Reducing Colorectal Cancer Health Disparities: An mHealth Intervention to Improve Screening among African American Men

Isa Associates, Inc., Alexandria VA

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT Poverty has a myriad of pernicious effects on health, including higher incidence and mortality for most forms of cancer. Colorectal cancer (CRC), the second overall leading cause of cancer death, is no exception. CRC is diagnosed 40% more often in those lower in socioeconomic status (SES). In the United States, race and SES are inextricably linked, leading to profound health disparities. Indeed, CRC is particularly burdensome for Black people; most notably African American men. CRC incidence is 20% higher in Black men as compared to white men with death rates 52% higher. African American men have the lowest survival rates at all CRC stages. Because the precancerous polyps that cause most CRCs grow slowly, adherence to CRC screening can prevent most cases from becoming invasive cancer. Unfortunately, use of screening tests is inadequate, especially among low SES African American men. Indeed, 40% of the racial disparity in CRC incidence and 20% of the mortality differences can be attributed to lack of screening. Being Black, male, and low SES in the United States intersect to form a complex set of institutional, provider, and patient-level barriers that lead to these differential screening rates. Most existing approaches to increase CRC screening in this group utilize in- person or telephone-based education and patient navigation. While effective, these approaches are costly and resource intensive, limiting their adoption among organizations that primarily serve low SES African American men, such as Federally Qualified Health Centers (FQHCs). To address the need for an effective, affordable, and scalable intervention to increase CRC screening among medically underserved African American men, this project will develop a theory-based, tailored, and culturally- targeted CRC screening mHealth intervention for this group. The proposed intervention will be based on the health belief model (HBM) and delivered via mobile phone. It will include text messages designed to improve CRC knowledge and health beliefs. Additionally, the program will present three web-based video components: scripted vignettes, unscripted peer narratives, and educational instruction. All program content will be designed to reduce health literacy barriers and promote adherence to CRC screening recommendations. Finally, it will be culturally targeted by contextualizing HBM constructs with the health beliefs most relevant to low SES African American men and by integrating gender- and race-congruent imagery, language, and values. Eight FQHC staff members and 20 African American men will be recruited for focus group discussions to shape the proposed intervention. When a prototype version of the program is completed, 20 African American men who are nonadherent to CRC screening (i.e., target end-users) will be recruited for usability testing. The usability test will include a series of tasks intended to highlight the different features of the proposed intervention. Three usability metrics will be assessed: efficiency, accuracy, and subjective satisfaction.