targeted either patient or provider/system barriers, with only modest results. To achieve the highest screening rates possible, a multilevel intervention that is time-efficient, easily implemented, and appropriate for varying literacy levels is urgently needed. The increasing popularity of user-friendly mobile devices makes mHealth, or the use of mobile technology to enhance patient care, an attractive option. We have designed an innovative low cost intervention to increase the receipt of CRC screening by leveraging mobile technology to inform, activate, and support patients before, during, and after their primary care visits. Our intervention can be easily disseminated and implemented in primary care practices and is appropriate for patients of all literacy levels. This project will evaluate the efficacy of our innovative multilevel mHealth CRC screening intervention (mCRC). The conceptual framework for the mCRC system is based on the social cognitive model emphasizing reciprocal determinism, or the dynamic interaction of the person, the behavior, and the environment. The mCRC system includes: 1) a tablet CRC screening decision aid that will collect patient information, deliver a screening message, and allow patients to make a screening decision; 2) "self-service" protocols that empower staff to order patient-requested screening tests; and 3) post-decision follow-up support for patients via automated and interactive text messaging. We will test the mCRC system in a randomized controlled trial conducted in community-based primary care practices serving a racially and socioeconomically diverse population. Patients will be randomized to either the mCRC system or a tablet educational program about healthy lifestyle habits. The trial will evaluate: 1) the ability of the mCRC system to increase receipt of CRC screening within 24 weeks as confirmed by medical chart reviews; 2) the potential mechanisms of change by which the mCRC system facilitates screening (i.e., patient ability to form a screening decision, patient attitudes and beliefs, patient self-efficacy, patient intention, and the occurrence of patient-provider CRC screening discussions); and 3) the additional cost of the mCRC system per patient screened, focusing on the system costs of staff time and technology. At the completion of our study, we will make the mCRC system freely available to help increase CRC screening and improve public health.