Community Dissemination of an Evidence-based Colorectal Cancer (CRC) Screening Intervention

Filipino Americans have lower rates of colorectal cancer (CRC) screening, later stage of diagnosis and poorer survival relative to other racial/ethnic groups. To address this disparity, the investigators developed a multi-component intervention to increase CRC screening and have determined its efficacy in a randomized trial (Maxwell,et. al., 2010). This study aims to determine how an intervention to increase CRC screening can best be integrated within the cultural norms and existing structures of churches and community based organizations (CBOs) with predominantly Filipino American membership to ensure broad dissemination to those in need of screening.
The investigators will provide our partner CBOs with resources and technical assistance, including training of community volunteers as health advisors, to enable them to promote CRC screening to their constituents. Using a scientifically rigorous research design, the investigators will compare two dissemination strategies: Basic dissemination which consists of a single kick-off event during which community health advisors will receive print materials and FOBT kits for distribution and training on how to conduct educational small-group sessions; and Organizational dissemination aimed at integrating CRC screening dissemination into organizational practices and processes that can be sustained after the end of the study. The study will be implemented in 20 CBOs and will train 100 community health advisors (CHAs). The impact of the two dissemination strategies will be comprehensively assessed by collecting data at the CBO level, from the CHAs and from 1000 Filipino American participants. The investigators will compare the proportion of Filipino American participants who obtain CRC screening by dissemination strategy, but the investigators will also assess how many are reached, if the intervention is implemented as planned, how CBOs support the screening efforts at their regular activities, and if CBOs and CHAs maintain their efforts over the 4 years of the study.
The investigators hypothesize that CBOs can implement evidence-based strategies to promote CRC screening and CHAs in the organizational dissemination arm will reach more participants and more screened participants than CHAs in the basic dissemination arm; and organizations in the organizational dissemination arm will adopt more CRC screening activities and maintain these better than organizations in the basic dissemination arm.

与其他种族/族裔群体相比，菲律宾裔美国人的结直肠癌（colorectal cancer, CRC）筛查率更低，确诊时分期更晚，预后也更差。为应对这一健康差异，研究者开发了一项旨在提升CRC筛查率的多组分干预措施，并在Maxwell等（2010）开展的随机对照试验中验证了其有效性。本研究旨在探索如何将提升CRC筛查的干预措施最优融入以菲律宾裔美国人为主要成员的教会及社区组织（community based organizations, CBOs）的文化规范与现有运行架构中，从而确保该干预措施能够广泛触达有筛查需求的人群。

研究者将为合作社区组织提供资源与技术支持，包括将社区志愿者培训为健康顾问，以协助其向服务对象推广CRC筛查。本研究采用科学严谨的研究设计，将对两种传播策略进行对比：其一为基础传播策略，仅包含一场启动活动，活动中社区健康顾问将领取印刷宣传材料与粪便隐血试验试剂盒（FOBT kits），并接受如何开展教育性小组讲座的培训；其二为组织化传播策略，旨在将CRC筛查传播工作融入组织的日常运营与流程，使其可在研究结束后持续推行。本研究将在20家社区组织中开展，计划培训100名社区健康顾问（community health advisors, CHAs）。将通过三个层面收集数据以全面评估两种传播策略的效果：社区组织层面、社区健康顾问层面，以及1000名菲律宾裔美国参与者层面。研究者将对比不同传播策略下完成CRC筛查的菲律宾裔美国参与者比例，同时还将评估以下指标：干预措施的触达人数、干预措施是否按方案实施、社区组织如何在日常活动中支持筛查工作，以及社区组织与社区健康顾问能否在研究为期4年的周期内持续推进相关工作。

研究者提出如下研究假设：社区组织可推行循证策略以推广CRC筛查，且组织化传播组的社区健康顾问相比基础传播组的社区健康顾问，能够触达更多目标人群，同时完成筛查的参与者人数也更多；此外，组织化传播组的社区组织相比基础传播组的社区组织，将开展更多CRC筛查相关活动，且能更持续地维持这些活动。