REACH UP & OUT: Eliminating Breast and Cervical Cancer Disparities

描述(由申请人提供)：有充分的文件证明，在与乳腺癌和宫颈癌有关的发病率和死亡率方面，非裔美国人和白人妇女之间存在差异。我们已经建立了一个非常积极的联盟，进行了全面的需求评估，并制定并试行了一项社区行动计划，以减少阿拉巴马州黑带白人和非裔美国女性之间的乳腺癌和宫颈癌筛查差距。尽管这一干预措施有效且受到社区的欢迎，但并未导致目标人群中所有妇女的行为改变。拟议干预的总体目的是通过提高巴氏涂片和乳房X光照相率，进一步减少阿拉巴马州黑带白人和非裔美国女性之间的乳腺癌和宫颈癌差异。我们建议开发和实施一种多成分干预，利用媒体、教育和更好的机会，将社会学和认知行为方法纳入信息的开发和实施中。这项干预是我们利用社区卫生顾问(CHAS)(社会学方法)进行试点工作的延伸。尽管试点干预措施显示，黑带地区非裔美国女性的乳腺癌和宫颈癌筛查人数大幅增加，但仍然有一个难以接触到的群体，尽管我们做出了努力，但他们没有进行乳腺癌和宫颈癌筛查。根据对这组妇女的后续访谈结果以及与我们的联盟成员和CHA的讨论，我们建议开发、实施和评估增强干预措施，其中包括挑战障碍的认知行为方法(例如，害怕发现她们患有癌症，相信筛查不会有任何不同)，并加强激励因素(例如，来自其他女性的支持)，让这一群体参与乳腺癌和宫颈癌筛查。虽然以社区为基础的参与性研究和赋权模式将是本研究的总体概念框架，但PEN-3和健康信念模式将指导干预措施的制定和实施。干预县将接受CHAS提供的教育和认知/行为技能培训，而控制县将继续接受我们目前已被证明成功的干预措施。研究将分两个阶段进行。在第一阶段，我们将通过形成性评估来完善增强的干预和评估工具。在第二阶段，我们将随机将县分为干预/对照组，实施并评估干预措施。

DESCRIPTION (provided by applicant): It has been well documented that disparities exist between African American and white women with regard to morbidity and mortality associated with breast and cervical cancer. We have established a very active coalition, conducted comprehensive needs assessments, and developed and pilot-tested a community action plan to reduce breast and cervical cancer screening disparities between white and African American women in Alabama's Black Belt. Although effective and well received by the community, this intervention did not lead to behavior change among all women within the targeted population. The overall purpose of the proposed intervention is to further reduce breast and cervical cancer disparities between white and African American women in the Black Belt of Alabama by increasing Pap smear and mammography rates. We propose to develop and implement a multi-component intervention that uses media, education, and enhanced access, incorporating sociological and cognitive behavioral approaches in the development and implementation of the messages. This intervention is an extension of our pilot work utilizing community health advisors (CHAs) (sociologic approach). Although the pilot intervention showed significant increase in breast and cervical cancer screening among African American women in the Black Belt, there is still a hard to-reach group, which, despite our efforts, has not engaged in breast and cervical cancer screening. Based on the results of follow-up interviews with this group of women and discussions with our coalition members and CHAs, we propose the development, implementation, and evaluation of an enhanced intervention, which incorporates cognitive behavioral approaches that will challenge the barriers (e.g., fear of finding out they have cancer, the belief that screening will not make any difference) and reinforce the motivators (e.g., support from other women) to engage this group in breast and cervical cancer screening. Although the Community-Based Participatory Research and the Empowerment Model will be the overall conceptual framework used in this study, the PEN-3 and the Health Belief Model will guide intervention development and implementation. The intervention counties will receive education and cognitive/behavioral skills training delivered by CHAs, while the control counties will continue to receive our current intervention that has proven to be successful. The study will be carried out in two phases. In Phase I, we will refine the enhanced intervention and assessment tools through formative assessment. In Phase II, we will randomly assign the counties to intervention/control groups, implement, and evaluate the intervention.