Health Literacy Intervention and Cancer Screening

描述(由申请人提供)：我们的主要目标是：1)测试全诊所健康素养(HL)干预措施的有效性，以改善联邦合格健康中心(FQHC)符合条件的患者首次和重复使用结直肠癌(CRC)和乳腺癌筛查的情况；2)比较HL干预措施在有和没有预防护士病例经理(PNCM)的情况下对FQHC患者筛查率的有效性。第二个目标是：3)评估HL干预措施的有效性，以提高这些FQHC患者对结直肠癌和乳腺癌筛查的了解、准备情况、信念和自我效能；4)探索在这些低收入患者中促进或阻碍首次和重复使用CRC和乳腺癌筛查的患者、提供者和系统因素。消除癌症筛查和结果方面的差异是国家的优先事项。收入较低、识字能力较低的人，对结直肠癌和乳腺癌筛查的知识较少，态度较差，没有接受适当筛查的风险更大。非裔美国人和收入较低的成年人识字能力有限的比例要高得多。联邦卫生机构最近的报告呼吁采取循证战略和更长期的系统一级干预措施，以解决卫生知识普及障碍和改善卫生结果。此外，改善癌症筛查的干预措施需要超越初始筛查，并将重点放在改善重复筛查上。该应用程序解决了这些问题。我们提出了一项为期五年的多点随机对照试验，以评估患者和提供者/系统指导的干预措施的有效性，以克服由于有限的健康素养和文化影响而导致的乳房和结直肠癌筛查障碍。具体来说，在三项ARM研究中，FQHC被随机分配接受1)HL干预(患者教育和持续的提供者培训，带清单提示，CQI，以及实施癌症筛查的计算机化跟踪系统2)HL干预加PNCM(HL+PNCM)，以提供病例管理，以克服系统层面的障碍和为患者提供持续支持，以提高患者对癌症的理解、准备情况、自我效能和完成首次和重复癌症筛查；3)仅使用计算机跟踪系统的标准护理。健康素养干预建立在调查人员之前广泛的研究基础上，并以多理论模型为基础。

DESCRIPTION (provided by applicant): Our primary aims are to: 1) test the effectiveness of a clinic-wide, health literacy (HL) intervention to improve initial and repeat use of colorectal (CRC) and breast cancer screening among eligible patients at Federally Qualified Health Centers (FQHCs) and 2) compare the effectiveness of the HL intervention, with and without a Prevention Nurse Case Manager (PNCM), on the screening rates of FQHC patients. The secondary aims are to: 3) evaluate the efficacy of the HL interventions to improve understanding, readiness, beliefs and self- efficacy toward CRC and breast cancer screening among patients at these FQHCs and 4) explore patient, provider, and system factors that facilitate or impede initial and repeat use of CRC and breast cancer screening among these low income patients. Eliminating disparities in cancer screening and outcomes is a national priority. Individuals with lower income and lower literacy skills have less knowledge and poorer attitudes concerning CRC and breast cancer screening and are at greater risk for not having received appropriate screening. African Americans and adults with low income have significantly higher rates of limited literacy skills. Recent reports by federal health agencies have called for evidence based strategies and longer-term system-level interventions to address health literacy barriers and improve health outcomes. Further, interventions to improve cancer screening need to move beyond initial screening and focus on improving repeat screening. This application addresses these concerns. We propose a five year multi-site, randomized controlled trial to evaluate the effectiveness of a patient and provider/ system-directed intervention to overcome barriers to breast and CRC screening caused by limited health literacy and cultural influences. Specifically, in the three arm study FQHCs are randomly assigned to receive either 1) the HL Intervention (patient education and ongoing provider training, prompting with a checklist, and CQI, as well as implementation of a computerized tracking system for cancer screening 2) the HL Intervention plus a PNCM (HL+ PNCM) to provide case management to overcome system-level barriers and to provide patients ongoing support to improve understanding, readiness, self-efficacy, and completion of initial and repeat cancer screening or 3) standard care with computer tracking system only. The health literacy interventions build off of extensive previous research by the investigators and are grounded in a multi-theoretical model.