A Collectivist Approach to Cervical Cancer Screening Among Latinos

描述（由申请人提供）：拉丁裔和其他少数民族对宫颈癌的筛查不足，因此承担了不成比例的疾病和死亡负担。有迹象表明，社会支持可以提高筛查率，但提供这种支持的最佳方式及其作用机制尚未得到明确研究。该K奖将提供在服务不足的人群中进行癌症筛查行为试验所需的技能培训。培训目标是：1)掌握行为干预试验设计和分析的必要技能；2)进一步开展与文化相关的社会生态和行为理论培训，以指导干预设计；3)培养定性与定量数据分析相结合的技能。培训目标将通过课程、研究所、讲习班和定向研究来实现。关于这些目标，研究部分将作为获得统计技能（纵向、调解和调节分析）、根据定性数据编制定量量表和定性地研究纵向分析中的不寻常（“偏差”）结果的训练基地。拟议的研究议程将确定在同侪征聘的94名拉丁妇女中采用集体主义方法进行筛选（“集体访问”）的可行性。最终目标是完善程序，用于随机行为试验，在拉丁裔和非裔美国人中测试这种方法，我假设，这将增加对筛查指南的遵守。具体目标是：1)评估“新增长地区”（快速增长但仍然孤立的拉丁裔社区）拉丁裔群体访问的可行性；2)通过纵向调查来评估拉丁裔群体访视对癌症筛查相关结果的影响，以比较结果，并得出这些结果的点估计、变异性测量和效应大小；3)通过分析妇女群体访问的经验，探索集体主义倾向于使用巴氏试验进行癌症筛查的社会心理基础：a)制定和试点测试有关集体主义筛查和社会支持的文化基础调查问题；b)揭示纵向分析中主要结果变量的“异常”结果。相关性：如果成功，团体访问方法有可能提供符合文化的护理，从而提高对筛查指南的遵守程度，从而预防疾病和死亡，并节省医疗保健费用。它还将推进自然社会网络和家庭在癌症筛查方面的整合知识。

DESCRIPTION (provided by applicant): Latinas and other minorities are underscreened for cervical cancer and share a disproportionate burden of disease and death due to this cause. There are indications that social support can improve screening rates, but the best way to deliver such support and the mechanism through which it acts upon have not been clearly studied. This K award will provide training in skills needed to conduct behavioral trials on cancer screening among underserved populations. The training goals are: 1) To acquire the necessary skills to design and analyze behavioral intervention trials; 2) To further develop training in culturally relevant social ecological and behavioral theories to guide intervention designs; and 3) To hone skills in the integration of qualitative and quantitative data analysis. The training goals will be achieved via courses, institutes, workshops, and directed studies. In relation to these goals, the research component will serve as training ground for acquiring statistical skills (longitudinal, mediation and moderation analyses), creating of quantitative scales based on qualitative data, and qualitatively studying unusual ("deviant") results in longitudinal analysis. The proposed research agenda will establish the feasibility of a collectivist approach to screening ("group visits") among 94 Latina women recruited by peers. The ultimate goal is to refine procedures to be used in a randomized behavioral trial to test this approach among Latinas and African Americans, which I hypothesize, will increase adherence to screening guidelines. The Specific Aims are to 1) Assess the feasibility of group visits among Latinas in "new growth areas" (fast growing but still isolated Latino communities); 2) Assess the effect of group visits on cancer screening related outcomes among Latinas using longitudinal surveys to compare outcomes and to derive point estimates, measures of variability and effect sizes on these outcomes; and 3) Explore the psychosocial basis for a collectivist orientation to cancer screening using Pap tests by analyzing women's experiences with group visits to a) develop and pilot test culturally-grounded survey questions regarding collectivist screening and social support, and b) shed light on "outlier" results in main outcome variables in longitudinal analysis. RELEVANCE: If successful, the group visit approach has the potential to deliver culturally competent care and therefore improve compliance with screening guidelines, thus preventing disease and deaths and also resulting in healthcare cost savings. It will also advance knowledge in the integration natural social networks and the family in cancer screening.