Promoting Mammography in African American Women Visiting the Emergency Department

描述(申请人提供)：乳腺癌是一个紧迫的公共卫生问题。它是非洲裔美国女性中最常见的癌症，也是癌症死亡的第二大原因。筛查乳房X光检查是早期发现乳腺癌最有效的单一方法；然而，非洲裔美国妇女的筛查率并不理想，在40岁及以上的非裔美国妇女中，只有53%的人在过去一年内进行过乳房X光检查。低收入妇女、没有医疗保险的妇女和没有正常医疗保健来源的妇女的筛查率更低，分别为44%、34%和28%。这些妇女中的许多人将急诊科作为唯一的医疗保健来源。通过一个由跨学科癌症控制和护理科学家团队指导的培训计划、正式的课堂作业和研讨会，K01奖将为申请者提供开发和进行研究的机会，该研究将试点测试由同行教育人员提供的文化定制、阶段匹配的干预措施，以增加急诊科就诊的非裔美国女性使用乳房X光检查。这项研究的具体目的是：(1)检查影响非裔美国妇女使用筛查乳房X光检查的障碍和好处，并开发同伴教育者提供的干预和定制的教育材料；(2)为非裔美国妇女开发和评估文化定制的、适合阶段的乳房X光检查教育材料，以确定急诊科妇女的文化可接受性、可读性和适用性；以及(3)在与非裔美国女性样本的随机对照试验中，比较两种不同干预措施(文化定制、阶段匹配的同伴教育人员乳腺癌干预与仅定制教育材料)对接受筛查乳房X光检查以及对筛查指南的了解和遵守指南的意愿的影响。这项研究的概念框架综合了健康信念模型和跨理论模型的概念。这些具体目标对应于三个阶段：定性阶段、发展阶段和干预阶段。这一循序渐进的研究项目与结构化的培训计划相结合，将使申请者为实现成为一名独立研究人员的长期目标做好准备，使她能够发展混合方法的技能，提高先进定量研究方法的技能，将沟通纳入癌症控制理论和原理，并展示将与健康差异和癌症控制相关的知识和经验整合到随机对照临床试验的设计和实施中的能力。此外，拟议项目的结果将构成进一步研究的基础，以促进在这一弱势妇女群体中使用筛查乳房X光检查。

DESCRIPTION (provided by applicant): Breast cancer is a pressing public health concern. It is the most common cancer and the second leading cause of cancer death among African American women. Screening mammography is the single most effective method of early detection of breast cancer; however, African American women are screened at suboptimal rates, with only 53% of African American women aged 40 and older having had a mammogram within the past year. Low income women, women without health insurance, and those without a usual source of health care have even lower screening rates of 44%, 34%, and 28% respectively. Many of these women use the Emergency Department as the only source of medical care. Through a training plan of mentoring by a team of interdisciplinary cancer control and nursing scientists, formal class work, and seminars, this K01 Award will provide the applicant with the opportunity to develop and conduct a study that pilot tests a culturally tailored, stage matched intervention delivered by peer educators to increase mammography use among African American women visiting the Emergency Department. The specific aims of the study are: (1) to examine the barriers and benefits that influence the use of screening mammography among African American women and develop a peer educator delivered intervention and tailored educational materials; (2) to develop and evaluate culturally tailored, stage appropriate mammography educational materials for African American women to determine cultural acceptability, readability, and applicability for women visiting the Emergency Department; and (3) to compare, in a randomized controlled trial with a sample of African American women, the effect of two different interventions (a culturally tailored, stage-matched peer educator breast cancer intervention versus tailored educational materials only) on receipt of a screening mammogram and knowledge of and intent to follow screening guidelines. The proposed study's conceptual framework integrates concepts from both the Health Belief Model and the Transtheoretical Model. These specific aims correspond to three phases: a qualitative phase, a developmental phase, and an intervention phase. The combination of this progressive research project and the structured training plan will prepare the applicant to meet the long-term goal of becoming an independent investigator, by allowing her to develop skills in mixed methodology, refine skills in advanced quantitative research methods, incorporate communication in cancer control theory and principles, and demonstrate the ability to integrate knowledge and experience related to health disparities and cancer control into the design and implementation of a randomized controlled clinical trial. In addition, the results from the proposed project will form the foundation for further research to promote the use of screening mammography among this vulnerable group of women.