一种增强乳腺癌、宫颈癌和结直肠癌筛查的文化感知模型：新墨西哥州农村地区美国印第安成年人和医疗保健提供者的观点。
A culturally informed model to enhance breast, cervical, and colorectal cancer screenings: perspectives of American Indian adults and healthcare providers in rural New Mexico.
机构信息
Departments of Pediatrics and Family and Community Medicine, and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM, 87131, USA.
Department of Internal Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM, 87131, USA.
出版信息
Cancer Causes Control. 2023 Oct;34(10):855-871. doi: 10.1007/s10552-023-01721-y. Epub 2023 Jun 6.
PURPOSE
American Indian/Alaska Native (AI/AN) populations have some of the lowest cancer screening rates compared to other racial/ethnic populations. Using community-based participatory research methods, we sought to characterize knowledge, attitudes, beliefs, and approaches to enhance breast, colorectal, and cervical cancer screening.
METHODS
We conducted 12 focus groups between October 2018 and September 2019 with 96 eligible AI adults and healthcare providers, recruited using non-probability purposive sampling methods from the Zuni Pueblo in rural New Mexico. We used the Multi-level Health Outcomes Framework (MHOF) to conduct a qualitative content analysis identifying mutable systems- and individual- level constructs important for behavior change that we crosslinked with the Community Preventive Services Task Force (CPSTF) recommended evidence-based interventions (EBIs) or approaches.
RESULTS
Salient systems-level factors that limited uptake of cancer screenings included inflexible clinic hours, transportation barriers, no on-demand service and reminder systems, and brief doctor-patient encounters. Individual-level barriers included variable cancer-specific knowledge that translated into fatalistic beliefs, fear, and denial. Interventions to enhance community demand and access for screening should include one-on-one and group education, small media, mailed screening tests, and home visitations by public health nurses. Interventions to enhance provider delivery of screening services should include translation and case management services.
CONCLUSIONS
The MHOF constructs crosslinked with CPSTF recommended EBIs or approaches provided a unique perspective to frame barriers and promoters of screening utilization and insights for intervention development. Findings inform the development of culturally tailored, theoretically informed, multi-component interventions concordant with CPSTF recommended EBIs or approaches aimed at improving cancer screening.
目的
与其他种族/族裔群体相比，美洲印第安人/阿拉斯加原住民（AI/AN）的癌症筛查率最低。我们使用基于社区的参与性研究方法，旨在描述知识、态度、信念和方法，以增强乳腺癌、结直肠癌和宫颈癌的筛查。
方法
我们于 2018 年 10 月至 2019 年 9 月期间在新墨西哥州农村的祖尼普韦布洛与 96 名符合条件的 AI 成年人和医疗保健提供者进行了 12 次焦点小组讨论，使用非概率目的性抽样方法进行招募。我们使用多层次健康结果框架（MHOF）进行定性内容分析，确定对行为改变重要的可改变系统和个体水平结构，我们将这些结构与社区预防服务工作队（CPSTF）推荐的循证干预措施（EBIs）或方法进行交叉链接。
结果
限制癌症筛查采用的突出系统层面因素包括诊所时间不灵活、交通障碍、没有按需服务和提醒系统以及医患短暂接触。个体层面的障碍包括可变的癌症特定知识，转化为宿命论信念、恐惧和否认。为增强社区对筛查的需求和获得，应包括一对一和小组教育、小型媒体、邮寄筛查测试和公共卫生护士家访。为增强提供者提供筛查服务，应包括翻译和病例管理服务。
结论
MHOF 结构与 CPSTF 推荐的 EBIs 或方法交叉链接，为框架筛选利用的障碍和促进因素提供了独特的视角，并为干预措施的制定提供了见解。研究结果为制定文化上合适、理论上合理、多成分的干预措施提供了信息，这些干预措施与 CPSTF 推荐的 EBIs 或方法一致，旨在提高癌症筛查。
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