Roland Katherine B, Milliken Erin L, Rohan Elizabeth A, DeGroff Amy, White Susan, Melillo Stephanie, Rorie William E, Signes Carmita-Anita C, Young Paul A
Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
NOVA Research Company, Silver Spring, Maryland.
Health Equity. 2017 May 1;1(1):61-76. doi: 10.1089/heq.2017.0001. eCollection 2017.
In the United States, disparities in cancer screening, morbidity, and mortality are well documented, and often are related to race/ethnicity and socioeconomic indicators including income, education, and healthcare access. Public health approaches that address social determinants of health have the greatest potential public health benefit, and can positively impact health disparities. As public health interventions, community health workers (CHWs), and patient navigators (PNs) work to address disparities and improve cancer outcomes through education, connecting patients to and navigating them through the healthcare system, supporting patient adherence to screening and diagnostic services, and providing social support and linkages to financial and community resources. Clinical settings, such as federally qualified health centers (FQHCs) are mandated to provide care to medically underserved communities, and thus are also valuable in the effort to address health disparities. We conducted a systematic literature review to identify studies of cancer-related CHW/PN interventions in FQHCs, and to describe the components and characteristics of those interventions in order to guide future intervention development and evaluation. We searched five databases for peer-reviewed CHW/PN intervention studies conducted in partnership with FQHCs with a focus on cancer, carried out in the United States, and published in English between January 1990 and December 2013. We identified 24 articles, all reporting positive outcomes of CHW/PNs interventions in FQHCs. CHW/PN interventions most commonly promoted breast, cervical, or colorectal cancer screening and/or referral for diagnostic resolution. Studies were supported largely through federal funding. Partnerships with academic institutions and community-based organizations provided support and helped develop capacity among FQHC clinic leadership and community members. Both the FQHC system and CHW/PNs were borne from the need to address persistent, complex health disparities among medically underserved communities. Our findings support the effectiveness of CHW/PN programs to improve completion and timeliness of breast, cervical, and colorectal cancer screening in FQHCs, and highlight intervention components useful to design and sustainability.
在美国，癌症筛查、发病率和死亡率方面的差异有充分记录，且往往与种族/族裔以及包括收入、教育和医疗保健可及性在内的社会经济指标相关。解决健康社会决定因素的公共卫生方法具有最大的潜在公共卫生效益，并可对健康差异产生积极影响。作为公共卫生干预措施，社区卫生工作者（CHW）和患者导航员（PN）致力于通过教育来解决差异并改善癌症治疗结果，帮助患者联系医疗保健系统并在其中顺利就医，支持患者坚持接受筛查和诊断服务，并提供社会支持以及与金融和社区资源的联系。诸如联邦合格健康中心（FQHC）等临床机构被要求为医疗服务不足的社区提供护理，因此在解决健康差异的努力中也很有价值。我们进行了一项系统的文献综述，以确定在FQHC中与癌症相关的CHW/PN干预措施的研究，并描述这些干预措施的组成部分和特征，以便为未来的干预措施开发和评估提供指导。我们在五个数据库中搜索了与FQHC合作开展的、以癌症为重点、在美国进行且于1990年1月至2013年12月期间以英文发表的同行评审的CHW/PN干预研究。我们确定了24篇文章，所有文章均报告了CHW/PN干预措施在FQHC中的积极结果。CHW/PN干预措施最常促进乳腺癌、宫颈癌或结直肠癌筛查和/或转诊以进行诊断解决。研究主要通过联邦资金获得支持。与学术机构和社区组织的合作提供了支持，并有助于培养FQHC诊所领导层和社区成员的能力。FQHC系统和CHW/PN均源于解决医疗服务不足社区中持续存在的复杂健康差异的需求。我们的研究结果支持CHW/PN项目在提高FQHC中乳腺癌、宫颈癌和结直肠癌筛查的完成率和及时性方面的有效性，并突出了对设计和可持续性有用的干预措施组成部分。
