社区到诊所导航干预对弱势群体结直肠癌筛查的影响。
Effects of a Community-to-Clinic Navigation Intervention on Colorectal Cancer Screening Among Underserved People.
作者信息
Menon Usha, Szalacha Laura A, Kue Jennifer, Herman Patricia M, Bucho-Gonzalez Julie, Lance Peter, Larkey Linda
机构信息
University of South Florida, Tampa, FL, USA.
The Ohio State University, Columbus, OH, USA.
出版信息
Ann Behav Med. 2020 Apr 20;54(5):308-319. doi: 10.1093/abm/kaz049.
BACKGROUND
Colorectal cancer screening remains suboptimal among poor and underserved people.
PURPOSE
We tested the effectiveness of a community-to-clinic navigator intervention to guide multicultural, underinsured individuals into primary care clinics to complete colorectal cancer screening.
METHODS
This two-phase behavioral intervention study was conducted in Phoenix, Arizona (2012-2018). Community sites were randomized to group education or group education plus tailored navigation to increase attendance at primary care clinics (Phase I). Individuals who completed a clinic appointment received the tailored navigation in person or via phone (Phase II).
RESULTS
In Phase I (N = 345), 37.9% of the intervention group scheduled a clinic appointment versus 19.4% of the comparison group. In Phase II, 26.5% of the original intervention group were screened versus only 10.4% of the original comparison group. Those in the intervention group were 3.84 times more likely to be screened than were those in the comparison group (odds ratio = 3.84; 95% confidence interval = 1.81-6.92).
CONCLUSIONS
Translation of an efficacious tailored navigation intervention for colorectal cancer screening to a community-to-clinic context is associated with significantly increased rates of colorectal cancer screening. Navigation assistance to address barriers to screening may serve as the most important component of any educational program to increase individual adherence to colorectal cancer screening.
背景
在贫困和医疗服务不足人群中，结直肠癌筛查情况仍不理想。
目的
我们测试了一种社区到诊所导航干预措施的有效性，该措施旨在引导多元文化、未参保个体前往初级保健诊所完成结直肠癌筛查。
方法
这项两阶段行为干预研究在亚利桑那州凤凰城开展（2012 - 2018年）。社区地点被随机分为接受团体教育组或团体教育加定制导航组，以提高前往初级保健诊所的就诊率（第一阶段）。完成诊所预约的个体亲自或通过电话接受定制导航（第二阶段）。
结果
在第一阶段（N = 345），干预组中有37.9%的人安排了诊所预约，而对照组为19.4%。在第二阶段，原干预组中有26.5%的人接受了筛查，而原对照组仅为10.4%。干预组接受筛查的可能性是对照组的3.84倍（优势比 = 3.84；95%置信区间 = 1.81 - 6.92）。
结论
将一种有效的结直肠癌筛查定制导航干预措施转化到社区到诊所的环境中，与结直肠癌筛查率显著提高相关。解决筛查障碍的导航协助可能是任何提高个体对结直肠癌筛查依从性的教育项目中最重要的组成部分。
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