Addressing Cervical Cancer Disparity in South Florida CBPR in Action

描述（由申请人提供）：南佛罗里达中心减少癌症差异，也被称为成功，支持一些校园社区合作伙伴关系，或社区咨询小组（CAG），整个迈阿密大都市区。这种伙伴关系是在以社区为基础的前瞻性研究（CBPR）的精神，促进大学调查人员和社区利益相关者在解决健康差距问题有意义的合作。拟议项目的重点是子宫颈癌，这是SUCCESS服务的三个社区（小海地、希亚利亚和西佩琳）的一个重大健康问题。像其他占主导地位的少数民族，低收入社区在美国各地，这些社区有助于过度宫颈癌的发病率和死亡率，主要是由于缺乏获得常规巴氏涂片筛查和及时跟进发现的异常。SUCCESS旨在解决这一差距。在过去的三年里，我们一直在进行一项社区试验，比较两种创新的疾病预防模式：导航到当地联邦合格的卫生中心（WHC）进行巴氏涂片筛查与基于家庭的人类乳头瘤病毒（HPV）自我采样，这是宫颈癌的主要原因。 在这两个武器，社区卫生工作者（CHW）发挥关键作用，在干预交付。然而，我们的初步数据表明，CHW参与可能比筛选方法本身更重要。在所有三个社区中，被随机分配到自我抽样的妇女的筛查率明显较高，这可能是因为家庭筛查易于使用，而且参与者更喜欢家庭筛查，因为家庭筛查规避了护理的结构和文化障碍。拟议的研究将通过比较CHW提供的自我采样与通过邮件提供的自我采样，正式测试CHW参与的重要性。我们将对来自我们三个目标社区的700名妇女进行一项双臂研究，CHW自我采样干预作为我们的对照组或手臂。我们的主要目标是1）确定哪种自我采样方法导致更大比例的妇女接受筛查。次要结果包括比较a）关于宫颈癌的知识，态度和信念以及早期发现疾病的重要性-B）获得护理（健康保险，有通常的护理来源，并在六个月内访问提供者），特别是在筛查异常和需要医疗干预的妇女中-和c）两种干预策略的相对成本。根据CBPR的原则，这些工作的重点和范围是由小海地、希亚利亚和西佩里纳的SUCCESS客户援助小组提供的。 通过在研究概念化中招募社区领导，我们确保我们能够成功实现我们的预期目标，即在对疾病发病率和死亡率有不成比例贡献的妇女中确定预防宫颈癌的最佳策略。

DESCRIPTION (provided by applicant): The South Florida Center for Reducing Cancer Disparities, also known as SUCCESS, supports a number of campus-community partnerships, or Community Advisory Groups (CAGs), throughout the Miami metropolitan area. Such partnerships were conceived in the spirit of Community-based Participatory Research (CBPR) and facilitate meaningful collaboration between University investigators and community stakeholders in addressing issues of health disparity. The proposed project focuses on cervical cancer, a topic of significant health concern for three communities served by SUCCESS: Little Haiti, Hialeah, and West Perrine. Like other predominately minority, low-income neighborhoods across the United States, these communities contribute to excess cervical cancer incidence and mortality, largely due to lack of access to routine Pap smear screening and timely follow up for detected abnormalities. SUCCESS aims to address this disparity. For the past three years, we have been engaged in a community trial comparing two innovative modalities for disease prevention: navigation to Pap smear screening at local Federally-Qualified Health Centers (FQHC) vs. home-based self-sampling for Human Papillomavirus (HPV), the principal cause of cervical cancer. In both arms, Community Health Workers (CHWs) play a critical role in intervention delivery. However, our preliminary data indicate that CHW involvement may matter less than the method of screening itself. Screening uptake is significantly higher among women randomized to self-sampling in all three communities, likely given the ease of use and participant preference for home-based screening, which circumvents structural and cultural barriers to care. The proposed study will formally test the significance of CHW participation by comparing self-sampling provided by a CHW with self-sampling provided by mail. We will implement a two-arm study of 700 women from across our three target communities, with the CHW-self sampling intervention serving as our control group, or arm. Our primary aim is 1) to determine which method of self-sampling results in a greater proportion of women screened. Secondary outcomes include comparisons of a) knowledge, attitudes and beliefs about cervical cancer and the importance of early detection of disease~ b) access to care (health insurance, having a usual source of care, and visit to provider in six months), particularly among women having abnormal screens and requiring medical intervention~ and the c) relative cost of the two intervention strategies. Consistent with the tenets of CBPR, the focus and scope of such work was informed by the SUCCESS CAGs in Little Haiti, Hialeah, and West Perrine. By enlisting community leadership in study conceptualization, we ensure that we can successfully achieve our intended goal, to identify the most optimal strategy for cervical cancer prevention among women who disproportionately contribute to disease incidence and mortality.