社区卫生工作者主导的多组分方案对南亚女性宫颈癌筛查的影响：一项整群随机对照试验。

A Community Health Worker-Led Multicomponent Program to Promote Cervical Cancer Screening in South Asian Women: A Cluster RCT.

机构信息

The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.

出版信息

Am J Prev Med. 2021 Jul;61(1):136-145. doi: 10.1016/j.amepre.2021.01.031. Epub 2021 Mar 26.

DOI:10.1016/j.amepre.2021.01.031

PMID:33781617

Abstract

INTRODUCTION

South Asian women in Hong Kong have low cervical cancer screening uptake because of multiple barriers to utilizing health resources. Interventions that effectively modify the cancer screening behaviors of this population are warranted. This study evaluates the effects of a community health worker-led multicomponent intervention on improving cervical cancer screening uptake among South Asian women in Hong Kong.

STUDY DESIGN

This study was an assessor-blind, cluster RCT that included a waitlist control group.

SETTING/PARTICIPANTS: Recruitment of eligible subjects took place in 6 nongovernmental organizations; these organizations were randomized into intervention and control groups with a 1:1 allocation ratio.

INTERVENTION

Participants in the intervention group received a 3-month multicomponent intervention comprising health education, monthly telephone follow-ups, and navigation assistance.

MAIN OUTCOME MEASURES

Participants' cervical cancer screening utilization and beliefs were assessed at baseline, after intervention, and 3 months after intervention. A longitudinal outcome comparison between the 2 groups was performed with generalized estimating equation analysis. Data were collected between September 2018 and January 2020 and were analyzed in 2019-2020.

RESULTS

A total of 387 participants completed the intervention. A significantly higher cervical cancer screening uptake was observed among participants in the intervention group (97.9%, 191 of 195) than among participants in the control group (52.6%, 101 of 192) at 3 months after intervention (p=0.005). Significantly greater decrements in perceived barriers to cervical cancer screening were found in the intervention group after intervention (-0.68, 95% CI= -1.35, -0.01, p=0.047) and 3 months after intervention (-0.86, 95% CI= -1.69, -0.04, p=0.041).

CONCLUSIONS

A community health worker-led multicomponent intervention is effective in promoting cervical cancer screening uptake and in reducing barriers to cancer screening utilization among South Asian women in Hong Kong. Combining a community health worker-led intervention with multiple intervention components could be an effective strategy for developing interventions to increase cervical cancer screening in underserved populations.

TRIAL REGISTRATION

This study was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn) ChiCTR1800017227 on July 18, 2018.

摘要

介绍

由于利用卫生资源的多种障碍，香港南亚裔妇女的宫颈癌筛查率较低。需要进行有效的干预措施来改变这一人群的癌症筛查行为。本研究评估了由社区卫生工作者主导的多组分干预对提高香港南亚裔妇女宫颈癌筛查率的效果。

研究设计

这是一项评估员盲、集群 RCT，包括一个候补对照组。

设置/参与者：合格受试者的招募在 6 个非政府组织进行；这些组织按照 1:1 的分配比例随机分为干预组和对照组。

干预

干预组的参与者接受为期 3 个月的多组分干预，包括健康教育、每月电话随访和导航辅助。

主要观察指标

在基线、干预后和干预后 3 个月评估参与者的宫颈癌筛查利用情况和信念。使用广义估计方程分析对两组的纵向结果进行比较。数据收集于 2018 年 9 月至 2020 年 1 月期间，并于 2019-2020 年进行分析。

结果

共有 387 名参与者完成了干预。干预组（97.9%，195 名中的 191 名）在干预后 3 个月的宫颈癌筛查率明显高于对照组（52.6%，192 名中的 101 名）（p=0.005）。干预后（-0.68，95%CI=-1.35，-0.01，p=0.047）和干预后 3 个月（-0.86，95%CI=-1.69，-0.04，p=0.041），干预组对宫颈癌筛查的感知障碍明显降低。