定制短信和Fotonovela项目,以提高大型城市社区诊所人群中结肠直肠癌筛查患者的参与度:质量改进项目。

IF 3.3 Q2 ONCOLOGY JMIR Cancer Pub Date : 2023-08-10 DOI:10.2196/43024
Monica Guo, Rena Brar Prayaga, Carly E Levitz, Elena S Kuo, Esmeralda Ruiz, Evelyn Torres-Ozadali, Anne Escaron
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引用次数: 1

摘要

背景:在美国,结直肠癌(CRC)是癌症相关死亡的第二大原因,适当的年度筛查是必不可少的预防措施。研究表明,结直肠癌筛查率受到各种社会健康决定因素(SDOH)因素的影响,包括种族、民族和地理。根据2018年的国家数据,西班牙裔或拉丁裔人的筛查参与率最低(56.1%)。在一个城市联邦合格医疗中心,进行了一项质量改进项目,以评估一个带有励志漫画的短信项目。Fotonovelas之前被用于提高对宫颈癌和人类乳头瘤病毒的认识,疫苗接种和抑郁症治疗的项目。目的:本研究旨在促进粪便免疫化学试验(FIT)筛查的依从性。病人参与了一个短信项目,通过行为改变技术通知了fotonovelas。本研究旨在了解患者动机、意图和完成筛查的障碍的定性特征。方法:共有5241名年龄在50至75岁的说英语或西班牙语的联邦合格健康中心患者被随机分配到干预组(为期4周的定制双向短信计划和fotonovela漫画)或常规护理组(短信提醒和患者导航电话)。短信供应商使用专有算法根据家庭地址将干预组患者分为SDOH频段(高影响=高社会需求,低影响=低社会需求)。在4周的时间里,患者收到了关于接收和返回FIT的短信,他们可能遇到的障碍,以及他们对fotonovela的想法。结果:SDOH指数分析显示,大部分患者处于高影响(555/2597,21.37%)和甚高影响(1416/2597,54.52%)SDOH频带类别。患者总共向短信系统发送了1969条回复。专题分析确定了这些回应中的3个主要主题:作为提醒的信息,患者报告他们有动力归还FIT,并且已经这样做了或将尽快这样做;增加患者对筛查重要性的理解,患者对FIT的目的和重要性的了解有所增加;以及表达障碍,患者分享不完成FIT的原因。结论:短信计划和fotonovela对每个SDOH波段的患者都有作用,包括高和非常高的冲击波段。创建适合文化的信息可以鼓励患者接受信息的内容,确认完成FIT的意图,并分享对行为改变障碍的见解。为了更好地支持所有接受结直肠癌筛查的患者的连续治疗,重要的是继续制定和评估策略,让那些没有寄回FIT的患者参与进来。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Tailoring a Text Messaging and Fotonovela Program to Increase Patient Engagement in Colorectal Cancer Screening in a Large Urban Community Clinic Population: Quality Improvement Project.

Background: Appropriate annual screenings for colorectal cancer (CRC) are an essential preventive measure for the second-leading cause of cancer-related death in the United States. Studies have shown that CRC screening rates are influenced by various social determinants of health (SDOH) factors, including race, ethnicity, and geography. According to 2018 national data, participation in screening is lowest among Hispanic or Latinx individuals (56.1%). At an urban Federally Qualified Health Center, a quality improvement project was conducted to evaluate a texting program with a motivational fotonovela-a short narrative comic. Fotonovelas have previously been used in programs to improve knowledge of cervical cancer and human papillomavirus, vaccinations, and treatments for depression.

Objective: This study aimed to encourage compliance with fecal immunochemical test (FIT) screening. Patient engagement involved a texting program with fotonovelas informed by behavior change techniques. This study sought to understand the qualitative characteristics of patient motivation, intention, and barriers to completing their screening.

Methods: A total of 5241 English-speaking or Spanish-speaking Federally Qualified Health Center patients aged 50 to 75 years were randomized to either intervention (a 4-week tailored 2-way texting program with a fotonovela comic) or usual care (an SMS text message reminder and patient navigator phone call). The texting vendor used a proprietary algorithm to categorize patients in the intervention group into SDOH bands based on their home addresses (high impact=high social needs and low impact=low social needs). Over 4 weeks, patients were texted questions about receiving and returning their FIT, what barriers they may be experiencing, and their thoughts about the fotonovela.

Results: The SDOH index analysis showed that most of the patient population was in the SDOH band categories of high impact (555/2597, 21.37%) and very high impact (1416/2597, 54.52%). Patients sent 1969 total responses to the texting system. Thematic analysis identified 3 major themes in these responses: messages as a reminder, where patients reported that they were motivated to return the FIT and had already done so or would do so as soon as possible; increasing patients' understanding of screening importance, where patients expressed an increased knowledge about the purpose and importance of the FIT; and expressing barriers, where patients shared reasons for not completing the FIT.

Conclusions: The texting program and fotonovela engaged a subset of patients in each SDOH band, including the high and very high impact bands. Creating culturally tailored messages can encourage patient engagement for accepting the content of the messaging, confirming intentions to complete their FIT, and sharing insights about barriers to behavior change. To better support all patients across the continuum of care with CRC screening, it is important to continue to develop and assess strategies that engage patients who did not return their home-mailed FIT.

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来源期刊
JMIR Cancer
JMIR Cancer ONCOLOGY-
CiteScore
4.10
自引率
0.00%
发文量
64
审稿时长
12 weeks
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