A Mobile TXT-based Intervention to Improve Adherence to Adjuvant Hormone Therapy and Symptom Management for BCa Survivors

乳腺癌（BCa）是西班牙裔妇女死亡的主要原因，也是最常见的诊断 癌症在这个少数群体，在美国最大和增长最快的种族群体。相比其他 在种族/民族群体中，西班牙裔女性停止辅助激素治疗（AHT）的比例较高 治疗这一发现特别相关，因为西班牙裔和NHW女性在BCa方面的差距 已知在雌激素敏感亚型中生存率最高， 年是改善结果的关键。由于不依从治疗已被证明会影响生存结局， 死亡率增加，AHT的差异使用可能部分导致西班牙裔BCa的差异 结果。在我们团队的认知-社会健康信息处理模型和健康 通信最佳实践，基于证据的移动的短信干预（Txt 2Adhere），设计 为了促进对AHT的依从性，通过以患者为中心的输入以及临床和行为 在第一年的父母补助金的评估。拟议的补充研究是一个逻辑的延伸， 这一系列研究在促进抗癌口服治疗的依从性方面，同时 通过提供以下方面的培训，增加克拉拉·格兰达-卡梅隆博士（补充补助金候选人）的专业知识： BCa健康差异和移动健康研究的交叉点，并采用理论指导和仔细测试 干预原型用于BCa人群中服务不足的部分。我们先来看看西班牙裔 以质性研究探讨乳癌幸存者知觉到的阻碍因素与促进因素对AHT依从性之影响。指导 西班牙裔社区咨询委员会和定性调查结果，我们将调整家长补助金干预措施 “Txt 2Adhere”对西班牙裔BCa进行语言适当和文化知情的干预（MeCuido） 幸存者通过三阶段的文化适应和形成性评估过程。三个优先培训领域， 1)定性和定量研究方法，2）少数民族人口的健康差距，以及3） mHealth和健康传播，被确定为提高博士Granda-Cameron的理解， 拟议补充研究的方法和结果。培训将通过正式的 课程、地方和国家讲习班、研讨会和培训机构，以及持续的互动 与具有相关专业知识的导师和顾问一起工作。温光毅博士（家长资助计划PI）和Ana博士 玛丽亚洛佩斯将提供他们的导师和指导，以1）促进博士的进展。 卡梅隆的培训活动，2）指导建议的补充研究项目的实施，以及3） 促使格兰达·卡梅隆医生转型为独立调查员这项研究意义重大，因为 MeCuido有可能减少西班牙裔BCa女性中AHT依从性的差异， 为Granda-Cameron博士提供必要的理论和方法论基础， 一个非常成功和独立的职业生涯，在减少癌症护理差距使用数字技术。

Breast cancer (BCa) is the leading cause of mortality in Hispanic women and the most commonly diagnosed cancer in this minority group, the largest and fastest growing ethnic group in the US. Compared with other racial/ethnic groups, Hispanic women have a higher rate of discontinuation of adjuvant hormone therapy (AHT) treatment. This finding is particularly relevant because the gap between Hispanic and NHW women in BCa survival is known to be largest among estrogen-sensitive subtypes in whom prolonged AHT treatment over years is key to improving outcomes. Because nonadherence has been shown to affect survival outcomes and increase mortality, differential utilization of AHT may contribute in part to the disparities in Hispanic BCa outcomes. Guided by our team's Cognitive-Social Health Information Processing Model and health communication best practices, an evidence-based mobile text messaging intervention (Txt2Adhere), designed to promote adherence to AHT, was iteratively developed with patient-centered input and clinical and behavioral evaluation during year 1 of the Parent Grant. The proposed supplement research study is a logical extension of this line of research in the area of adherence promotion to anticancer oral treatment, while at the same time adding Dr. Clara Granda-Cameron's (the supplement grant candidate) expertise by providing training in the intersection of BCa health disparities and mHealth research, and adapting a theory-guided and carefully-tested intervention prototype of use with an underserved segment of BCa population. We will first examine Hispanic BCa survivors' perceived barriers and facilitators on adherence to AHT through a qualitative study. Guided by a Hispanic community advisory board and the qualitative findings, we will adapt the Parent Grant intervention “Txt2Adhere” to a linguistically-appropriate and culturally-informed intervention (MeCuido) for Hispanic BCa survivors through a 3-stage cultural adaptation and formative evaluation process. Three priority training areas, 1) qualitative and quantitative research methodologies, 2) health disparities in minority populations, and 3) mHealth and health communication, are identified to enhance Dr. Granda-Cameron's understanding of the methodologies and results of the proposed supplement study. Training will be implemented through formal coursework, local and national workshops, seminars and training institutes, as well as continuous interaction with mentors and advisors with relevant expertise. Dr. Kuang-Yi Wen (PI of the Parent Grant) and Dr. Ana Maria Lopez will provide their mentorship and guidance to 1) facilitate the progression of Dr. Granda- Cameron's training activities, 2) guide the implementation of the proposed supplement research project, and 3) promote Dr. Granda-Cameron's transition to an independent investigator. This study is significant because MeCuido has the potential to reduce disparities in AHT adherence among Hispanic BCa women and will provide Dr. Granda-Cameron with the necessary theoretical and methodological foundation from which to build a highly successful and independent career in reducing cancer care disparities using digital technologies.