Reducing Colorectal Cancer Health Disparities: An mHealth Intervention to Improve Screening among African American Men

项目摘要/摘要 贫困对健康有无数有害影响，包括大多数人的发病率和死亡率更高。 各种形式的癌症。结直肠癌(CRC)是癌症死亡的第二大原因，也不例外。 在社会经济地位(SES)较低的人群中，结直肠癌的确诊几率要高出40%。在美国，种族和 自闭症之间有着千丝万缕的联系，导致了巨大的健康差距。事实上，《儿童权利公约》对以下方面的负担尤其沉重 黑人；最著名的是非洲裔美国人。与黑人男性相比，黑人男性的CRC发病率高出20% 白人男性的死亡率要高出52%。在所有的CRC分期中，非裔美国人的存活率最低。 由于导致大多数结直肠癌的癌前息肉生长缓慢，坚持结直肠癌筛查可以 防止大多数病例成为浸润性癌症。不幸的是，筛查测试的使用是不够的， 尤其是在SES较低的非洲裔美国人中。事实上，40%的种族差异在CRC发病率和 20%的死亡率差异可以归因于缺乏筛查。身为黑人、男性和低社会地位者 美国交叉形成了一套复杂的机构、提供者和患者层面的障碍，这些障碍导致 这些不同的筛查率。在这一组中，大多数现有的增加CRC筛查的方法都利用了- 基于人员或电话的教育和患者导航。虽然有效，但这些方法成本高昂，而且 资源密集型，限制了主要为低SES非裔美国人服务的组织采用它们 男性，如联邦合格健康中心(FQHC)。 为了满足对有效、负担得起和可扩展的干预措施的需求，以增加以下人群的CRC筛查 医疗服务不足的非洲裔美国人，这个项目将开发一种基于理论、量身定做和文化上的- 针对这一群体的有针对性的结直肠癌筛查和健康干预。拟议的干预将基于 健康信念模式(HBM)，并通过手机传递。它将包括旨在改善 儿童疾病知识和健康信念。此外，该节目还将呈现三个基于网络的视频组件： 有脚本的小插曲、无脚本的同行叙事和教育指导。所有节目内容都将 旨在减少卫生知识普及障碍，促进遵守儿童权利公约筛查建议。 最后，它将通过将HBM结构与与以下内容最相关的健康信念联系在一起而成为文化目标 低社会地位非裔美国人男性，通过整合性别和种族一致的形象、语言和价值观。 将招募8名FQHC工作人员和20名非裔美国人参加焦点小组讨论，以 塑造拟议的干预措施。当该项目的原型版本完成后，20名非洲裔美国人 不遵守CRC筛查的男性(即目标最终用户)将被招募进行可用性测试。这个 可用性测试将包括一系列任务，旨在突出建议的 干预。将评估三个可用性指标：效率、准确性和主观满意度。

PROJECT SUMMARY/ABSTRACT Poverty has a myriad of pernicious effects on health, including higher incidence and mortality for most forms of cancer. Colorectal cancer (CRC), the second overall leading cause of cancer death, is no exception. CRC is diagnosed 40% more often in those lower in socioeconomic status (SES). In the United States, race and SES are inextricably linked, leading to profound health disparities. Indeed, CRC is particularly burdensome for Black people; most notably African American men. CRC incidence is 20% higher in Black men as compared to white men with death rates 52% higher. African American men have the lowest survival rates at all CRC stages. Because the precancerous polyps that cause most CRCs grow slowly, adherence to CRC screening can prevent most cases from becoming invasive cancer. Unfortunately, use of screening tests is inadequate, especially among low SES African American men. Indeed, 40% of the racial disparity in CRC incidence and 20% of the mortality differences can be attributed to lack of screening. Being Black, male, and low SES in the United States intersect to form a complex set of institutional, provider, and patient-level barriers that lead to these differential screening rates. Most existing approaches to increase CRC screening in this group utilize in- person or telephone-based education and patient navigation. While effective, these approaches are costly and resource intensive, limiting their adoption among organizations that primarily serve low SES African American men, such as Federally Qualified Health Centers (FQHCs). To address the need for an effective, affordable, and scalable intervention to increase CRC screening among medically underserved African American men, this project will develop a theory-based, tailored, and culturally- targeted CRC screening mHealth intervention for this group. The proposed intervention will be based on the health belief model (HBM) and delivered via mobile phone. It will include text messages designed to improve CRC knowledge and health beliefs. Additionally, the program will present three web-based video components: scripted vignettes, unscripted peer narratives, and educational instruction. All program content will be designed to reduce health literacy barriers and promote adherence to CRC screening recommendations. Finally, it will be culturally targeted by contextualizing HBM constructs with the health beliefs most relevant to low SES African American men and by integrating gender- and race-congruent imagery, language, and values. Eight FQHC staff members and 20 African American men will be recruited for focus group discussions to shape the proposed intervention. When a prototype version of the program is completed, 20 African American men who are nonadherent to CRC screening (i.e., target end-users) will be recruited for usability testing. The usability test will include a series of tasks intended to highlight the different features of the proposed intervention. Three usability metrics will be assessed: efficiency, accuracy, and subjective satisfaction.