Department of Social and Behavioral Sciences, Virginia Commonwealth University, Richmond, VA, United States.
Massey Comprehensive Cancer Center, Richmond, VA, United States.
JMIR Form Res. 2024 Oct 10;8:e50028. doi: 10.2196/50028.
In the United States, colorectal cancer (CRC) is the third leading cause of cancer death among Black men. Compared to men of all other races or ethnicities, Black men have the lowest rates of CRC screening participation, which contributes to later-stage diagnoses and greater mortality. Despite CRC screening being a critical component of early detection and increased survival, few interventions have been tailored for Black men.
This study aims to report on the multistep process used to translate formative research including prior experiences implementing a national CRC education program, community advisory, and preliminary survey results into a culturally tailored mobile health (mHealth) intervention.
A theoretically and empirically informed translational science public health intervention was developed using the Behavioral Design Thinking approach. Data to inform how content should be tailored were collected from the empirical literature and a community advisory board of Black men (n=7) and reinforced by the preliminary results of 98 survey respondents.
A community advisory board identified changes for delivery that were private, self-paced, and easily accessible and content that addressed medical mistrust, access delays for referrals and appointments, lack of local information, misinformation, and the role of families. Empirical literature and survey results identified the need for local health clinic involvement as critical to screening uptake, leading to a partnership with local Federally Qualified Health Centers to connect participants directly to clinical care. Men surveyed (n=98) who live or work in the study area were an average of 59 (SD 7.9) years old and held high levels of mistrust of health care institutions. In the last 12 months, 25% (24/98) of them did not see a doctor and 16.3% (16/98) of them did not have a regular doctor. Regarding CRC, 27% (26/98) and 38% (37/98) of them had never had a colonoscopy or blood stool test, respectively.
Working with a third-party developer, a prototype mHealth app that is downloadable, optimized for iPhone and Android users, and uses familiar sharing, video, and text messaging modalities was created. Guided by our results, we created 4 short videos (1:30-2 min) including a survivor vignette, animated videos about CRC and the type of screening tests, and a message from a community clinic partner. Men also receive tailored feedback and direct navigation to local Federally Qualified Health Center partners including via school-based family clinics. These content and delivery elements of the mHealth intervention were the direct result of the multipronged, theoretically informed approach to translate an existing but generalized CRC knowledge-based intervention into a digital, self-paced, tailored intervention with links to local community clinics.
ClinicalTrials.gov NCT05980182; https://clinicaltrials.gov/study/NCT05980182.
在美国，结直肠癌（CRC）是导致黑人男性癌症死亡的第三大原因。与所有其他种族或族裔的男性相比，黑人男性接受 CRC 筛查的比例最低，这导致了更晚期的诊断和更高的死亡率。尽管 CRC 筛查是早期发现和提高生存率的关键组成部分，但针对黑人男性的干预措施却很少。
本研究旨在报告将形成性研究转化为文化上量身定制的移动健康（mHealth）干预的多步骤过程，这些研究包括之前实施国家 CRC 教育计划、社区咨询和初步调查结果的经验。
使用行为设计思维方法开发了一种理论和经验丰富的转化科学公共卫生干预措施。从实证文献和一个由 7 名黑人男性组成的社区咨询委员会（n=7）中收集了有关如何进行内容定制的信息，并通过 98 名调查参与者的初步结果进行了强化。
社区咨询委员会确定了一些改变，包括私密、自我安排和易于访问的交付方式，以及针对医疗不信任、转诊和预约延迟、缺乏当地信息、错误信息和家庭角色等问题的内容。实证文献和调查结果表明，当地卫生诊所的参与对于筛查的接受至关重要，这导致与当地联邦合格的健康中心建立合作关系，将参与者直接连接到临床护理。在研究区域居住或工作的接受调查的男性（n=98）平均年龄为 59（SD 7.9）岁，对医疗机构高度不信任。在过去的 12 个月中，25%（24/98）的人没有看医生，16.3%（16/98）的人没有固定医生。关于 CRC，27%（26/98）和 38%（37/98）的人分别从未进行过结肠镜检查或大便潜血检查。
与第三方开发者合作，创建了一个可下载的原型 mHealth 应用程序，该应用程序针对 iPhone 和 Android 用户进行了优化，并使用了熟悉的共享、视频和短信模式。根据我们的结果，我们创建了 4 个短视频（1:30-2 分钟），包括一个幸存者小插曲、关于 CRC 和筛查测试类型的动画视频，以及来自社区诊所合作伙伴的信息。男性还会收到量身定制的反馈，并直接导航到当地的联邦合格健康中心合作伙伴，包括通过基于学校的家庭诊所。这些 mHealth 干预的内容和交付元素是将现有的但通用的 CRC 基于知识的干预转化为具有数字、自我安排、量身定制的干预的多管齐下、理论驱动方法的直接结果，其中包括与当地社区诊所的链接。
ClinicalTrials.gov NCT05980182；https://clinicaltrials.gov/study/NCT05980182。
