Han Hae-Ra, Lee Yoon-Jae, Min Deborah, Chepkorir Joyline, Hwang DaSol Amy, Chae Steve
Johns Hopkins School of Nursing, 525 N. Wolfe St, Baltimore, MD, 21205, United States, 1 410-614-2669, 1 410-502-5481.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
JMIR Hum Factors. 2025 Aug 25;12:e66092. doi: 10.2196/66092.
BACKGROUND: Women with limited English proficiency continue experiencing an unequal cancer burden. Non-White immigrant women present with more advanced breast and cervical cancer than non-Hispanic Whites, attributed to significant cultural barriers as well as low health literacy in attempting to navigate the United States health care system for cancer screening. Community-based Health litEracy-focused intervention for breast and cervical Cancer Control (CHECC-uP) was an in-person, community health worker-led intervention, addressing both cultural and health literacy barriers through health literacy education and follow-up counseling with navigation assistance. The in-person program was tested in a large cluster-randomized trial and yielded high efficacy in promoting mammogram and Papanicolaou test screening in Korean-speaking women. With over 90% of Americans now having online access, the in-person program was adapted to web-based delivery. OBJECTIVE: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of the web version of the intervention-e-CHECC-uP. METHODS: A randomized pilot trial was conducted. A total of 40 women were enrolled and randomized (20 per arm). The study intervention consisted of web-based health literacy education followed by phone counseling with navigation assistance. Study assessments were done at baseline, 3 months, and 6 months. The study's primary outcomes were cancer screening behaviors verified by medical record review. Upon completion of final study assessments, intervention participants were invited to join postintervention interviews. RESULTS: In total, 34 women (intervention: n=15; control: n=19) completed the assessment at 6 months, yielding a retention rate of 85%. The intervention participants were highly satisfied with e-CHECC-uP with a median rating of 8 on a 10-point scale. Between-group differences in screening rates were 34.6%, 47.9%, and 37.5%, respectively, for completion of the mammogram, Papanicolaou test, and both at 6 months. CONCLUSIONS: We achieved a high retention rate and high participant satisfaction. Although the study was not powered for significance testing, the e-CHECC-uP intervention resulted in large group differences across all cancer screening outcomes in the pilot sample. Online technology can help address multiple logistical barriers associated with in-person intervention delivery. Our findings suggest that web-based delivery of CHECC-uP may be used to promote cancer screening among immigrant women with limited English proficiency, as a promising avenue to ultimately reduce health disparities in underserved communities.
背景:英语水平有限的女性持续面临不平等的癌症负担。非白人移民女性比非西班牙裔白人患更晚期乳腺癌和宫颈癌的几率更高,这归因于重大的文化障碍以及她们在试图在美国医疗保健系统中进行癌症筛查时健康素养较低。基于社区的以健康素养为重点的乳腺癌和宫颈癌控制干预措施(CHECC-uP)是一项由社区卫生工作者主导的面对面干预措施,通过健康素养教育以及提供导航协助的后续咨询来解决文化和健康素养障碍。该面对面项目在一项大型整群随机试验中进行了测试,并在促进说韩语女性的乳房X光检查和巴氏试验筛查方面取得了高效能。由于现在超过90%的美国人可以上网,该面对面项目被改编为基于网络的形式。 目的:本研究旨在评估干预措施的网络版——电子CHECC-uP的可行性、可接受性和初步效能。 方法:进行了一项随机试点试验。总共招募了40名女性并将她们随机分组(每组20人)。研究干预包括基于网络的健康素养教育,随后是提供导航协助的电话咨询。在基线、3个月和6个月时进行研究评估。研究的主要结局是通过病历审查核实的癌症筛查行为。在完成最终研究评估后,邀请干预参与者参加干预后访谈。 结果:总共有34名女性(干预组:n = 15;对照组:n = 19)在6个月时完成了评估,保留率为85%。干预参与者对电子CHECC-uP非常满意,在10分制量表上的中位数评分为8分。在6个月时,乳房X光检查、巴氏试验以及两者都完成的筛查率组间差异分别为34.6%、47.9%和37.5%。 结论:我们实现了高保留率和高参与者满意度。尽管该研究没有足够的效力进行显著性检验,但电子CHECC-uP干预在试点样本的所有癌症筛查结局中导致了较大的组间差异。在线技术有助于解决与面对面干预实施相关的多种后勤障碍。我们的研究结果表明,基于网络的CHECC-uP形式可用于促进英语水平有限的移民女性进行癌症筛查,作为最终减少服务不足社区健康差距的一条有前景的途径。
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