Adapting patient navigation to promote cancer screening in Chicagos Chinatown

描述（由申请人提供）：尽管芝加哥有五个主要的学术医疗中心，一个大型的县医院和两个NCI指定的综合癌症中心，但芝加哥在美国的收入群体之间存在着一些最严重的癌症差异。对于在语言和文化上孤立的移民来说，这种负担更加沉重，因为他们传统上既不受益于研究，也不参与研究。特别是，芝加哥的华裔女性，一个明显未被充分研究的人群，乳腺癌和宫颈癌的筛查率低得令人无法接受，只有白人女性的一半。芝加哥唐人街社区的领导人表达了对低收入的中国妇女进行癌症预防和控制教育和授权的关注，这一申请是他们关注的直接结果。患者导航员（PN）已在非裔美国人、拉丁裔和白人人群中进行了研究。然而，PN研究主要集中在癌症或异常发现患者的随访，很少提高筛查率。我们试图通过实施量身定制的PN干预来研究PN行为健康服务干预的传播，重点是增加乳腺癌和宫颈癌筛查，以及对唐人街低收入妇女移民人口的随访。我们提出的研究建立在两项NIH资助的PN研究，我们的唐人街RC4研究基础设施资助活动，包括社区数据资源中心，以及我们与唐人街主要安全网提供者仁慈医疗中心的长期社区参与性研究（CBPR）合作伙伴关系。在社区研究合作伙伴美国华人服务联盟的支持下，我们采用CBPR方法中的混合方法，旨在评估PN适应和扩展到癌症控制教育和筛查的有效性。我们将研究所需的基本机制，以最佳地适应针对文化和语言孤立的移民人口的干预措施。拟议的项目旨在扩大助产士的作用，更多地了解是什么决定了助产士作为健康教育者的有效性，如何鼓励乳腺癌和宫颈癌筛查，以及如何使助产士成为值得信赖和尊重的社区卫生工作者和倡导者，为芝加哥唐人街的低收入妇女提供社区和卫生保健系统之间的重要联系。本研究将评估中国妇女如何通过PN团队与健康信息和资源互动，以做出健康决策并进入医疗保健系统。妇女在卫生工作者、卫生消费者和其家庭和社区的卫生决策者中占最大比例，但在亚洲移民人口中获得适当卫生服务的人数不足。妇女一旦被赋予权力，成为知情的保健消费者，她们就成为社会变革的催化剂。

DESCRIPTION (provided by applicant): Despite the presence of five major academic medical centers, a large county hospital, and two NCI designated comprehensive cancer centers, Chicago has some of the worst cancer disparities between income groups in the US. This burden is accentuated with respect to linguistically and culturally isolated immigrants who do not traditionally benefit from nor participate in research. In particular, Chinese women in Chicago, a significantly understudied population, have unacceptably low breast and cervical cancer screening rates which are only half the rates of white women. This application is a direct outgrowth of concerns expressed by leaders of Chicago's Chinatown community about the need to educate and empower low income Chinese women about cancer prevention and control. Patient navigators (PN) have been studied in African American, Latino, and white populations. However, PN research has largely focused on follow-up of patients with cancer or abnormal findings, rarely to improve screening rates. We seek to study the dissemination of PN behavioral health services interventions by implementing a tailored PN intervention with a focus on increasing breast and cervical cancer screening as well as follow-up for the largely immigrant population of low income women in Chinatown. Our proposed research builds on two NIH funded PN studies, our Chinatown RC4 research infrastructure grant activities, including a community data resource center, and our long-standing community based participatory research (CBPR) partnership with Chinatown's major safety net provider, Mercy Medical Center. Using mixed methods within a CBPR approach, we aim to evaluate the effectiveness of PN adaptation and extension to cancer control education and screening under the auspices of our community research partner, the Chinese American Service League. We will study the fundamental mechanisms required to optimally adapt interventions focused on immigrant populations that are culturally and linguistically isolated. The proposed project seeks to expand the role of PNs, to learn more about what determines the effectiveness of PNs as health educators, how to encourage breast and cervical cancer screening, and how PNs can become trusted and respected community health workers and advocates that provide essential links between the community and the health care system for low income women in Chicago's Chinatown. This research will assess how Chinese women interact with health information and resources via a PN team to make health decisions and access the health care system. Women comprise the largest segment of health workers, health consumers, and health decision makers for their families and communities, but are underrepresented accessing appropriate health services among Asian immigrant populations. Once women are empowered, informed health consumers, they become catalysts for social change.