Tailored Touchscreen Colorectal Cancer Prevention in American Indian Communities

描述（由申请人提供）：结直肠癌（CRC）死亡率不成比例地影响少数民族。很少有研究涉及特定少数民族人群（如美国印第安人）的筛查。本研究将评估一种基于预防采用过程模型（PAPM）和“实施意图”概念（计划行为理论的最新阐述）的创新整合的新型定制触摸屏计算机干预的效果。大多数干预措施将在部落诊所和初级保健机构通过多媒体音频叙述和视频信息，在低成本触摸屏电脑上提供。研究还没有测试文化定制沟通的有效性，具体说明了改善该群体CRC筛查的“实施意图”。随机设计将测试通用信息与多媒体定制干预的比较条件，具体解决每个参与者的筛查测试方式偏好、当前CRC筛查决策阶段（PAPM）和CRC筛查“实施意图”（筛查的“何时”、“何地”和“如何”细节）。行为干预材料将在文化专家、试点测试和先前焦点小组研究中收集的数据的帮助下开发，我们用于评估对AIs的CRC筛查的关键影响。该研究将在460名有资格进行结直肠癌筛查的AI患者中进行，这些患者是在部落或地区安全网诊所就诊时招募的。所有参与者将接受基线触摸屏管理评估，并根据陈述的偏好，提供免疫化学粪便隐血检查（iFOBT-InSure TM）或结肠镜检查。参与者将被随机分配到C组（比较组-计算机提供通用CRC信息）或AI2组（主动干预-计算机根据个人PAPM阶段、行为结构和“实施意图”提供量身定制的文化信息）。一项简短的办公室离职调查将评估患者与提供者对结直肠癌筛查的讨论以及对计算机信息材料的满意度。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) mortality disproportionately impacts minorities. Few studies have addressed screening among specific minority populations such as American Indians (AI). This study will assess the efficacy of a novel tailored touch screen computer intervention based on an innovative integration of the Precaution Adoption Process Model (PAPM) and the concept of "implementation intentions," a recent elaboration of the Theory of Planned Behavior. The majority of the intervention will be delivered in tribal clinics and primary care settings on low-cost touch screen computers through multimedia audio-narrative and video messages. Studies have not tested the effectiveness of culturally tailored communications specified to stated "implementation intentions" for improving CRC screening in this group. A randomized design will test a comparison condition of generic information versus a multimedia tailored intervention that specifically addresses each participant's screening test modality preference, current CRC screening decisional stage (PAPM), and CRC screening "implementation intentions" (the "when", "where" and "how" details of screening). Behavioral intervention materials will be developed with the help of cultural experts, a pilot test, and from data gathered in a prior focus group study we used to assess key influences on CRC screening for AIs. The study will be conducted with 460 AI patients eligible for CRC screening and recruited while presenting for care in tribal or regional safety-net clinics. All participants will receive a baseline touch screen administered assessment and, depending on stated preference, be offered either an immunochemical fecal occult blood test (iFOBT-InSure TM) or colonoscopy. Participants will be randomized to either C (comparison group-computer delivered generic CRC information) or AI2 (active intervention-computer delivered culturally tailored messaging based on individual PAPM stage, behavior constructs, and "Implementation Intentions"). A brief office exit survey will assess patient-provider discussions of CRC screening and satisfaction with computerized message materials.