Ansa Benjamin E, Alema-Mensah Ernest, Sheats Joyce Q, Mubasher Mohamed, Akintobi Tabia Henry
Institute of Public and Preventive Health, Augusta University, Augusta Georgia.
Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia.
AJPM Focus. 2023 Jun 13;2(4):100121. doi: 10.1016/j.focus.2023.100121. eCollection 2023 Dec.
African Americans are disproportionately affected by mortality risk for colorectal cancer. This study aimed to determine the most effective educational approach of 4 study arms that enhances the likelihood of pursuing subsequent colorectal cancer screening, and to identify the associated factors.
Age-eligible adults (N=2,877) were recruited to participate in a cluster randomized control dissemination and intervention implementation trial titled Educational Program to Increase Colorectal Cancer Screening. The project began in May 2012 and ended in March 2017 (the implementation phase lasted 36 months). Educational sessions were conducted through 16 community coalitions that were randomized into 1 of 4 conditions: website access (to facilitator training materials and toolkits) without technical assistance, website access with technical assistance, in-person training (provided by research staff and website access) without technical assistance, and in-person training with technical assistance. A follow-up to determine participant CRC screening was conducted 3 months later.
Compared with the website access with technical assistance intervention group, 2 groups, in-person training with technical assistance and without technical assistance, indicated significantly higher odds for obtaining colorectal cancer screening (OR=1.31; 95% CI=1.04, 1.64; =0.02 and OR=1.35; 95% CI=1.07, 1.71; =0.01, respectively). Though sociodemographic factors were not significantly associated with pursuing subsequent colorectal cancer screening, the postintervention cancer knowledge increased significantly among the study participants.
The importance of in-person interactions, local coalitions, and community contexts may play a key role for successfully increasing colorectal cancer screening rates among African Americans as reflected through this study. The integration of telehealth and use of other virtual technologies to engage the public in research have increased since the COVID-19 pandemic and should be assessed to determine their impact on the degree to which in-person interventions are significantly more effective when compared with solely web-assisted ones.
The study is registered at www.clinicaltrials.gov NCT01805622.
非裔美国人在结直肠癌死亡风险方面受到的影响尤为严重。本研究旨在确定4种研究方案中哪种教育方法最能提高后续进行结直肠癌筛查的可能性，并找出相关因素。
招募符合年龄要求的成年人（N = 2877）参与一项名为“增加结直肠癌筛查教育项目”的整群随机对照传播与干预实施试验。该项目于2012年5月开始，2017年3月结束（实施阶段持续36个月）。通过16个社区联盟开展教育课程，这些联盟被随机分为4种情况之一：可访问网站（获取 facilitator 培训材料和工具包）但无技术支持、可访问网站且有技术支持、面对面培训（由研究人员提供并可访问网站）但无技术支持、面对面培训且有技术支持。3个月后进行随访以确定参与者的结直肠癌筛查情况。
与有技术支持的网站访问干预组相比，另外两组，即有技术支持的面对面培训组和无技术支持的面对面培训组，进行结直肠癌筛查的几率显著更高（OR = 1.31；95% CI = 1.04, 1.64；P = 0.02和OR = 1.35；95% CI = 1.07, 1.71；P = 0.01）。尽管社会人口学因素与后续进行结直肠癌筛查没有显著关联，但研究参与者干预后的癌症知识显著增加。
正如本研究所示，面对面互动、地方联盟和社区环境的重要性可能对成功提高非裔美国人的结直肠癌筛查率起到关键作用。自新冠疫情以来，远程医疗的整合以及使用其他虚拟技术让公众参与研究的情况有所增加，应评估它们对面对面干预与单纯网络辅助干预相比显著更有效的程度的影响。
