Improving Routine Asymptomatic Cancer Screening among Federally Qualified Health Center Users in Florida: Application of a Health Literacy Framework

摘要 作为最近任命的公共卫生终身助理教授，我的长期职业目标是使 为消除癌症差异做出了有意义的贡献。在这样做的时候，我希望建立自己作为一个 国家认可的独立调查员，在使用健康传播方面具有专业知识， 癌症差异我在行为研究方面受过大量训练，主要集中在理解 各种社会和文化因素对癌症差异的影响。在此基础上，我需要额外的培训 填补与卫生传播干预措施的设计、实施和评价有关的空白。我 导师团队和我准备了一个全面的职业发展计划，包括导师， 课程，专家咨询，研讨会，体验式学习和创新的研究项目。我 我提出的研究计划与我的总体职业目标一致，即寻求改善常规癌症筛查 在联邦合格的健康中心（CIMCs），癌症的负担比一般的健康中心更大。 人口普查，但筛查率远低于全国平均水平。尽管作出了重大贡献， 降低乳腺癌、宫颈癌和结肠直肠癌（CRC）发病率和死亡率的常规筛查， 种族/少数民族和低社会经济地位人口之间的差距仍然存在， 未充分利用筛选。在减少由于其滑动费用造成的这些差异方面， 医疗服务不足地区的薪酬结构和地点。K 01研究项目的目标是 了解目前的CIMHC用户如何看待常规无症状癌症筛查，并制定和预先 测试一个电子健康工具，以促进对艾滋病毒/艾滋病用户的筛查。具体目标是：（1）进行养成教育 研究与CIMHC用户，以了解他们如何看待和决策的日常无症状 癌症筛查;（2）设计和预测试电子健康工具，解决健康素养的每个领域 框架，并纳入了在使用者中进行无症状癌症筛查的关键决策标准;以及 (3)在一个旨在提供适当扫盲的机构内，对电子保健干预措施进行试点测试，“决定- 关于常规无症状癌症筛查的“相关”信息。这项指导性研究 奖励将提供必要的保护时间，以实现以下培训目标：（1）发展专业知识 在健康素养框架内，将决策分析应用于健康传播;（2）成为 熟悉诊所运营、用户配置文件和CDC内的服务交付，沿着成功的研究 （3）建立健康传播干预设计、实施 （4）培养必要的技能，将传播研究转化为实践， 特别是在一个有组织犯罪的环境中。这项研究将为更大的R 01级健康水平奠定基础。 沟通干预研究。这些发现不仅可以为癌症筛查提供信息，还可以为其他健康问题提供信息。 在社区卫生服务中心采取促进干预措施，这些中心越来越多地成为社会经济地位低的人口的医疗之家。

ABSTRACT As a recently appointed tenure-track Assistant Professor of Public Health, my long-term career goal is to make a meaningful contribution to the elimination of cancer disparities. In doing this, I wish to establish myself as a nationally-recognized independent investigator with expertise in the use of health communication to address cancer disparities. I have substantial training in behavioral research, primarily focused on understanding the role of various social and cultural factors on cancer disparities. Building on this foundation, I require additional training to fill gaps related to the design, implementation, and evaluation of health communication interventions. My Mentorship Team and I have prepared a comprehensive career development plan that consists of mentorship, coursework, expert consultations, workshops, experiential learning, and an innovative research project. My proposed research plan aligns with my overarching career goal in seeking to improve routine cancer screening within federally qualified health centers (FQHCs), where the burden of cancer is greater compared to the general population, but screening rates are much lower than national averages. Despite the significant contribution of routine screening in the reduction of breast, cervical, and colorectal cancer (CRC) incidence and mortality, disparities persist among racial/ethnic minority and low socioeconomic (SES) populations who continue to underutilize screening. FQHCs can be invaluable partners in reducing these disparities due to their sliding-fee pay structure and location in medically underserved areas. The goal of the proposed K01 research project is to understand how current FQHC users perceive routine asymptomatic cancer screening, and develop and pre- test an eHealth tool that promotes screening among FQHC users. The specific aims are to: (1) Conduct formative research with FQHC users to understand how they perceive and make decisions about routine asymptomatic cancer screening; (2) Design and pre-test an eHealth tool that addresses each domain of the health literacy framework, and incorporates key decision criteria of asymptomatic cancer screening among FQHC users; and (3) Pilot test an eHealth intervention within an FQHC setting aimed at delivering literacy appropriate, “decision- relevant” information about routine asymptomatic cancer screening to FQHC users. This Mentored Research Award would provide the necessary protected time to achieve the following training goals: (1) Develop expertise in the application of decision analysis to health communication, within a health literacy framework; (2) Become familiar with clinic operations, user profiles, and service delivery within FQHCs, along with successful research collaboration with FQHCs; (3) Build competence in health communication intervention design, implementation, and evaluation; and (4) Develop the necessary skills to translate communication research into practice, specifically within an FQHC setting. This research would set the stage for a larger R01-level health communication intervention study. Findings might inform not only cancer screening, but also other health promotion interventions in FQHCs, which are increasingly becoming medical homes for low SES populations.