Development of a Cervical Cancer Screening Program for Refugee Women

 自1975年以来，已有300多万难民在美国重新定居。目前，所有新接纳的难民中约有一半来自不丹或缅甸。建议所有21-65岁的女性定期进行宫颈癌筛查。难民群体的宫颈癌发病率非常高，而宫颈癌筛查率非常低。疾病控制和预防中心的指导方针规定，难民妇女在重新安置期间应尽早接受宫颈癌检查。多个组织向新到和最近抵达的难民提供服务;这些组织包括自愿重新安置机构、互助协会、族裔社区组织、地方卫生部门和为弱势群体服务的保健设施。我们的长期目标是评估针对难民妇女在重新安置期间的背景相关宫颈癌控制计划。该方案将涉及使用文化定制的视频，以及获得筛查服务（即导航）的后勤援助。难民重新安置组织人员将执行干预措施。这一发展性应用有以下目标：（1）通过重点小组研究，查明和描述难民妇女中子宫颈癌筛查的障碍和促进因素;（2）制作符合文化特点的教育和激励子宫颈癌筛查录像（可用于多种重新安置环境）;（3）干预方案试点测试（视频使用和后勤援助），并对该方案进行探索性评估;（4）通过与难民安置组织代表的关键线人访谈，评估难民组织在安置过程中实施我们干预计划的准备情况。该研究小组拥有与难民社区和重新安置组织合作的丰富经验，并在弱势群体中开展宫颈癌控制研究。我们的研究将在华盛顿州进行。这项发展研究将侧重于来自不丹和缅甸的难民妇女（她们对西方的卫生系统以及癌症和预防保健的概念特别不熟悉）。然而，我们的干预计划可以在未来适用于其他难民群体。我们将在整个项目中与社区咨询小组（包括难民重新安置组织的代表）合作。弱势群体行为模式将指导我们对难民妇女研究的各个方面。韦纳的组织准备理论将指导我们与难民安置组织代表的关键线人访谈。我们的探索性评估将包括评估视频对中间结果的潜在影响（例如知识和筛查意图），视频的可接受性（即妇女对视频的满意度）以及对后勤援助的需求（即妇女对后勤援助的接受）。

 DESCRIPTION (provided by applicant): Since 1975, more than 3 million refugees have been resettled in the United States. Currently, about one-half of all newly admitted refugees are from Bhutan or Burma. Regular cervical cancer screening is recommended for all women ages 21-65. Refugee groups have very high cervical cancer incidence rates and very low cervical cancer screening rates. Centers for Disease Control and Prevention guidelines specify that refugee women should be offered cervical cancer screening early in their resettlement period. Multiple organizations provide services to newly and recently arrived refugees; these organizations include voluntary resettlement agencies, mutual assistance associations, ethnic community organizations, local health departments, and health care facilities that serve vulnerable groups. Our long-term goal is to evaluate a contextually relevant cervical cancer control program targeting refugee women during their resettlement. The program would involve use of culturally tailored videos, as well as logistic assistance accessing screening services (i.e. navigation). Refugee resettlement organization personnel would implement the intervention components. This developmental application has the following objectives: (1) Through focus group research, identify and describe cervical cancer screening barriers and facilitators among refugee women; (2) Develop culturally tailored educational and motivational cervical cancer screening videos (that could be used in multiple resettlement settings); (3) Pilot test the intervention program (video use and logistic assistance), and conduct an exploratory evaluation of the program; and (4) Through key informant interviews with representatives from refugee resettlement organizations, assess refugee organizations readiness to implement our intervention program during the resettlement process. The investigator group has extensive experience working with refugee communities and resettlement organizations, as well as conducting cervical cancer control research in vulnerable populations. Our research will be conducted in Washington State. This developmental research will focus on refugee women from Bhutan and Burma (who are particularly unfamiliar with western health systems, as well as concepts of cancer and preventive care). However, our intervention program could be adapted for use with other refugee groups in the future. We will collaborate with a community advisory group (that includes representatives from refugee resettlement organizations) throughout the project. The Behavioral Model for Vulnerable Populations will guide all aspects of our research with refugee women. Weiner's Theory of Organizational Readiness will guide our key informant interviews with representatives from refugee resettlement organizations. Our exploratory evaluation will include assessments of the videos' potential effect on intermediate outcomes (e.g. knowledge and screening intentions), the videos' acceptability (i.e. women's satisfaction with the videos), and demand for logistic assistance (i.e. women's uptake of logistic assistance).