Addressing Cervical Cancer Disparity in South Florida CBPR in Action

描述（由申请人提供）：南佛罗里达减少癌症差异中心，也被称为SUCCESS，在整个迈阿密大都市区支持许多校园-社区合作伙伴关系或社区咨询小组（CAGs）。这种伙伴关系是本着以社区为基础的参与性研究的精神构想的，并促进大学研究人员和社区利益攸关方在解决健康差距问题方面进行有意义的合作。拟议项目的重点是宫颈癌，这是SUCCESS服务的三个社区：小海地、海厄利亚和西佩林的一个重大健康问题。与美国其他以少数族裔为主的低收入社区一样，这些社区的宫颈癌发病率和死亡率很高，主要原因是缺乏常规的子宫颈抹片检查和及时随访发现的异常情况。SUCCESS旨在解决这种差异。在过去的三年里，我们一直在进行一项社区试验，比较两种疾病预防的创新模式：在当地联邦合格的健康中心（FQHC）进行巴氏涂片检查，还是在家庭中进行人乳头瘤病毒（HPV）的自我抽样，HPV是宫颈癌的主要原因。在这两方面，社区卫生工作者（CHWs）在提供干预措施方面发挥着关键作用。然而，我们的初步数据表明，CHW的参与可能比筛查方法本身更重要。在所有三个社区中，随机进行自我抽样的妇女接受筛查的比例明显更高，这可能是由于使用方便和参与者更喜欢以家庭为基础的筛查，这规避了护理的结构和文化障碍。建议的研究将通过比较CHW提供的自抽样与邮件提供的自抽样，正式检验CHW参与的显著性。我们将对来自三个目标社区的700名妇女进行两组研究，以chw自我抽样干预作为我们的对照组或对照组。我们的主要目的是1)确定哪种自我抽样方法能使接受筛查的女性比例更高。次要结果包括比较a)关于子宫颈癌的知识、态度和信念以及早期发现疾病的重要性；b)获得护理的机会（健康保险、拥有通常的护理来源、六个月内去看医生），特别是筛查异常并需要医疗干预的妇女；以及c)两种干预策略的相对成本。与CBPR的原则相一致，在小海地、海厄利亚和西佩林开展的SUCCESS cag为此类工作的重点和范围提供了信息。通过在研究构想中争取社区领导，我们确保能够成功实现我们的预期目标，即确定预防宫颈癌的最优战略，这些妇女对疾病发病率和死亡率的贡献不成比例。

DESCRIPTION (provided by applicant): The South Florida Center for Reducing Cancer Disparities, also known as SUCCESS, supports a number of campus-community partnerships, or Community Advisory Groups (CAGs), throughout the Miami metropolitan area. Such partnerships were conceived in the spirit of Community-based Participatory Research (CBPR) and facilitate meaningful collaboration between University investigators and community stakeholders in addressing issues of health disparity. The proposed project focuses on cervical cancer, a topic of significant health concern for three communities served by SUCCESS: Little Haiti, Hialeah, and West Perrine. Like other predominately minority, low-income neighborhoods across the United States, these communities contribute to excess cervical cancer incidence and mortality, largely due to lack of access to routine Pap smear screening and timely follow up for detected abnormalities. SUCCESS aims to address this disparity. For the past three years, we have been engaged in a community trial comparing two innovative modalities for disease prevention: navigation to Pap smear screening at local Federally-Qualified Health Centers (FQHC) vs. home-based self-sampling for Human Papillomavirus (HPV), the principal cause of cervical cancer. In both arms, Community Health Workers (CHWs) play a critical role in intervention delivery. However, our preliminary data indicate that CHW involvement may matter less than the method of screening itself. Screening uptake is significantly higher among women randomized to self-sampling in all three communities, likely given the ease of use and participant preference for home-based screening, which circumvents structural and cultural barriers to care. The proposed study will formally test the significance of CHW participation by comparing self-sampling provided by a CHW with self-sampling provided by mail. We will implement a two-arm study of 700 women from across our three target communities, with the CHW-self sampling intervention serving as our control group, or arm. Our primary aim is 1) to determine which method of self-sampling results in a greater proportion of women screened. Secondary outcomes include comparisons of a) knowledge, attitudes and beliefs about cervical cancer and the importance of early detection of disease~ b) access to care (health insurance, having a usual source of care, and visit to provider in six months), particularly among women having abnormal screens and requiring medical intervention~ and the c) relative cost of the two intervention strategies. Consistent with the tenets of CBPR, the focus and scope of such work was informed by the SUCCESS CAGs in Little Haiti, Hialeah, and West Perrine. By enlisting community leadership in study conceptualization, we ensure that we can successfully achieve our intended goal, to identify the most optimal strategy for cervical cancer prevention among women who disproportionately contribute to disease incidence and mortality.