Testing Approaches to Promote Breast Cancer Screening in Rural Ghana

项目摘要 乳腺癌(BC)是全世界女性中最常见的癌症，对 妇女及其家庭的福祉。在撒哈拉以南非洲，卑诗省的发病率正在上升，表现较晚的是 通常，年轻女性受到的影响不成比例，而且存活率很低。其中一个 加纳政府抗击BC的首要战略是通过常规筛查及早发现，但 筛查率很低。我们的多学科团队设计了两项干预措施，以克服三个关键问题 社会文化和经济障碍，增加BC筛查的利用率，包括(1)时间和 交通费用，(2)文化信仰和耻辱，(3)男性在决策中的主导地位和缺乏 对女性的社会支持。捆绑干预为妇女提供BC和随后的糖尿病教育 在同一次访问当地诊所期间进行BC和II型糖尿病筛查。提供同步服务 (捆绑)筛查假设通过几种机制增加BC筛查，包括 减少时间/运输成本，冲淡自己寻求BC筛查的耻辱。梅格家族 (男性参与性别和健康)计划为女性及其男性伴侣提供BC教育， 邀请合作伙伴参加每周7次讨论小组会议(5名男性和2名女性和男性)，以及 随后在当地诊所为女性提供BC筛查。Megh计划被假设为增加 通过几个机制进行BC筛查，包括改变男性的性别态度，增加女性的 控制决策，增加男性的社会支持。我们的长期目标是测试 这些干预措施在未来集群式随机对照试验中的有效性。拟议的R21项目的总体目标 将在一项可行性研究中最后确定未来区域工作队的设计和实施方面。具体的 目标是：(1)完善学习材料(教育材料、MEGH计划课程、数据收集 关于文化相关性和实施的文书)。我们与一个专家咨询委员会和一个 一个迭代过程中的地方委员会。(2)采用序贯方法确定两种干预措施的可行性 混合方法。我们评估了三个临床区的干预措施(2个干预措施+1个对照)。 年龄20岁以上(MEGH组男性伴侣)。我们进行基线和终点调查，然后 定性深度访谈。(2a)根据招聘、保留和可接受性建立可行性。 (2B)评估有效性和干预保真度的初步证据，并通过以下方式澄清这些发现 参与者从后续深度访谈中获得的见解。我们评估了 干预措施、干预保真度面临的挑战以及实施方法。(2C)审查首字母 干预措施对机制的影响的证据，并通过参与者的 洞察力。(2D)利用研究结果最终确定未来集群化随机对照试验的方案。这些新的 干预措施解决了改善妇女关键健康行为-BC筛查-的关键障碍。这个 这项研究将产生一个解决低收入环境中BC高发问题的原型。

Project Summary Breast cancer (BC) is the most common cancer among women worldwide and has profound implications for the well-being of women and their families. In sub-Saharan Africa, BC incidence is rising, late presentation is common, younger women are disproportionately affected, and survival rates are low. One of the Government of Ghana’s top strategies to combat BC is early detection through routine screening, yet screening rates are low. Our multidisciplinary team has designed two interventions to surmount three key sociocultural and economic barriers and increase the utilization of BC screening, including (1) time and transportation costs, (2) cultural beliefs and stigma, and (3) male dominance in decision-making and lack of social support for women. The BUNDLING intervention offers women BC and diabetes education followed by BC and type II diabetes screenings during the same visit to the local clinic. Provision of simultaneous (bundled) screenings is hypothesized to increase BC screening through several mechanisms, including reducing time/transportation costs and diluting the stigma of seeking BC screening on its own. The MEGH (Male Engagement in Gender and Health) Program offers BC education to women and their male partners, invites partners to 7 weekly discussion group sessions (5 men-only and 2 women and men), and subsequently offers women BC screening at the local clinic. The MEGH Program is hypothesized to increase BC screening through several mechanisms, including changing men’s gender attitudes, increasing women’s control over decision-making, and increasing men’s social support. Our long-term goal is to test the effectiveness of these interventions in a future clustered RCT. The overall goal of the proposed R21 project is to finalize the design and implementation aspects for the future RCT in a feasibility study. The specific aims are: (1) Refine study materials (education materials, MEGH Program curriculum, data collection instruments) for cultural relevance and implementation. We consult with an expert advisory committee and a local committee in an iterative process. (2) Determine the feasibility of the two interventions using sequential mixed methods. We assess the interventions in three clinic zones (2 interventions + a control) with women age 20+ (and male partners in the MEGH group). We conduct baseline and endline surveys, followed by qualitative in-depth interviews. (2A) Establish feasibility based on recruitment, retention, and acceptability. (2B) Assess initial evidence of efficacy and intervention fidelity, and clarify these findings through participants’ insights from follow-on in-depth interviews. We assess the strengths and weaknesses of the interventions, challenges to intervention fidelity, and implementation approaches. (2C) Examine initial evidence of the effect of interventions on the mechanisms, and clarify these findings through participants’ insights. (2D) Finalize the protocol for the future clustered RCT using study findings. These new interventions tackle key barriers to improving a critical health behavior—BC screening—for women. The study will generate a prototype for addressing the high incidence of BC in low-income settings.