Frerichs Leah, Beasley Cherry, Pevia Kim, Lowery Jan, Ferrari Renée, Bell Ronny, Reuland Dan
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Carolina Cancer Screening Initiative, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Health Equity. 2020 Apr 1;4(1):91-98. doi: 10.1089/heq.2019.0095. eCollection 2020.
American Indian adults have not experienced decreases in colorectal cancer (CRC) incidence and mortality observed in other races or ethnic groups and their screening rates are low. Decision aids that explain available CRC screening options are one potential strategy to promote screening. The goal of this study was to test the effect of a culturally adapted decision aid on CRC-related outcomes among American Indian adults, including screening-related knowledge, attitudes, self-efficacy, intentions, and screening modality preferences. We recruited American Indian adults aged 50-75 years who were not current with CRC screening. Participants viewed a 9-min multimedia decision aid that used narrative vignettes to provide educational information about screening along with messages to address culturally specific barriers and values uncovered in formative research. We conducted a single-arm (pre-post) study and assessed screening-related outcomes at baseline and immediately after viewing the decision aid. Among =104 participants, knowledge scores increased from a mean of 36% correct to 76% correct. Participants also had statistically significant increases in positive attitudes, perceived social norms, self-efficacy, and intent. The proportion of participants who identified a preference for a specific CRC screening modality rose from 81% identified at pre-intervention to 93% post-intervention (=0.013). Our study provides promising new findings that our culturally adapted decision aid is efficacious in educating American Indian adults about CRC screening and increases their screening intentions and ability to state modality preferences. Future research is needed to test the decision aid as a component of CRC screening interventions with American Indian adults.
美国印第安成年人并未经历其他种族或族裔群体中观察到的结直肠癌（CRC）发病率和死亡率下降，且他们的筛查率较低。解释现有CRC筛查选项的决策辅助工具是促进筛查的一种潜在策略。本研究的目的是测试一种文化适应性决策辅助工具对美国印第安成年人CRC相关结果的影响，包括与筛查相关的知识、态度、自我效能感、意图以及筛查方式偏好。我们招募了年龄在50 - 75岁、目前未进行CRC筛查的美国印第安成年人。参与者观看了一个9分钟的多媒体决策辅助工具，该工具使用叙事 vignettes 来提供有关筛查的教育信息，同时传达信息以解决在形成性研究中发现的特定文化障碍和价值观。我们进行了一项单臂（干预前 - 干预后）研究，并在基线和观看决策辅助工具后立即评估与筛查相关的结果。在104名参与者中，知识得分从平均36%正确提高到76%正确。参与者在积极态度、感知社会规范、自我效能感和意图方面也有统计学上的显著增加。确定对特定CRC筛查方式有偏好的参与者比例从干预前的81%上升到干预后的93%（P = 0.013）。我们的研究提供了有前景的新发现，即我们的文化适应性决策辅助工具在教育美国印第安成年人进行CRC筛查方面是有效的，并提高了他们的筛查意图以及说出方式偏好的能力。未来需要进行研究，以测试该决策辅助工具作为美国印第安成年人CRC筛查干预措施一部分的效果。
