Developing and evaluating scalable and culturally relevant interventions to improve breast cancer screening among White Mountain Apache women

制定和评估可扩展且与文化相关的干预措施，以改善白山阿帕奇妇女的乳腺癌筛查

• 批准号: 10223758
• 负责人: Mary Allison Barlow
• 金额: $ 24.05万
• 依托单位: WHITE MOUNTAIN APACHE TRIBE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10223758
• 关键词: Address; Age; Alaska Native; American Indians; Apache; Arizona; Breast Cancer Detection; Breast Cancer Early Detection; Breast Cancer Patient; Breast Cancer Risk Factor; COVID screening; COVID-19; COVID-19 pandemic; Caring; Clinic; Communities; Continuity of Patient Care; Data Collection; Diagnosis; Disease; Distant; Education; Educational Curriculum; Epidemiology; Ethnic Origin; Family; Focus Groups; Funding; Goals; Grant; Health; Healthy People 2020; Individual; Intervention; Interview; Learning Module; Mammography; Morbidity - disease rate; Motivation; Names; Native American Research Center for Health; Outpatients; Patients; Physical activity; Population; Process; Provider; Race; Randomized; Readiness; Recording of previous events; Research; Resources; Rural Population; Schedule; Stress; Survival Rate; System; Tablets; Testing; Time; Transportation; Visit; Voice; White Mountain Apache; Woman; Women' s Health; Work; aged; arm; base; behavior change; breast cancer survival; cancer care; community based participatory research; coronavirus disease; data format; design; efficacy evaluation; evidence base; experience; improved; learning community; mHealth; malignant breast neoplasm; mortality; nutrition; obesity risk; peer; screening; telephone coaching; tool; tribal community; tribal lands; tribal leader; uptake

PROJECT SUMMARY White Mountain Apache (WMA) leaders have voiced an urgent need to prioritize breast cancer screening research in NARCH XI due to concern about low screening rates. As of 2018, screening rates among eligible WMA women were more than 2 times lower than the Healthy People 2020 target, 39.1% compared to 81.1%, and substantially lower than screening rates among AI/AN women nationally. In Arizona (AZ), where the WMA tribal lands are located, 32% of AI women are diagnosed at later stage disease (i.e., either regional or distant vs. local disease) compared to 25% of AZ women overall. There is a great need for culturally appropriate interventions to improve screening rates and reduce mortality and morbidity from breast cancer in the WMAT population. This project will support the WMA-JHU partners and our established cancer care Community Advisory Board to design two motivational tools based on findings regarding barriers and facilitators to breast screening among Apache women, and he shortage of providers’ time and resources to provide clinic- based education. The first tool will be delivered on a tablet in the clinic with highly graphic, culturally congruent breast-cancer screening information. It is named Tablet-based Education to improve Acceptance of Mammography” or “TEAM.” The second tool will be an Individual-based one-to-one peer-educational module delivered by a paraprofessional Apache women’s health coach, called “COACH,” to address individuals’ personal barriers and facilitators to breast cancer and screening concerns and provide one-to-one support for scheduling, transportation and completing a mammogram. We will evaluate these intervention tools through an RCT with n= 500 women aged 50+ who receive a mammography referral after a local outpatient visit. Women will be stratified by prior history of mammography (never or ever) and age (<65 or 65+), and then randomized 1:1 to receive either TEAM alone or TEAM+Coach. The WMA-JHU partners bring extensive experience building and evaluating motivational behavior change curricula delivered one-on-one and with mobile health tools that have now been scaled to >140 tribal communities across 21 states.

项目概要 白山阿帕奇 (WMA) 领导人表示迫切需要优先考虑乳腺癌筛查 由于担心筛查率较低，NARCH XI 进行了研究 截至 2018 年，筛查率 符合资格的 WMA 女性比例比 2020 年健康人口目标低 2 倍多，即 39.1% 相比之下，全国 AI/AN 女性的筛查率为 81.1%。 WMA 部落土地所在的亚利桑那州 (AZ)，32% 的 AI 女性在后期才被诊断出来 与 25% 的 AZ 女性相比，存在疾病（即区域性或远处性疾病与局部疾病）。 非常需要采取适合文化的干预措施来提高筛查率并降低死亡率 WMAT 人群中乳腺癌的发病率。 该项目将支持 WMA-JHU 合作伙伴和我们已建立的癌症护理社区咨询 委员会根据有关乳房障碍和促进因素的调查结果设计两种激励工具 对阿帕奇妇女进行筛查，并且提供者缺乏提供临床服务的时间和资源 第一个工具将在诊所的平板电脑上提供，具有高度图形化、文化性。 它被称为基于平板电脑的教育，以改善。 “接受乳房X光检查”或“团队”。第二个工具将是基于个人的一对一工具。 由一名专业阿帕奇妇女健康教练提供的同伴教育模块，称为 “COACH”，旨在解决个人乳腺癌和筛查的个人障碍和促进因素 关注并为安排、运输和完成乳房 X 光检查提供一对一的支持。 我们将通过一项随机对照试验来评估这些干预工具，该随机对照试验涉及 500 名 50 岁以上女性，她们接受了 当地门诊就诊后进行乳房X光检查转诊的女性将根据既往病史进行分层。 乳房 X 光检查（从未或曾经）和年龄（<65 或 65+），然后按 1:1 随机分配接受任一团队 单独或团队+教练 WMA-JHU 合作伙伴带来丰富的构建和评估经验。 动机行为改变课程是一对一提供的，并使用移动健康工具，这些工具现在已经 已扩展到 21 个州的超过 140 个部落社区。