社区卫生工作者干预措施能否提高美国的筛查性乳房 X 光检查率？系统评价。
Do community health worker interventions improve rates of screening mammography in the United States? A systematic review.
机构信息
University of South Florida, Tampa, FL 33612, USA.
出版信息
Cancer Epidemiol Biomarkers Prev. 2011 Aug;20(8):1580-98. doi: 10.1158/1055-9965.EPI-11-0276. Epub 2011 Jun 8.
BACKGROUND
Community health workers (CHW) are lay individuals who are trained to serve as liaisons between members of their communities and health care providers and services.
METHODS
A systematic review was conducted to synthesize evidence from all prospective controlled studies on effectiveness of CHW programs in improving screening mammography rates. Studies reported in English and conducted in the United States were included if they: (i) evaluated a CHW intervention designed to increase screening mammography rates in women 40 years of age or older without a history of breast cancer; (ii) were a randomized controlled trial (RCT), case-controlled study, or quasi-experimental study; and (iii) evaluated a CHW intervention outside of a hospital setting.
RESULTS
Participation in a CHW intervention was associated with a statistically significant increase in receipt of screening mammography [risk ratio (RR): 1.06 (favoring intervention); 95% CI: 1.02-1.11, P = 0.003]. The effect remained when pooled data from only RCTs were included in meta-analysis (RR: 1.07; 95% CI: 1.03-1.12, P = 0.0005) but was not present using pooled data from only quasi-experimental studies (RR: 1.03; 95% CI: 0.89-1.18, P = 0.71). In RCTs, participants recruited from medical settings (RR: 1.41; 95% CI: 1.09-1.82, P = 0.008), programs conducted in urban settings (RR: 1.23; 95% CI: 1.09, 1.39, P = 0.001), and programs where CHWs were matched to intervention participants on race or ethnicity (RR: 1.58, 95% CI: 1.29-1.93, P = 0.0001) showed stronger effects on increasing mammography screening rates.
CONCLUSIONS
CHW interventions are effective for increasing screening mammography in certain settings and populations.
IMPACT
CHW interventions are especially associated with improvements in rate of screening mammography in medical settings, urban settings, and in participants who are racially or ethnically concordant with the CHW.
背景
社区卫生工作者（CHW）是经过培训的非专业人员，他们充当社区成员与医疗保健提供者和服务之间的联络人。
方法
系统评价对所有前瞻性对照研究进行了综合评估，以评估 CHW 方案在提高筛查性乳房 X 光检查率方面的有效性。如果研究报告的是英文，并在美国进行，且符合以下标准，则纳入研究：（i）评估旨在提高 40 岁或以上无乳腺癌病史的女性筛查性乳房 X 光检查率的 CHW 干预措施；（ii）是随机对照试验（RCT）、病例对照研究或准实验研究；和（iii）在医院环境之外评估 CHW 干预措施。
结果
参与 CHW 干预与接受筛查性乳房 X 光检查的几率呈统计学显著增加相关（风险比 [RR]：1.06（有利于干预）；95%置信区间 [CI]：1.02-1.11，P = 0.003）。当将仅来自 RCT 的汇总数据纳入荟萃分析时，该效果仍然存在（RR：1.07；95%CI：1.03-1.12，P = 0.0005），但当仅使用来自准实验研究的汇总数据时，该效果不存在（RR：1.03；95%CI：0.89-1.18，P = 0.71）。在 RCT 中，从医疗环境中招募的参与者（RR：1.41；95%CI：1.09-1.82，P = 0.008）、在城市环境中开展的计划（RR：1.23；95%CI：1.09,1.39，P = 0.001）以及在 CHW 与干预参与者的种族或民族相匹配的计划中（RR：1.58，95%CI：1.29-1.93，P = 0.0001），对提高乳房 X 光检查率的效果更强。
结论
CHW 干预措施在某些环境和人群中有效提高了筛查性乳房 X 光检查率。
影响
CHW 干预措施与医疗环境、城市环境中筛查性乳房 X 光检查率的提高以及与 CHW 种族或民族相匹配的参与者的检查率提高尤其相关。
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