Developing a Peer Coach Program to Improve Adherence Rates for Colonoscopy

制定同伴辅导计划以提高结肠镜检查的依从率

• 批准号: 8844246
• 负责人: Shanhaz Sultan
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-01-01 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8844246
• 关键词: Address; Adherence; Advertising; Appointment; Award; Awareness; Behavior; Cancer Etiology; Catchment Area; Cessation of life; Characteristics; Chronic; Clinical; Colon; Colonoscopy; Communication; Community Outreach; Data; Demographic Factors; Development; Diagnostic; Educational Materials; Effectiveness; Ensure; Evaluation; Focus Groups; Future; Health; Hepatitis C; Imagery; Incidence; Individual; Interferons; Intervention; Interview; Knowledge; Language; Learning; Logistic Regressions; Manuals; Medical Electronics; Mentors; Methods; Modeling; Morbidity - disease rate; Outcome; Pilot Projects; Process; Process Assessment; Provider; Psychosocial Factor; Qualitative Research; Recruitment Activity; Research; Research Technics; Resources; Sampling; Schedule; Self Management; Services; Site; Solutions; Sultan; System; Techniques; Telephone; Telephone Interviews; Testing; Training; Training Programs; Treatment Cost; United States; Veterans; Work; base; behavior change; behavior prediction; colorectal cancer screening; contextual factors; design; effective intervention; follow-up; improved; literacy; mortality; motivational enhancement therapy; multi-component intervention; peer; predictive modeling; primary outcome; programs; prototype; psychosocial; screening; skills; therapy development; user-friendly; volunteer

DESCRIPTION (provided by applicant): BACKGROUND: CRC is the third leading cause of cancer-related deaths in the United States. Colonoscopy, an invasive test that allows for direct visualization of the colon, is the most common test used to screen for CRC. Non-adherence to colonoscopy (estimated to be 25% to 45%) represents a significant problem and contributes to CRC-related morbidity and mortality. A multi-component intervention using peer coaches has the potential to improve adherence since it allows for individualized tailored support and can be used to modify multiple factors that are necessary for behavior change (increased adherence). METHODS: Dr. Sultan and her mentoring team will develop a multi-component peer coach intervention (MCPCI), based on the theoretical framework of the Integrative Model of Behavior Prediction, to increase colonoscopy adherence rates among veterans. Using qualitative research techniques, focus groups will be conducted to determine the factors that veterans perceive as barriers and facilitators for colonoscopy completion (Aim 1a). Findings from this study will be directly used to develop a Peer Coach Toolkit, which will be a manual to be used by peer coaches as part of the MCPCI. This Toolkit will contain educational materials, texted scripts for motivating veterans to be adherent, and strategies to overcome the most commonly identified barriers to colonoscopy completion. This Toolkit will be field-tested and refined using focus groups of veterans and providers (Aim 1b). Aim 2 consists of recruiting, training, and developing a formal peer coach training program, which will include motivational interviewing techniques. Aim 3 will consist of conducting two separate pilot studies. Pilot study #1 will identify characteristics associated with adherence to colonoscopy for development of a prototype predictive model. Using a random convenience sample of 218 veterans referred for screening and diagnostic colonoscopy, information regarding clinical, demographic, and psychosocial characteristics will be obtained using telephone interviews and electronic medical chart review. The primary outcome will be adherence to colonoscopy. Multivariate logistic regression will be used to develop a prototype predictive model. Pilot study #2 will test the feasibility of telephone- based peer coach interviews using the MCPCI in a random convenience sample of 215 veterans referred for screening and diagnostic colonoscopy. Veterans, who are likely to be non- adherent using the prototype predictive model, will be assigned a peer coach. Peer coaches will use the Peer Coach Toolkit to deliver the MCPCI via the telephone. Primary outcome will process outcomes related to feasibility of telephone interviews. For Aim 4 we will conduct a formative evaluation to optimize the MCPCI prior to formal testing. SIGNIFICANCE: The incidence of CRC in veterans is currently estimated to be 4,000 cases annually. Programs that successfully improve adherence to colonoscopy completion are critical for reducing CRC-related morbidity and mortality among veterans.

描述（由申请人提供）： 背景：CRC是美国与癌症相关死亡的第三大主要原因。结肠镜检查是一种可直接可视化结肠的侵入性测试，是用于筛选CRC的最常见测试。对结肠镜检查的不遵守（估计为25％至45％）是一个重大问题，并有助于与CRC相关的发病率和死亡率。使用同伴教练的多组分干预有可能提高依从性，因为它允许个性化量身定制的支持，并且可以用于修改行为改变所需的多个因素（提高依从性）。方法：基于行为预测的综合模型的理论框架，苏丹博士和她的指导团队将开发多组分的同伴干预（MCPCI），以提高退伍军人之间的结肠镜检查率。使用定性研究技术，将进行焦点小组，以确定退伍军人认为是结肠镜检查完成的障碍和促进因子的因素（AIM 1A）。这项研究的发现将直接用于开发同伴教练工具包，该工具包将是同伴教练用作MCPCI的一部分的手册。该工具包将包含教育材料，文本脚本，以激发退伍军人的遵守，以及克服最常见的结肠镜检查障碍的策略。该工具包将使用退伍军人和提供商的焦点组（AIM 1B）进行现场测试和完善。 AIM 2包括招募，培训和制定正式的同伴教练培训计划，其中包括励志面试技术。 AIM 3将包括进行两项独立的试点研究。初步研究＃1将确定与遵守结肠镜检查有关开发原型预测模型的特征。使用向筛查和诊断结肠镜检查的218名退伍军人的随机便利样本，将使用电话访谈和电子医学图表审查获得有关临床，人口统计学和社会心理特征的信息。主要结果将是遵守结肠镜检查。多元逻辑回归将用于开发原型预测模型。试点研究＃2将在215名退伍军人的随机便利样本中使用MCPCI进行基于电话的同伴教练访谈的可行性，这些退伍军人参考了筛查和诊断结肠镜检查。退伍军人可能会使用原型预测模型来遵守，他们将被分配为同伴教练。同行教练将使用同行教练工具包通过电话交付MCPCI。主要结果将处理与电话访谈的可行性有关的结果。对于AIM 4，我们将进行形成性评估，以在正式测试之前优化MCPCI。意义：当前，退伍军人中CRC的发生率每年估计为4,000例。成功提高遵守结肠镜检查的计划对于降低与CRC相关的发病率和死亡率至关重要。