Colorectal screening fear-reduction and racially-targeted norm messaging entreaties to increase colorectal cancer screening rates among African Americans

摘要摘要 结直肠癌(CRC)是美国和非洲癌症死亡的主要原因之一 与欧洲裔美国人相比，美国人在结直肠癌发病率和死亡率方面仍然较差 (EuAM)。在非洲AM中提高CRC筛查率的干预措施有助于解决 结直肠癌发病率和死亡率的差异。尽管有文献表明AfAms的恐惧(例如，结肠镜检查) 手术或癌症诊断)是结直肠癌筛查的障碍，没有任何干预措施使用理论指导 直接针对恐惧信念的方法。此外，还没有研究检查种族差异的程度。 身份认同缓和了针对种族的消息传递的影响，尽管使用有针对性的健康消息无处不在 在少数群体中传递恳求信息。这一点特别相关，因为我们的工作表明，在种族方面- 有针对性的筛查请求增加了识别不那么强烈的非洲AM的结直肠癌筛查意向， 但抑制了非洲裔美国人的这些意图，他们对自己的种族群体有更强烈的认同感。缺乏 对其他突出的CRC筛查障碍的关注可能会让高度认同的非裔美国人感到反感。 我们建议检查是否将减少恐惧和以种族为目标的基于规范的信息结合起来 将提高所有非裔美国人对基于家庭粪便的结直肠癌筛查的接受度和接受度 种族认同感的水平。鉴于居家筛查试剂盒的退货率较低，我们还将探讨是否将 明确承诺退货筛查试剂盒与增加试剂盒退货量相关。 目标1：在计划行为理论的指导下，通过 出版文献，与AFAM社区专家合作。 目标2：检查减少恐惧的恳求是否增加了对居家生活的接受和接受 当与以种族为目标的基于规范的消息相结合时，CRC筛查。 目标3：检查种族认同和感知的CRC风险对恐惧的影响的调节作用- 减少和以种族为目标的基于规范的消息恳求。 目标4：我们将探索明确承诺退还FIT试剂盒的参与者是否会退还它们 与那些没有做出此类承诺的人相比，这一比例更高。 这项拟议的研究具有重要意义，因为它直接解决了记录在案的CRC筛查缺陷 在服务不足的人群中，并具有创新性，因为它的设计以理论和文学为基础 知情的干预措施，以解决以前未解决的在非洲非小岛屿发展中国家中进行CRC筛查的障碍。

Summary Abstract Colorectal cancer (CRC) is one of the leading causes of cancer mortality in the United States, and African Americans (AfAms) still fare worse in CRC incidence and mortality compared to European Americans (EuAms).Interventions to increase CRC screening rates among AfAms are instrumental to address the disparities in CRC incidence and mortality. Despite literature indicating that AfAms’ fears (e.g., of colonoscopy procedures or cancer diagnosis) serve as barriers to CRC screening, no interventions have used theory-guided methods to directly target fear-based beliefs. Additionally, no research has examined the extent to which racial identity moderates the effects of racially targeted messaging, despite the ubiquity of using targeted health messaging entreaties among minority groups. This is particularly relevant given our work showing that racially- targeted screening entreaties increased CRC screening intentions among AfAms who identified less strongly, but depressed those intentions among AfAms who identified more strongly with their racial group. Lack of focus on other salient CRC screening barriers may have been off-putting to highly identified African Americans. We propose to examine whether combining both fear-reduction and racially-targeted norm-based messages will increase at-home stool-based CRC screening receptivity and uptake for all African American regardless of level of racial identity. Given low return rates of at-home screening kits, we will also explore whether making an explicit commitment to return screening kits is associated with increased kit returns. Aim 1: To develop and refine a fear-reduction intervention guided by the theory of planned behavior and by published literature, in conjunction with AfAm community experts. Aim 2: To examine whether the fear-reduction entreaty increases receptivity to, and uptake of at-home CRC screening when coupled with racially-targeted norm-based messages. Aim 3: To examine the moderating roles of racial identity and perceived CRC risk on the effects of fear- reduction and racially-targeted norm-based messaging entreaties. Aim 4: We will explore whether participants who make explicit commitments to return FIT Kits return them at a higher rate compared to those who do not make such commitments. This proposed study is significant because it directly addresses documented CRC screening deficits among an underserved population, and is innovative given its design of a theory-based and literature informed intervention to address previously unaddressed barriers to CRC screening among AfAms.