Comparative Effectiveness of Interventions to Improve Screening Among Rural Women

改善农村妇女筛查干预措施的比较有效性

• 批准号: 8987262
• 负责人: Victoria Lee Champion
• 金额: $ 65.62万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-13 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8987262
• 关键词: Accounting; Address; Adherence; Age; Appalachian Region; Area; Behavior; Behavioral Risk Factor Surveillance System; Breast; Cancer Burden; Cervical; Classification; Colonoscopy; Colorectal; Colorectal Cancer; Communities; County; Depressed mood; Diagnosis; Effectiveness; Effectiveness of Interventions; Environment; Fecal occult blood; Female; Goals; Guideline Adherence; Guidelines; Health; Health behavior; Health behavior change; Indiana; Individual; Intervention; Life; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Mammography; Maps; Medical Records; Modeling; Ohio; Outcome; Pap smear; Patients; Population Group; Prevalence; Preventive; Randomized; Research; Resources; Rural; Rural Population; Screening for cancer; Site; Source; Surveys; Telephone; Testing; Underserved Population; United States; Woman; Work; base; behavior test; cancer health disparity; colorectal cancer screening; comparative; comparative effectiveness; compare effectiveness; computer program; cost effective; cost effectiveness; experience; health disparity; improved; innovation; malignant breast neoplasm; mortality; public health relevance; screening; social; socioeconomics; theories; treatment as usual

 DESCRIPTION (provided by applicant): In 2014 approximately 310,030 women in the United States (U.S.) will be diagnosed with breast cancer (BC), cervical cancer (CC), or colorectal cancer (CRC), and 68,060 women will die from these cancers. These three cancers account for 39% of the cancer burden and 25% of the cancer mortality among women in the U.S. Although effective screening tests are widely available for all three cancers, many women do not adhere to screening guidelines. Furthermore, the burden of these cancers is higher among some population groups and regions. Thirty-two rural counties in northwest Ohio and northeast Indiana share similar socioeconomically underserved populations of predominately (96.2%) white women who have elevated BC, CRC, and CC mortality rates, and lower screening rates with mammography, Pap tests, and fecal occult blood testing or colonoscopy. No known intervention has addressed improving screening rates for these three main female cancers simultaneously, even though multiple health behavior change research is emerging as a new model to change the way in which interventions can be packaged. The proposed project uses an overall theoretical framework to understand health disparities which includes individual, social and community level variables, and a conceptual model for the intervention which uses a multiple behavior theoretical approach, all of which have demonstrated efficacy in improving adherence to single screening test behaviors, as well as other preventive health behaviors. The goal of this proposal is to test the comparative effectiveness of a tailored interactive computer program delivered via DVD (TIDVD) vs. a TIDVD + telephone-based patient navigation (PN) intervention (TNI) vs. Usual Care (UC) to increase guideline-based screening rates for BC, CC, and CRC among women age 50 to 74 living in these rural counties of Ohio and Indiana. Specific aims are to: 1) compare the effectiveness of a tailored and interactive DVD (TIDVD) vs. TIDVD + telephone-based PN intervention (TNI) vs. UC, to increase guideline-based cancer screening rates at 12 months post randomization for BC, CC, and CRC among 1058 women age 50 to 74 living in rural northwest Ohio and northeast Indiana; and 2) compare the cost effectiveness of the TIDVD and the TIDVD + TNI intervention vs. UC, for adherence to each screening outcome or combination of screening tests. As an Exploratory Aim, we will identify associations between theoretical variables (community, social, and individual) and screening outcomes, including interactions with the interventions. If found to be cost effective, either or both interventions hae the potential to be immediately disseminated to increase BC, CC, and CRC screening rates and ultimately reduce cancer disparities for underserved rural women.

 描述（由申请人提供）： 2014 年，美国 (U.S.) 约有 310,030 名女性将被诊断患有乳腺癌 (BC)、宫颈癌 (CC) 或结直肠癌 (CRC)，并且 68,060 名女性将死于这些癌症这三种癌症占美国女性癌症负担的 39% 和癌症死亡率的 25%。尽管有效的筛查测试已广泛使用对于所有三种癌症，许多妇女不遵守筛查指南，而且，俄亥俄州西北部和印第安纳州东北部的 32 个农村县的人口中，这些癌症的负担较高（96.2）。 %) BC、CRC 和 CC 死亡率较高，而乳房 X 光检查、巴氏涂片检查、粪便潜血检测或结肠镜检查筛查率较低的白人女性，目前尚无已知的干预措施能够提高这三种主要疾病的筛查率。尽管多种健康行为改变研究正在作为一种新模型出现，以改变干预措施的包装方式，但拟议的项目使用总体理论框架来了解包括个人、社会和社区层面变量在内的健康差异，以及使用多种行为理论方法的干预概念模型，所有这些都已证明可以有效提高对单一筛查测试行为以及其他预防性健康行为的依从性。该提案的目标是测试各种行为的相对有效性。通过 DVD (TIDVD) 提供的定制交互式计算机程序与 TIDVD + 基于电话的患者导航 (PN) 干预 (TNI) 与常规护理 (UC) 相比，以提高居住在这些农村县的 50 至 74 岁女性中基于指南的 BC、CC 和 CRC 筛查率俄亥俄州和印第安纳州的具体目标是： 1) 比较定制交互式 DVD (TIDVD) 与 TIDVD + 基于电话的 PN 干预 (TNI) 与 UC 的有效性，以提高基于指南的癌症筛查率 12在俄亥俄州西北部农村地区和印第安纳州东北部地区的 1058 名 50 至 74 岁女性中进行 BC、CC 和 CRC 随机分组后几个月；2) 比较 TIDVD 和 TIDVD + TNI 干预与 UC 的成本效益，以了解每种干预措施的依从性作为探索性目标，我们将确定理论变量（社区、社会和个人）与筛查结果之间的关联，包括与干预措施的相互作用（如果发现其中之一或两者具有成本效益）。干预措施有可能立即传播，以提高 BC、CC 和 CRC 筛查率，并最终减少服务不足的农村妇女的癌症差异。