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2.  Efficacy to effectiveness transition of an Educational Program to Increase Colorectal Cancer Screening (EPICS): study protocol of a cluster randomized controlled trial 
Background
African Americans have the highest incidence and mortality and are less likely than whites to have been screened for colorectal cancer (CRC). Many interventions have been shown to increase CRC screening in research settings, but few have been evaluated specifically for use in African-American communities in real world settings. This study aims to identify the most efficacious approach to disseminate an evidence-based intervention in promoting colorectal screening in African Americans and to identify the factors associated with its efficacy.
Methods/design
In this study, investigators will recruit 20 community coalitions and 7,200 African-Americans age 50 to 74 to test passive and active approaches to disseminating the Educational Program to Increase Colorectal Cancer Screening (EPICS); to measure the extent to which EPICS is accepted and the fidelity of implementation in various settings and to estimate the potential translatability and public health impact of EPICS. This four-arm cluster randomized trial compares the following implementation strategies: passive arms, (web access to facilitator training materials and toolkits without technical assistance (TA) and (web access, but with technical assistance (TA); active arms, (in-person access to facilitator training materials and toolkits without TA and (in-person access with TA). Primary outcome measures are the reach (the proportion of representative community coalitions and individuals participating) and efficacy (post-intervention changes in CRC screening rates). Secondary outcomes include adoption (percentage of community coalitions implementing the EPICS sessions) and implementation (quality and consistency of the intervention delivery). The extent to which community coalitions continue to implement EPICS post-implementation (maintenance) will also be measured. Cost-effectiveness analysis will be conducted.
Discussion
Implementing EPICS in partnership with community coalitions, we hypothesized, will result in more rapid adoption than traditional top-down approaches, and resulting changes in community CRC screening practices are more likely to be sustainable over time. With its national reach, this study has the potential to enhance our understanding of barriers and enablers to the uptake of educational programs aimed at eliminating cancer disparities.
Trial registration
http://www.ClinicalTrials.gov NCT01805622
doi:10.1186/1748-5908-8-86
PMCID: PMC3750535  PMID: 23924263
Dissemination; Implementation; Colorectal cancer screening; Health disparities; Community-based participatory research
3.  Community Health Workers Support Community-based Participatory Research Ethics: 
Ethical principles of community-based participatory research (CBPR)— specifically, community engagement, mutual learning, action-reflection, and commitment to sustainability—stem from the work of Kurt Lewin and Paulo Freire. These are particularly relevant in cancer disparities research because vulnerable populations are often construed to be powerless, supposedly benefiting from programs over which they have no control. The long history of exploiting minority individuals and communities for research purposes (the U.S. Public Health Service Tuskegee Syphilis Study being the most notorious) has left a legacy of mistrust of research and researchers. The purpose of this article is to examine experiences and lessons learned from community health workers (CHWs) in the 10-year translation of an educational intervention in the research-to-practice-to-community continuum. We conclude that the central role played by CHWs enabled the community to gain some degree of control over the intervention and its delivery, thus operationalizing the ethical principles of CBPR.
doi:10.1353/hpu.2012.0156
PMCID: PMC3586526  PMID: 23124502
Colorectal cancer; African Americans; cancer disparities; community-based participatory research; ethics; translational research; community health workers
4.  Operationalization of community-based participatory research principles across the National Cancer Institute’s Community Network Programs 
American Journal of Public Health  2011;102(6):1195-1203.
Objectives
To examine how the National Cancer Institute-funded Community Network Program (CNP) operationalized principles of community-based participatory research (CBPR).
Methods
Based on our review of the literature and extant CBPR measurement tools, scientists from nine of 25 CNPs developed a 27-item questionnaire to self-assess CNP operationalization of nine CBPR principles.
Results
Of 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles to recognize community as a unit of identity, build on community strengths, facilitate co-learning, embrace iterative processes in developing community capacity, and achieve a balance between data generation and intervention. CNPs varied in extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging community in research dissemination, and striving for sustainability.
Conclusions
Although tool development in this field is in its infancy, findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.
doi:10.2105/AJPH.2011.300304
PMCID: PMC3292685  PMID: 22095340
Cancer disparities; community health; empowerment; health status disparities; indigenous populations; minority health; partnerships; training
5.  A Trial of Three Interventions to Promote Colorectal Cancer Screening in African Americans 
Cancer  2010;116(4):922-929.
Background
Colorectal cancer (CRC) is the second-leading cause of cancer death in the U.S. CRC incidence and mortality rates are higher in blacks than in whites and screening rates are lower in blacks than in whites. We tested three interventions intended to increase the rate of colorectal cancer screening among African Americans.
Methods
The interventions were chosen to address evidence gaps in the Guide to Community Preventive Services: one-on-one education, group education, and reducing out-of-pocket costs. Three hundred sixty-nine African American men and women aged ≥50 years were enrolled in this randomized controlled community intervention trial. The main outcome measures were post-intervention increase in colorectal cancer knowledge and obtaining a screening test within six months.
Results
There was substantial attrition: 257 participants completed the intervention and were available for follow-up 3–6 months later. Among completers, there were significant increases in knowledge in both educational cohorts but in neither of the other two. By the 6 month follow-up, 17.7% (11/62) of control group members reported having undergone screening, as compared to 33.9% (22/65) of the group education cohort (p = 0.039). Screening rate increases in the other 2 cohorts were not statistically significant.
Conclusions
Group education can increase colorectal cancer screening rates among African Americans. The screening rate of less than 35% in a group of people who participated in an educational program through multiple sessions over a period of several weeks indicates that there are still barriers to overcome.
doi:10.1002/cncr.24842
PMCID: PMC2819540  PMID: 20052732
Colorectal cancer; health status disparities; minority health; health education; screening; community-based participatory research

Results 1-5 (5)