Evidence-Based Approach to Empower Asian American Women in Cervical Cancer Screening

增强亚裔美国女性宫颈癌筛查能力的循证方法

• 批准号: 10590744
• 负责人: Carolyn Y. Fang
• 金额: $ 60.2万
• 依托单位: RESEARCH INST OF FOX CHASE CAN CTR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10590744
• 关键词: Address; American; Asian Americans; Asian population; Belief; Black race; Cervical Cancer Screening; Clinic; Collection; Communities; Community Health Education; Cost Effectiveness Analysis; Cytology; Data; Education; Emerging Technologies; Environment; Environmental Risk Factor; Ethnic Origin; Evidence based program; Expectancy; Future; Goals; Guidelines; HPV-High Risk; Health Personnel; Health Promotion; Healthy People 2020; Hispanic; Hour; Human Papillomavirus; Incidence; Individual; Insurance; Koreans; Language; Limited English Proficiency; Malignant neoplasm of cervix uteri; Mediator; Medical; Not Hispanic or Latino; Pap smear; Participant; Physical environment; Population; Randomized; Recommendation; Reporting; Resistance; Resource-limited setting; Resources; Sampling; Self Efficacy; Site; Subgroup; Testing; Time; United States; United States Preventative Services Task Force; Vietnamese; Woman; community setting; cost; cost effectiveness; demographics; design; empowerment; evidence base; experience; follow-up; health care availability; implementation strategy; improved; incremental cost-effectiveness; medically underserved; mortality; population health; post intervention; programs; psychosocial; racial population; relative cost; screening; screening guidelines; screening participation; screening program; social; social cognitive theory

PROJECT SUMMARY The introduction of the Pap test has led to significant reductions in cervical cancer incidence and mortality in the US. However, screening rates are suboptimal in many Asian American subgroups, and remain persistently lower than rates in non-Hispanic White, non-Hispanic Black, and Hispanic women. Studies report that Korean and Vietnamese American women, in particular, have among the lowest rates of screening compared to other ethnic/racial groups. Multiple factors may contribute to non-screening among Asian American women. Embarrassment, cost, lack of insurance or regular healthcare provider, lack of time, and language difficulties are key barriers to screening in this population. Emerging technologies supporting self-sampling for human papillomavirus (HPV) testing may offer a valuable, evidence-based strategy for empowering Asian American women who have been resistant -- or unable -- to obtain clinic-based cervical cancer screening. National guidelines now include primary HPV screening every 5 years as an appropriate cervical cancer screening strategy. Because HPV self-sampling in non-clinical settings has comparable accuracy to HPV-testing on clinician-obtained samples, self-collection may represent an important strategy for increasing screening rates among underscreened populations. In the United States, the provision of self-sampling kits improved screening rates among women with limited resources and was highly acceptable. Notably, women reported experiencing less embarrassment with self-sampling, and some studies found it improved subsequent participation in clinic- based screening. Although prior studies have demonstrated that HPV self-sampling can be feasibly offered in low-resource community settings, not one study has focused on underserved Asian American women, despite the fact that this population has among the lowest cervical cancer screening rates. Therefore, the goal of the proposed project is to examine HPV self-sampling in a community-based study of 800 Asian American women. Using a matched-pair design, 12 community sites (n=400 women) will receive our previously tested community education program on cervical cancer screening plus navigation, along with HPV self-sampling kits; and 12 community sites (n=400) will receive our previously tested community education program plus navigation to clinic-based screening. The aims of the proposed project are to: (1) Compare rates of providing a self-collected sample vs. obtaining clinic-based screening among 800 Asian American women; (2) Examine mediators of participation; and (3) Assess the relative cost-effectiveness of HPV self-sampling vs. clinic-based screening. Demographics, social/cultural environment, and physical environment factors will be assessed at baseline, post- intervention, and 6-month follow-up. Participation in self-sampling or clinic-based screening will be assessed at 6- month follow-up. The proposed project will be the first large-scale study to evaluate HPV self-sampling among underserved Asian American women. Study findings will inform future evidence-based programs designed to enhance screening participation among Asian American women nationally.

项目概要 巴氏试验的引入显着降低了宫颈癌的发病率和死亡率 美国。然而，许多亚裔美国人亚群体的筛查率并不理想，并且持续存在 低于非西班牙裔白人、非西班牙裔黑人和西班牙裔女性的比率。研究报告称，韩国 与其他地区相比，尤其是越南裔美国女性的筛查率最低 民族/种族群体。多种因素可能导致亚裔美国女性不进行筛查。 尴尬、费用、缺乏保险或定期医疗保健提供者、缺乏时间和语言困难 是对该人群进行筛查的主要障碍。支持人类自我采样的新兴技术 乳头状瘤病毒 (HPV) 检测可能为增强亚裔美国人的能力提供有价值的、基于证据的策略 一直抵制或无法获得基于临床的宫颈癌筛查的女性。国家的 现在的指南包括每 5 年进行一次初级 HPV 筛查作为适当的宫颈癌筛查 战略。因为非临床环境中的 HPV 自我采样与 HPV 检测的准确性相当。 临床医生获得的样本，自行收集可能是提高筛查率的重要策略 在筛查不足的人群中。在美国，提供自采样试剂盒改善了筛查 资源有限的妇女中的这一比率是高度可以接受的。值得注意的是，女性报告称经历过 减少自我采样的尴尬，一些研究发现它改善了随后的临床参与 为基础的筛选。尽管之前的研究表明 HPV 自我采样可以在以下情况下提供： 在资源匮乏的社区环境中，没有一项研究关注服务不足的亚裔美国女性，尽管 事实上，这一人群的宫颈癌筛查率最低。因此，该项目的目标是 拟议的项目是在一项针对 800 名亚裔美国女性的社区研究中检查 HPV 自我采样。 使用配对设计，12 个社区站点（n = 400 名女性）将收到我们之前测试过的社区 关于宫颈癌筛查和导航的教育计划，以及 HPV 自采样套件；和 12 社区网站 (n=400) 将接受我们之前测试的社区教育计划以及导航 基于临床的筛查。拟议项目的目标是： (1) 比较提供自取服务的比率 对 800 名亚裔美国女性进行样本筛查与进行临床筛查； (2) 考察中介者 参与； (3) 评估 HPV 自我采样与临床筛查的相对成本效益。 人口统计、社会/文化环境和物理环境因素将在基线、后期进行评估 干预和 6 个月的随访。自我采样或临床筛查的参与情况将在 6- 月随访。拟议的项目将是第一个评估 HPV 自我采样的大规模研究 得不到充分服务的亚裔美国女性。研究结果将为未来的循证计划提供信息，旨在 提高全国亚裔美国女性的筛查参与度。