Health Literacy Intervention and Cancer Screening

描述（由申请人提供）：我们的主要目的是：1)测试临床范围内的健康素养（HL）干预的有效性，以改善联邦合格健康中心（FQHC）合格患者对结直肠癌（CRC）和乳腺癌筛查的初始和重复使用；2)比较HL干预在有和没有预防护士病例管理（PNCM）的情况下对FQHC患者筛查率的有效性。次要目的是：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理解、准备、信念和自我效能；4)探索促进或阻碍这些低收入患者首次和重复使用结直肠癌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。收入较低和文化水平较低的个体对结直肠癌和乳腺癌筛查的知识和态度较差，并且没有接受适当筛查的风险更大。非裔美国人和低收入成年人读写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基于证据的战略和长期的系统级干预措施，以解决卫生素养障碍并改善健康结果。此外，改善癌症筛查的干预措施需要超越初始筛查，并注重改善重复筛查。这个应用程序解决了这些问题。我们建议进行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引起的乳腺癌和CRC筛查障碍。具体来说，在三组研究中，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，用清单和CQI提示，以及实施计算机化的癌症筛查跟踪系统）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，以提高理解，准备，自我效能，完成最初和重复的癌症筛查或仅使用计算机跟踪系统的标准治疗。健康素养干预建立在调查人员先前广泛研究的基础上，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.