Feasibility of a Multi-Channel Intervention to Promote Colorectal Cancer Screening among American Indians in Oklahoma

项目摘要 结直肠癌（CRC）是美国男性和女性癌症死亡的第二大原因。 States.与全国平均水平相比，美洲印第安人承受着不成比例的CRC负担。 发病率和CRC特异性死亡率。筛查是一种有效的早期发现策略， CRC相关死亡，但AI的CRC筛查率最低。在俄克拉荷马州，只有51%的人工智能上升 迄今为止，与近三分之二的合格美国成年人相比，努力提高筛查率 重点是增加家庭粪便筛查的可及性（即，粪便免疫化学试验; FIT），如许多AI 生活在农村社区，必须长途跋涉才能获得筛查服务。部落社区保健 教育工作者（TCHE）是在AI社区内促进FIT筛查的有效策略， 克服历史上的不信任、卫生知识普及方面的差距，并提供文化上一致的教育信息。 然而，TCHE的成功受到其影响范围的限制，因为它们无法在后勤上与所有必要的AI进行交互 社区.虚拟人技术，它可以创建逼真的，交互式的虚拟TCHE（v-TCHE）提供 一项可扩展的战略，以克服面对面提供健康教育所固有的后勤障碍。 因此，本提案的总体目标是利用与印度卫生服务部的现有关系 克林顿服务单位和夏延和阿拉帕霍部落，以审查共同开发和 传播v-TCHE作为多通道通信干预的一部分。干预将是 通过两个渠道传播：（1）社交媒体（即，通过在线研究广告访问）和（2）诊所（即， 通过SMS文本中的研究链接直接向患者发送消息）。在这两个渠道中，我们将检查覆盖范围（主要 干预措施的结果）及其潜在功效（提高CRC知识和完成FIT套件） 通过随机对照试验。一旦参与者点击研究链接，他们将以1：1的比例被随机分配到 两个干预条件：（1）观看真实部落社区健康的叙述性证词视频 教育者（对照）或（2）与v-TCHE的互动。然后，参与者将完成干预后调查， 之后，他们可以在其中点击订购FIT套件。第一个研究目标是共同开发一个多渠道的 俄克拉荷马州的人工智能通信干预。第二个研究目标将确定其范围和潜力 功效本提案高度响应PA-20-272中的第2轨，因为它试图解决 AI人群中的CRC结局。我们研究了共同开发和传播一个多- 渠道沟通干预，以促进美国预防服务工作队建议 癌症筛查测试如果成功，研究结果将支持一种首创的、高度可扩展的方法， 部落社区健康教育工作者面临的范围限制。未来的R 01将确定 不同的v-TCHE，以促进在其他部落医疗保健系统的FIT筛查。

PROJECT SUMMARY Colorectal cancer (CRC) is the second-leading cause of cancer death in both men and women in the United States. Compared to national averages, American Indians (AI) endure a disproportionate burden of CRC incidence and CRC-specific mortality. Screening is an effective early detection strategy to decrease preventable CRC-related deaths, but AI have some of the lowest CRC screening rates. In Oklahoma, only 51% of AI are up to date with screening compared to nearly two-thirds of eligible US adults. Efforts to improve screening rates have focused on increasing access to home stool screening (i.e.. fecal immunochemical test; FIT), as many AI live in rural communities and must drive long distances to access screening services. Tribal community health educators (TCHE) are an effective strategy to promote FIT screening within AI communities as they can overcome historical mistrust, health literacy gaps, and provide culturally concordant educational messaging. However, success of TCHE is limited by their reach as they cannot logistically engage with all necessary AI communities. Virtual human technology, which can create photorealistic, interactive virtual TCHE (v-TCHE) offer a scalable strategy to overcome the logistical barriers inherent with in-person delivered health education. Therefore, the overall objective of this proposal is to leverage existing relationships with Indian Health Service Clinton Service Unit and the Cheyenne and Arapaho Tribes to examine the feasibility of co-developing and disseminating a v-TCHE as part of a multi-channel communication intervention. The intervention will be disseminated across two channels: (1) Social Media (i.e., accessed via online study adverts) and (2) Clinic (i.e., direct messaging to patients via a study link in a SMS text). Across both channels, we will examine reach (primary outcome) of the intervention and its potential efficacy (on improving CRC knowledge and completing a FIT kit) via a randomized controlled trial. Once participants click on the study link they will be randomized 1:1 to one of two intervention conditions: (1) watch a Narrative Testimonial Video of a real-life Tribal community health educator (control) or (2) an interaction with a v-TCHE. Participants will then complete a post-intervention survey, in which they can click to order a FIT kit afterwards. The first study aim will co-develop a multi-channel communication intervention with AI in Oklahoma. The second study aim will determine its reach and potential efficacy. This proposal is highly responsive to Track 2 in the PA-20-272 as it attempts to address inequities in CRC outcomes among AI populations. We examine the feasibility of co-developing and disseminating a multi- channel communication intervention to promote a United States Preventive Services Taskforce recommended cancer screening test. If successful, findings will support a first-of-its-kind, highly scalable approach to overcome the reach limitations that Tribal community health educators face. A future R01 will determine the efficacy of different v-TCHE to promote FIT screening across other Tribal healthcare systems.