Overcoming barriers to cancer screening among women living in rural and segregated communities

项目摘要 2018年，4，170名妇女将死于宫颈癌，23，240名妇女将死于结直肠癌，但许多妇女将死于宫颈癌。 这些死亡可以通过癌症筛查避免。癌症死亡率和筛查流行率因 地理，生活在农村和种族隔离地区的妇女更有可能死于，但不太可能 与其他地区的妇女相比，这些癌症的筛查。农村和隔离地区的妇女面临 对筛选的独特的多级障碍（例如，低癌症风险认知，高旅行负担）。居家自- 收集宫颈癌的人乳头瘤病毒（HPV）检测和粪便免疫化学检测（FIT） 结直肠癌，配合文化上适当的教育材料，可以克服这些障碍。 然而，在农村和隔离社区成功实施这种干预措施， 替补演员拟议的研究将使用健康行为理论和干预设计和适应 阐明与农村妇女癌症筛查有关的个人和环境因素的技术 隔离区。 在拟定的K22项目中，主要研究者（PI）和合作者将采用混合方法 形成性研究（包括空间数据分析、深入访谈、调查和焦点小组）， 研究环境和个人水平的相关性，在妇女（年龄50-65岁）中进行癌症筛查， 农村隔离区（目标1）。利用这些发现，该团队将调整现有的，基于证据的癌症 筛选教育材料，这些材料将分发给农村、隔离社区、 结合自我收集的HPV检测和FIT（目标2）。该小组将研究可行性和初步 本试点研究的结局数据，以支持R 01水平的随机混合有效性实施试验 在这些服务不足和研究不足的社区， 除了这些研究活动外，拟议的K22项目还包括几项培训活动，以支持 主要研究者Jennifer L博士的职业发展。莫斯莫斯博士的长期职业目标是成为一名 跨学科研究癌症预防行为的地理差异的科学领导者， 结果。她的短期职业目标包括获得混合方法分析方面的额外培训， 干预设计和资助写作。有了研究和进一步培训的保护时间，莫斯博士可以利用 拟议的K22项目，作为一名独立的行为科学家，为国家做出贡献， 癌症研究所的使命是减轻癌症对人口的负担。

PROJECT SUMMARY In 2018, 4,170 women will die from cervical cancer and 23,240 will die from colorectal cancer, yet many of these deaths avoidable through cancer screening. Cancer mortality rates and screening prevalence vary by geography, with women living in rural and racially-segregated areas more likely to die from, but less likely to screen for, these cancers compared to women in other areas. Women in rural and segregated areas face unique multilevel barriers to screening (e.g., low cancer risk perceptions, high travel burden). Home-based self- collection of human papillomavirus (HPV) tests for cervical cancer and fecal immunochemical tests (FIT) for colorectal cancer, paired with culturally-appropriate educational materials, could overcome these barriers. However, the successful implementation of such interventions in rural and segregated communities is understudied. The proposed study will use health behavior theory and intervention design and adaptation techniques to clarify person- and environment-level factors related to cancer screening among women in rural and segregated areas. In the proposed K22 project, the principal investigator (PI) and collaborators will conduct mixed methods formative research (including analysis of spatial data, in-depth interviews, surveys, and focus groups) to examine environment- and person-level correlates of cancer screening among women (ages 50-65 years) in rural, segregated areas (Aim 1). Using those findings, the team will adapt existing, evidence-based cancer screening educational materials, which will be delivered to eligible women in rural, segregated communities in conjunction with self-collected HPV tests and FIT (Aim 2). The team will examine feasibility and preliminary outcomes data for this pilot study to support an R01-level randomized hybrid effectiveness-implementation trial of the intervention materials to improve cancer screening in these underserved and understudied communities. In addition to these research activities, the proposed K22 project includes several training activities to support the career development of the PI, Dr. Jennifer L. Moss. Dr. Moss’s long-term career goal is to become a scientific leader in transdisciplinary research on geographic disparities in cancer prevention behaviors and outcomes. Her short-term career goals include obtaining additional training in mixed methods analysis, intervention design, and grant writing. With protected time for research and further training, Dr. Moss can use the proposed K22 project to launch a career as an independent behavioral scientist contributing to the National Cancer Institute’s mission to reduce the burden of cancer in the population.