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

描述（由申请人提供）：结直肠癌（CRC）筛查可以挽救生命，但在美国仍然没有得到充分利用，大约三分之一的合格美国人仍然没有接受筛查。先前的研究已经记录了CRC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，医生时间不足，日程安排 障碍，缺乏访视后患者支持）。先前增加CRC筛查的尝试通常针对患者或提供者/系统障碍，结果有限。为了实现尽可能高的筛查率，迫切需要一种多层次的干预措施，这种干预措施具有时间效率，易于实施，适合不同的识字水平。用户友好型移动的设备的日益普及使得移动健康或使用移动的技术来增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，通过利用移动的技术在初级保健就诊之前、期间和之后通知、激活和支持患者，来增加CRC筛查的接受率。我们的干预措施可以在初级保健实践中轻松传播和实施，并且适合所有文化水平的患者。该项目将评估我们创新的多层次mHealth CRC筛查干预（mCRC）的有效性。mCRC系统的概念框架是基于社会认知模型，强调互惠决定论，或人，行为和环境的动态相互作用。mCRC系统包括：1）平板电脑CRC筛查决策辅助，其将收集患者信息，传递筛查消息，并允许患者做出筛查决定; 2）“自助”协议，其授权工作人员订购患者请求的筛查测试;以及3）通过自动化和交互式文本消息为患者提供决策后随访支持。我们将在一项随机对照试验中测试mCRC系统，该试验在为种族和社会经济多样化人群服务的社区初级保健实践中进行。患者将被随机分配至mCRC系统或关于健康生活习惯的平板电脑教育计划。本试验将评价：1）mCRC系统增加接受 经病历审查确认的24周内的CRC筛查; 2）mCRC系统促进筛查的潜在变化机制（即，患者形成筛查决策的能力、患者态度和信念、患者自我效能、患者意图， 以及患者-提供者CRC筛查讨论的发生）;以及3）每名接受筛查的患者的mCRC系统的额外成本，重点是员工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筛查和改善公共卫生。

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.