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.

项目摘要 PAP测试的引入导致宫颈癌的发生率和死亡率显着降低 美国。但是，在许多亚裔美国人亚组中，筛查率是次优的，并且保持持久 低于非西班牙裔白人，非西班牙裔黑人和西班牙裔妇女的比率。研究报告韩语 尤其是越南妇女，与其他相比，筛查率最低 种族/种族群体。多种因素可能导致亚裔妇女不进行筛查。 尴尬，成本，缺乏保险或常规医疗保健提供者，缺乏时间和语言困难 是该人群筛查的关键障碍。支持人类自杀的新兴技术 乳头瘤病毒（HPV）测试可能会为赋予亚裔美国人权力的有价值的，基于证据的策略 耐药或无法获得基于诊所的宫颈癌筛查的妇女。国家的 现在的指南包括每5年作为适当的宫颈癌筛查每5年进行一次筛查 战略。因为在非临床设置中的HPV自我采样与HPV测试具有可比的精度 临床医生被视为样本，自我收集可能代表提高筛查率的重要策略 在未划分的人群中。在美国，提供自我采样套件改进了筛选 资源有限的妇女的比率是高度可接受的。值得注意的是，妇女报告经历 自我采样的尴尬较小，一些研究发现，随后参与诊所的参与 基于筛选。尽管先前的研究表明，可以在 低资源社区环境，尽管没有一项研究专注于服务不足的亚裔美国妇女 该人群具有最低的宫颈癌筛查率这一事实。因此， 拟议的项目是在一项基于社区的800名亚裔妇女的研究中检查HPV的自我采样。 使用匹配的配对设计，12个社区网站（n = 400名女性）将获得我们先前测试的社区 宫颈癌筛查以及导航的教育计划以及HPV自动采样套件；和12 社区站点（n = 400）将收到我们先前测试的社区教育计划，以及导航 基于诊所的筛查。拟议项目的目的是：（1）比较提供自我收集的率 样本与800名亚裔美国妇女的基于诊所的筛查； （2）检查调解员 参与； （3）评估HPV自抽采样与基于诊所的筛查的相对成本效益。 人口统计学，社会/文化环境和身体环境因素将在基线时进行评估， 干预和6个月的随访。参与自我采样或基于诊所的筛查将在6-- 一个月随访。拟议的项目将是第一项评估HPV自换采样的大规模研究 服务不足的亚裔妇女。研究结果将为未来的基于证据的计划提供信息 加强全国亚裔妇女的筛查参与。