Enhancing the Effectiveness of Community Health Workers to Reduce Cervical Cancer Disparities in African American Women

提高社区卫生工作者的有效性，减少非裔美国妇女的宫颈癌差异

基本信息

批准号：
10710217
负责人：
DOUGLAS W BILLINGS
金额：
$ 70.94万
依托单位：
ISA ASSOCIATES, INC.
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-23 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10710217
关键词：
Adherence African American African American population Age Attention Behavior Therapy Benchmarking Breast Cancer Prevention Caring Case Management Cellular Phone Cervical Cervical Cancer Screening Communication Communities Community Health Aides Complex Computer software Consultations Data Development Devices Diagnosis Diagnostic Disease Disparity Effectiveness Electronic Health Record Emotional Funding Goals Health Personnel Health Promotion and Education Health education Hispanic Hysterectomy Incidence Insurance Intervention Interview Knowledge Lesion Malignant Neoplasms Malignant neoplasm of cervix uteri Marketing Measures Medical Morbidity - disease rate National Cancer Institute Not Hispanic or Latino Online Systems Participant Patients Performance Phase Pilot Projects Provider Public Health Randomized Research Resolution Risk Assessment Screening for cancer Self Efficacy Services Testing Text Messaging Time Transportation Trust Tumor stage Underserved Population Uninsured Woman Work black patient black women cancer care cancer health disparity cancer prevention dashboard design effectiveness evaluation follow-up health literacy improved member mortality mortality disparity outreach patient navigation premalignant product development programs prototype screening screening disparities screening guidelines skills socioeconomic disadvantage success tool treatment as usual video delivery

项目摘要

PROJECT SUMMARY/ABSTRACT The hysterectomy-corrected incidence of cervical cancer (CC) is more than 40% higher among African American women than white women. Black women are also twice as likely to die from CC. It does not have to be this way. Widespread screening and proper follow-up would eliminate most new cases of CC because the natural progression of precancerous cervical lesions is slow, allowing for treatment and cure. The best evidence indicates that this is not happening. Adherence to screening guidelines is too low among Black women. One promising solution to this problem is patient navigation (PN). PN was originally developed to help socioeconomically disadvantaged Black women overcome the systemic, provider, and personal barriers to timely cancer prevention and care using community members as lay navigators. Recently, however, there has been a general shift away from navigating poor and uninsured patients, towards higher SES patients in better funded, more comprehensive cancer care centers. While nearly all can benefit from PN, if not targeted to those most in need, delivering these services to more privileged patients can exacerbate disparities. In previous pilot work, we developed and tested a prototype, mobile PN intervention for both African American women (mNav) and lay navigators (mNav-D) to reduce CC health disparities. These products are front-ends to the same server-based program, and thus fully integrated. For patients, mNav includes an integrated web-based risk assessment that allows our SMS software app to select and deliver videos and text messages specific to each woman’s particular cervical screening challenges. Pilot work with 42 African American women ages 21 to 65 informed the development of this product. For lay navigators, mNav-D provides an “at a glance” overview of key performance metrics while also supporting easy entry of encounter- level patient data. Development of this product was informed by formative research with 16 PNs working in a range of settings. We also interviewed 12 participants who either had upstream or downstream touch points with electronic health record (EHR) workflows. The data across these pilot studies strongly supports the feasibility and potential effectiveness of these products, far exceeding the proposed benchmarks. During Phase II we will complete development of mNav and mNav-D in consultation with our three content experts. We will then examine the effectiveness of mNav and mNav-D to increase adherence to cervical screening guidelines via medical review among nonadherent African American women. Participants will be randomly assigned to either the intervention condition (PN + mNav/mNav-D) or to usual care (PN only). Secondary measures will assess cancer screening knowledge, benefits and barriers of cancer screening, and intentions.

项目概要/摘要非洲人经子宫切除术纠正的宫颈癌 (CC) 发病率高出 40% 以上美国女性死于 CC 的可能性也是白人女性的两倍。通过这种方式，广泛的筛查和适当的后续行动将消除大多数新的 CC 病例，因为自然宫颈病变进展缓慢，是治疗和治愈的最佳证据。表明黑人女性对筛查指南的遵守率太低。患者导航 (PN) 最初是为了帮助解决这一问题而开发的。社会弱势黑人女性克服了系统性、提供者和个人的障碍然而，最近，利用社区成员作为非专业导航员进行及时的癌症预防和护理。这是一个普遍的转变，从引导贫困和没有保险的患者转向生活条件较好、社会经济地位较高的患者虽然几乎所有中心都可以从 PN 中受益，但如果不是针对这些中心的话。如果向最需要帮助的患者提供这些服务，可能会加剧不平等。在之前的试点工作中，我们开发并测试了针对非洲和非洲的移动 PN 干预原型美国女性 (mNav) 和非专业导航员 (mNav-D) 可以减少 CC 健康差异。前端连接到同一基于服务器的程序，因此对于患者来说，mNav 包括一个。基于网络的集成风险评估，允许我们的短信软件应用程序选择和传送视频和文本与 42 名非洲女性开展试点工作，针对每位女性面临的特定宫颈筛查挑战发布信息。 mNav-D 的开发面向 21 至 65 岁的美国女性。提供关键绩效指标的“一目了然”概述，同时还支持轻松输入遭遇- 该产品的开发基于 16 个 PN 的形成性研究。我们还采访了 12 位有上游或下游接触点的参与者。这些试点研究的数据有力地支持了电子健康记录 (EHR) 工作流程。这些产品的可行性和潜在有效性，远远超出了建议的基准。在第二阶段，我们将与我们的三个团队协商完成 mNav 和 mNav-D 的开发然后，我们将检查 mNav 和 mNav-D 提高颈椎病依从性的有效性。通过对不遵守规定的非洲裔美国女性进行医学审查的筛查指南。随机分配至干预条件（PN + mNav/mNav-D）或常规护理（仅限 PN）。次要措施将评估癌症筛查知识、癌症筛查的益处和障碍，以及意图。