Effekten av grunnleggende behovsvurdering og støtte for å forbedre koloskopivisningsfrekvensen (BASICS)

Eksperimentell: Arm 1: Sosiale behovsnavigatorprogram

Deltakerne vil bli sammenkoblet med en helsearbeider i samfunnet som vil gi skreddersydd støtte for å møte udekkede sosiale behov. Antallet og frekvensen av samtaler begrenses kun av deltakernes behov, interesse og vilje til å samhandle. Typen kontakt kan omfatte telefonsamtaler eller besøk i hjemmet/samfunnet. Helsearbeideren vil: (1) identifisere og vurdere pasienters udekkede sosiale behov; (2) i fellesskap generere løsninger; (3) bidra til å prioritere blant flere behov; (4) identifisere fellesskapsressurser som kan bidra til å løse problemet(e); (5) bestemme kvalifisering for tjenester; (6) hjelpe pasienter med tilgang til tilgjengelige ressurser ved å planlegge avtaler og gi avtalepåminnelser; (7) forberede pasienter til å samhandle med servicebyråer og/eller opptre som talsmann; (8) gi støtte som å arrangere transport; (9) overvåke oppfølging av problemløsningshandlinger; og (10) vurdere fremskritt som er gjort for å løse udekkede sosiale behov og tilpasse løsninger.

Atferdsmessig: Sosiale behovsnavigatorprogram

4 måneders bistand tilpasset deltakerens behov

Aktiv komparator: Arm 2: Forbedret vanlig pleie

Deltakerne vil motta verbal henvisning til en føderalt finansiert, gratis, 24-timers assistansetelefon, United Way 2-1-1, som kobler innringere med samfunnstjenester for å hjelpe til med å møte udekkede sosiale behov.

Atferdsmessig: Forbedret vanlig omsorg

Henvisning til United Way 2-1-1

Ingen inngripen: Arm 3: Klinikkleverandør

4 leverandører av WUSM-kolposkopi, 4 ansatte og 1 helsearbeider i samfunnet vil bli undersøkt for å vurdere potensialet for spredning.

Adherence to Colposcopy Visit as Measured as Number of Participants Who Complete Colposcopy Visit Within 6 Weeks After Enrollment

Total Number of Unmet Basic Needs

-Unmet basic needs include food security, housing, personal safety, neighborhood safety, sufficient money for necessities, childcare (if applicable), and transportation. A questionnaire will be given to participants to identify the number of unmet basic needs the participant has.

Change in General Distress Score as Measured by the NCCN Distress Thermometer and Problem List

Participants will be asked to rate the amount of distress (scale of 0 to 10, 10=extreme distress) that they have experienced in the past week and the amount of distress (scale of 0 to 10) that they attribute to their abnormal cervical cancer screen. The NCCN distress problem list is a 40-item list categorized into five themes-practical, family, emotional, spiritual, and physical problems¬-and leaves room for patients to describe "other". A higher score indicates the greater the amount of distress.

Intent to Use Intervention Over Time

-Providers are asked after completion of enrollment to indicate on a scale of 1=not committed to 10=fully committed of how committed they are to use the intervention in their clinic.

Patients' Satisfaction With Intervention

-The interview guide has two questions that relate to patient satisfaction related to the intervention. 1) Was the [community health worker or 2-1-1 operator] helpful to you? 2) Would you recommend [the community healthworker/2-1-1] to a family member or friend?

Providers' Satisfaction With Intervention

-Providers are asked after completion of enrollment to indicate their satisfaction with the intervention. They are given 12 statements about the satisfaction of the intervention and are asked to circle responses of 1=completely disagree, 2=disagree, 3=neither agree nor disagree, 4=agree, or 5=completely agree. The higher the score the more satisfied the provider is with the intervention.

Resources Needed to Sustain Intervention

-Validated questionnaire that will be administered to providers, staff, and community health workers: Self-administered 15-minute online survey that will be completed at the end of the study enrollment period. The survey will ask about specific implementation outcomes using the Acceptability Intervention Measure, the Intervention Appropriateness Measure, and the Feasibility of Intervention Measure.

Likelihood That Intervention Will Become Built Into Usual Care

-Providers are asked after completion of enrollment to indicate the likelihood that the intervention can be built into usual care in their clinic. The responses are either likely, very likely, neutral, unlikely, very unlikely, or unsure.