Comparative Effectiveness of Interventions to Improve Screening Among Rural Women

 描述(由申请人提供)：2014年，美国约有310,030名女性(美国)将被诊断为乳腺癌(BC)、宫颈癌(CC)或结直肠癌(CRC)，68,060名妇女将死于这些癌症。这三种癌症占美国女性癌症负担的39%和癌症死亡率的25%。尽管对这三种癌症都有有效的筛查测试，但许多女性并不遵守筛查指南。此外，在一些人群和地区中，这些癌症的负担更高。俄亥俄州西北部和印第安纳州东北部的32个农村县有着相似的社会经济贫困人口，主要是白人女性(96.2%)，她们的BC、CRC和CC死亡率较高，而乳房X光检查、巴氏试验、粪便潜血测试或结肠镜检查的筛查率较低。目前还没有已知的干预措施同时提高这三种主要女性癌症的筛查率，尽管多项健康行为变化研究正在成为一种改变干预措施包装方式的新模式。拟议的项目使用了一个全面的理论框架来理解健康差异，其中包括个人、社会和社区层面的变量，以及一个使用多行为理论方法的干预概念模型，所有这些都证明了在改善对单一筛查测试行为的遵守以及其他预防性健康行为方面的有效性。这项提案的目标是测试通过DVD(TIDVD)与TIDVD+基于电话的患者导航(PN)干预(TNI)与普通护理(UC)提供的量身定制的交互式计算机程序的比较有效性，以提高居住在俄亥俄州和印第安纳州这些农村县的50至74岁女性中BC、CC和CRC的基于指南的筛查率。具体目标是：1)比较定制互动DVD(TIDVD)与TIDVD+基于电话的PN干预(TNI)与UC的有效性，以提高随机分组后12个月BC、CC和CRC基于指南的癌症筛查率；以及2)比较TIDVD、TIDVD+TNI干预与UC在坚持每种筛查结果或筛查测试组合方面的成本效益。作为一个探索性目标，我们将确定理论变量(社区、社会和个人)与筛查结果之间的关联，包括与干预措施的交互作用。如果发现具有成本效益，任何一种或两种干预措施都有可能立即传播，以提高结肠癌、结直肠癌和结直肠癌筛查率，并最终减少服务不足的农村妇女的癌症差异。

 DESCRIPTION (provided by applicant): In 2014 approximately 310,030 women in the United States (U.S.) will be diagnosed with breast cancer (BC), cervical cancer (CC), or colorectal cancer (CRC), and 68,060 women will die from these cancers. These three cancers account for 39% of the cancer burden and 25% of the cancer mortality among women in the U.S. Although effective screening tests are widely available for all three cancers, many women do not adhere to screening guidelines. Furthermore, the burden of these cancers is higher among some population groups and regions. Thirty-two rural counties in northwest Ohio and northeast Indiana share similar socioeconomically underserved populations of predominately (96.2%) white women who have elevated BC, CRC, and CC mortality rates, and lower screening rates with mammography, Pap tests, and fecal occult blood testing or colonoscopy. No known intervention has addressed improving screening rates for these three main female cancers simultaneously, even though multiple health behavior change research is emerging as a new model to change the way in which interventions can be packaged. The proposed project uses an overall theoretical framework to understand health disparities which includes individual, social and community level variables, and a conceptual model for the intervention which uses a multiple behavior theoretical approach, all of which have demonstrated efficacy in improving adherence to single screening test behaviors, as well as other preventive health behaviors. The goal of this proposal is to test the comparative effectiveness of a tailored interactive computer program delivered via DVD (TIDVD) vs. a TIDVD + telephone-based patient navigation (PN) intervention (TNI) vs. Usual Care (UC) to increase guideline-based screening rates for BC, CC, and CRC among women age 50 to 74 living in these rural counties of Ohio and Indiana. Specific aims are to: 1) compare the effectiveness of a tailored and interactive DVD (TIDVD) vs. TIDVD + telephone-based PN intervention (TNI) vs. UC, to increase guideline-based cancer screening rates at 12 months post randomization for BC, CC, and CRC among 1058 women age 50 to 74 living in rural northwest Ohio and northeast Indiana; and 2) compare the cost effectiveness of the TIDVD and the TIDVD + TNI intervention vs. UC, for adherence to each screening outcome or combination of screening tests. As an Exploratory Aim, we will identify associations between theoretical variables (community, social, and individual) and screening outcomes, including interactions with the interventions. If found to be cost effective, either or both interventions hae the potential to be immediately disseminated to increase BC, CC, and CRC screening rates and ultimately reduce cancer disparities for underserved rural women.