Stomach or gastric cancer is the fifth most common cancer and the third leading cause of cancer mortality in the world, with a disproportionate burden experienced among Asians globally and Asian Americans in the US. Stomach cancer incidence among Chinese Americans is nearly twice that of non-Hispanic whites. In New York City (NYC), Asian men have twice the stomach cancer mortality of non-Hispanic white men and Asian women have the highest rates across all racial/ethnic groups. The bacterium Helicobacter pylori (H. pylori) is the strongest risk factor for stomach cancer. Up to 75% of all stomach cancer cases in the US present with late- stage disease, underscoring the need for more prevention and early detection. H. pylori eradication through triple antibiotic therapy is the most effective prevention method, however, it requires patient education and provider support to yield high adherence, especially for limited English and low health literacy populations. Many patients at high risk for stomach cancer enter primary care and endoscopy clinics for dyspepsia symptoms associated with H. pylori, thus representing a key window for prevention. H. pylori eradication efforts in the US, however, are limited in practice and poorly integrated within health systems. Health information technology (HIT) and community health worker (CHW)-led interventions have demonstrated effectiveness in improving screening, treatment, and follow-up care to bridge this gap, yet no studies have investigated the impact of integrating these strategies into a test-and-treat H. pylori approach. Led by Dr. Simona Kwon, the study goal of this full Research Project is to assess the efficacy, adoption, and impact of an integrated intervention to improve adherence to recommended stomach cancer prevention guidelines for at-risk, limited English proficient, low-income Chinese Americans in NYC. The integrated multifaceted theory-based intervention involves: 1) a health systems-level intervention using electronic health record (EHR)-based tools to facilitate H. pylori test-and-treat strategies; and 2) a theory-informed culturally and linguistically adapted CHW-led patient navigation program. Using a two-arm randomized controlled trial design, we will enroll 144 Chinese American patients across NYC safety net hospital settings to achieve the following specific aims: 1) Collaboratively develop an EHR- based clinical decision support system and a CHW-led culturally and linguistically adapted stomach cancer prevention program to improve H. pylori eradication for the LEP, Chinese American patients; 2) Implement and assess the efficacy of a H. pylori test-and-treat EHR-CHW intervention; and 3) Use a mixed-methods approach and the RE-AIM evaluation framework to systematically assess the implementation process and delineate factors that influence feasibility, acceptability, adoption, sustainability, and scalability of a combined EHR-CHW strategy within safety net health care systems.
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