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，尤其是非洲裔美国人。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。 筛查(例如结肠镜检查、粪便检查)可以预防大多数侵袭性结直肠癌病例。然而，吸收是 不足，特别是在SES较低的非洲裔美国人中。事实上，儿童权利公约中40%的种族差距 发病率和20%的死亡率差异可归因于缺乏筛查。成为黑人、男性和下层 美国的SE交叉形成了一组复杂的机构、提供者和患者级别的障碍，这些障碍导致 不同的筛查率。在这一群体中，增加结直肠癌筛查的大多数努力都是面对面或电话- 以教育和导航为基础。虽然有效，但这些方法是资源密集型的，限制了它们的 由服务于低SES黑人男性的组织采用，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战略的需求，以在以下方面增加CRC筛查 医疗服务不足的非洲裔美国男性，这个项目将开发一种流动的结直肠癌筛查 对这一组进行干预(m-CRCSI)。M-CRCSI将基于健康信念模型(HBM)并交付 通过移动电话。它将包括旨在提高儿童权利公约知识和健康信念的短信。一些人 短信将包括三种视频类型之一的链接：教育指导、脚本小插曲和 无剧本的同辈叙事。计划内容将减少健康素养障碍并促进结直肠癌筛查 坚持不懈。最后，它将是文化的目标，通过将HBM构建与最健康的信念联系在一起 与低SES黑人男性相关，并整合性别和种族一致的形象、语言和价值观。 在第一阶段开发了一个原型m-CRCSi。这一发展是由形成性研究提供信息的。 与社区护理提供者和目标终端用户合作。第一阶段的结果远远超过建议的 并大力支持干预措施的可用性、可接受性和潜在有效性。 在第二阶段，我们将完成m-CRCSi的开发。然后，与家庭和 医疗咨询服务(我们的合作伙伴FQHC)，我们将审查m-CRCSI的有效性，以增加 对非裔美国人进行结直肠癌筛查。参与者将被随机分配到干预措施中的任何一个 条件或匹配的对照条件。次要措施将评估健康信念、医疗不信任、 癌症宿命论、患者-提供者互动和知识。

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. Screening (e.g., colonoscopy, stool-based tests) can prevent most cases of invasive CRC. However, uptake is inadequate, especially among low SES African American men. Indeed, 40% of the racial disparity in CRC incidence and 20% of mortality differences can be attributed to lack of screening. Being Black, male, and low SES in the U.S. intersect to form a complex set of institutional, provider, and patient-level barriers that lead to differential screening rates. Most efforts to increase CRC screening in this group utilize in-person or telephone- based education and navigation. While effective, these approaches are resource intensive, limiting their adoption by organizations that serve low SES Black men, such as Federally Qualified Health Centers (FQHCs). To address the need for an effective, affordable, and scalable strategy to increase CRC screening among medically underserved African American men, this project will develop a mobile colorectal cancer screening intervention (m-CRCSI) for this group. m-CRCSI 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. Some text messages will include links to one of three types of videos: educational instruction, scripted vignettes, and unscripted peer narratives. Program content will reduce health literacy barriers and promote CRC screening adherence. Finally, it will be culturally targeted by contextualizing HBM constructs with the health beliefs most relevant to low SES Black men and by integrating gender- and race-congruent imagery, language, and values. A prototype m-CRCSi was developed in Phase I. This development was informed by formative research with community-based care providers and target end-users. The results of Phase I far exceeded the proposed benchmarks and strongly support the usability, acceptability, and potential effectiveness of the intervention. During Phase II we will complete development of the m-CRCSi. Then, in collaboration with Family and Medical Counseling Service (our partner FQHC), we will examine the effectiveness of the m-CRCSi to increase CRC screening in African American men. Participants will be randomly assigned to either the intervention condition or to a matched control condition. Secondary measures will assess health beliefs, medical mistrust, cancer fatalism, patient-provider interaction, and knowledge.