Health Literacy Intervention and Cancer Screening

描述（申请人提供）：我们的主要目标是：1）测试诊所范围内的健康素养（HL）干预措施的有效性，以改善联邦合格卫生中心（CIMCs）合格患者中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干预措施的有效性，有和没有预防护士病例管理员（PNCM），对慢性丙型肝炎患者的筛查率。次要目标是：3）评价HL干预措施在改善这些低收入患者对CRC和乳腺癌筛查的理解、准备、信念和自我效能方面的有效性; 4）探索促进或阻碍这些低收入患者首次和重复使用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的差异是国家的优先事项。收入较低和识字技能较低的人对CRC和乳腺癌筛查的知识较少，态度较差，并且没有接受适当筛查的风险更大。非裔美国人和低收入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长期的系统级干预措施，以解决卫生知识普及障碍和改善卫生成果。此外，改善癌症筛查的干预措施需要超越初步筛查，并侧重于改善重复筛查。本申请解决了这些问题。我们提出了一项为期五年的多地点随机对照试验，以评估患者和提供者/系统指导的干预措施的有效性，以克服由有限的健康素养和文化影响造成的乳腺癌和CRC筛查障碍。具体而言，在三组研究中，将NSCLC随机分配接受1）HL干预（患者教育和持续的提供者培训，使用检查表和CQI进行提示，以及癌症筛查计算机化跟踪系统的实施2）HL干预加PNCM（HL+ PNCM）提供病例管理，以克服系统级障碍，并为患者提供持续支持，以改善理解、准备、自我效能，以及完成初次和重复癌症筛查或3）仅使用计算机跟踪系统的标准护理。健康素养干预措施建立在调查人员以前的广泛研究基础上，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.