Kreuter Matthew W, Sugg-Skinner Celette, Holt Cheryl L, Clark Eddie M, Haire-Joshu Debra, Fu Qiang, Booker Angela C, Steger-May Karen, Bucholtz Dawn
Health Communication Research Laboratory and Center of Excellence in Cancer Communication Research, Department of Community Health, School of Public Health, Saint Louis University (SLU), 3545 Lafayette Avenue, St. Louis, MO 63104, USA.
Prev Med. 2005 Jul;41(1):53-62. doi: 10.1016/j.ypmed.2004.10.013. Epub 2004 Nov 26.
It is widely accepted that disease prevention efforts should consider cultural factors when addressing the needs of diverse populations, yet there is surprisingly little evidence that doing so enhances effectiveness. The Institute of Medicine has called for randomized studies directly comparing approaches that do and do not consider culture.
In a randomized trial, 1227 lower-income African-American women from 10 urban public health centers were assigned to either a usual care control group, or to receive a series of six women's health magazines with content tailored to each individual. By random assignment, these magazines were generated from either behavioral construct tailoring (BCT), culturally relevant tailoring (CRT) or both (BCT + CRT). The CRT magazines were based on four cultural constructs: religiosity, collectivism, racial pride, and time orientation. All tailored magazines sent to women ages 40-65 promoted use of mammography; magazines sent to women ages 18-39 promoted fruit and vegetable (FV) intake. Analyses examined changes from baseline to 18-month follow-up in use of mammography and servings of FV consumed daily.
Women receiving BCT + CRT magazines were more likely than those in the BCT, CRT, and control groups to report getting a mammogram (76% vs. 65% vs. 64% vs. 55%, respectively), and had greater increases in FV servings consumed daily (+0.96 vs. + 0.43 vs. + 0.25 vs. + 0.59).
Systematically integrating culture into tailored cancer prevention and control interventions may enhance their effectiveness in diverse populations.
人们普遍认为，疾病预防工作在满足不同人群需求时应考虑文化因素，但令人惊讶的是，几乎没有证据表明这样做能提高成效。美国国家医学院呼吁开展随机研究，直接比较考虑文化因素和不考虑文化因素的方法。
在一项随机试验中，来自10个城市公共卫生中心的1227名低收入非裔美国女性被分配到常规护理对照组，或接受一系列六本针对个人量身定制内容的女性健康杂志。通过随机分配，这些杂志分别基于行为构建定制（BCT）、文化相关定制（CRT）或两者结合（BCT + CRT）生成。CRT杂志基于四种文化构建：宗教信仰、集体主义、种族自豪感和时间取向。所有发送给40 - 65岁女性的定制杂志都宣传乳房X光检查的使用；发送给18 - 39岁女性的杂志则宣传水果和蔬菜（FV）的摄入量。分析考察了从基线到18个月随访期间乳房X光检查的使用情况以及每日FV摄入量的变化。
与接受BCT、CRT杂志和对照组的女性相比，接受BCT + CRT杂志的女性更有可能报告进行了乳房X光检查（分别为76%对65%对64%对55%），并且每日FV摄入量的增加幅度更大（分别为+0.96对+0.43对+0.25对+0.59）。
将文化因素系统地融入量身定制的癌症预防和控制干预措施中，可能会提高其在不同人群中的效果。
