Health Equity and Colorectal Cancer Awareness: a Community Health Educator Initiative

Disparities in colorectal cancer (CRC) incidence and mortality persist in rural and underserved communities. Our Community Outreach and Engagement (COE) activities are grounded in a bi-directional Community-to-Bench model in which the National Outreach Network Community Health Educator (NON CHE) Screen to Save (S2S) initiative was implemented. In this study, we assessed the impact of the NON CHE S2S in rural and underserved communities. Descriptive and comparative analyses were used to examine the role of the NON CHE S2S on CRC knowledge and CRC screening intent. Data included demographics, current CRC knowledge, awareness, and future CRC health plans. A multivariate linear regression was fit to survey scores for CRC knowledge. The NON CHE S2S engaged 441 participants with 170 surveys completed. The difference in participants' CRC knowledge before and after the NON CHE S2S intervention had an overall mean of 0.92 with a standard deviation of 2.56. At baseline, White participants had significantly higher CRC knowledge scores, correctly answering 1.94 (p = 0.007) more questions on average than Black participants. After the NON CHE S2S intervention, this difference was not statistically significant. Greater than 95% of participants agreed that the NON CHE S2S sessions impacted their intent to get screened for CRC. Equity of access to health information and the health care system can be achieved with precision public health strategies. The COE bi-directional Community-to-Bench model facilitated community connections through the NON CHE and increased awareness of CRC risk reduction, screening, treatment, and research. The NON CHE combined with S2S is a powerful tool to engage communities with the greatest health care needs and positively impact an individual's intent to "get screened" for CRC.

Effect of Patient and Provider Education on Antibiotic Overuse for Respiratory Tract Infections

Antibiotic overuse for respiratory tract infections (RTIs) in primary care (PC) is a known important contributor to the serious health threat of antibiotic resistance, yet remains a difficult problem to improve. The purpose of the study was to assess the effects of a combination patient and provider education program on antibiotic prescribing in RTIs in a rural primary care clinic. Utilizing a quasi-experimental pretest-posttest design, a retrospective electronic medical record review was conducted to determine if a patient and provider education program changed the rates of antibiotics being prescribed (immediate or delayed) during a visit for RTI for 207 randomly selected patients during the established evaluation time periods. The antibiotic prescription rate for the preintervention group was 56.3% compared to 28.8% for the postintervention group (p < .01). Immediate antibiotics were ordered in the preintervention group 31.1% of the time compared to 13.5% for the postintervention group (p < .05). The results of this study demonstrate that educational interventions can be effective in rural settings and that changes in antibiotic prescribing are possible.

The influence of beliefs on organ donation intention

Purpose

Recent technological developments in healthcare have enabled an increased number of organ transplantation surgeries. At the same time, there is an increase in the number of people awaiting organ transplant, coupled with the difficulty in donation. To bridge this gap, this study aims to propose to evaluate the effect of three types of beliefs (clinical beliefs, financial incentive beliefs and beliefs on the social benefits of altruism and solidarity) on the intention to donate organs. Moreover, this paper uses the attitudes in relation to donation to explain the effect of these beliefs on the intention to donate organs.

Design/methodology/approach

The research was conducted using a survey of 422 Brazilian participants and a mediation analysis to test the mediation hypotheses.

Findings

The results suggest that the effect of three types of beliefs (clinical, economic order and social solidarity) influence the intention to donate organs indirectly through the formation of attitudes concerning organ donation.

Research limitations/implications

This article contributes to the understanding of the formation of organ donation intentions and the role of different types of beliefs in the formation of such intentions.

Originality/value

The findings extend the discussions regarding the role of beliefs in the formation of attitudes and intentions of organ donation and have significant value in creating public policies that further promote organ donation.

Older Rural- and Urban-Dwelling Appalachian Adults With Mild Cognitive Impairment

PURPOSE

Mild cognitive impairment (MCI) is a well-recognized risk state for Alzheimer's disease and other dementias. MCI is rapidly increasing among older adults in general and has not yet been examined in older adults within the Appalachian region. Our objective was to compare MCI symptom severity among older rural and urban Appalachian adults with MCI at an initial neuropsychological testing visit.

METHODS

A cross-sectional, descriptive study of older Appalachian adults with MCI was conducted using data from the National Alzheimer's Coordinating Center Uniform Data Set. Symptom severity was conceptualized as neuropsychological composite scores across 4 cognitive domains and Clinical Dementia Rating-Sum of Boxes (CDR-SOB) score. For group comparisons, MANCOVA was used for cognitive domains and ANCOVA for CDR-SOB.

RESULTS

The sample (N = 289) was about half male (54.3%), predominantly white (91.7%), and living with others (83.5%), with a mean (±SD) 74.6 ± 6.2 years of age and 15.4 ± 3.0 years of education. Rural and urban groups differed significantly in years since onset of cognitive symptoms (2.98 ± 1.91 in rural and 3.89 ± 2.70 in urban adults, t[260] = -2.23, P = .03), but they did not differ across sociodemographic features or comorbid conditions. Rural and urban participants were similar across the 4 cognitive domains and CDR-SOB (P ≥ .05).

DISCUSSION

No differences were found between rural and urban Appalachian residents on MCI symptom severity. However, urban residents reported a longer time lapse from symptom identification to diagnosis than their rural counterparts. Future studies using more representative population samples of Appalachian and non-Appalachian adults will provide an important next step to identifying disparate cognitive health outcomes in this traditionally underserved region.

Process Evaluation of Cancer Prevention Media Campaigns in Appalachian Ohio

The purpose of this study is to provide process data from campaigns (2009-2010) to improve colorectal cancer (CRC; intervention) screening and fruit and vegetable (F&V; comparison) consumption in 12 Appalachian Ohio counties. County-specific campaigns included one billboard, posters, and articles for local newspapers. Participants in CRC screening counties who reported seeing CRC screening billboards had greater intention to talk to a doctor/nurse about screening in the next 6 months (odds ratio [OR] = 2.92, 95% confidence interval [CI; 1.71, 4.99]) and had twice the odds of talking to a doctor/nurse about screening in the past year (OR = 2.15, 95% CI [1.29, 3.60]) compared to those who did not see the billboards. Participants in F&V counties who reported seeing F&V billboards had twice the odds (OR = 2.27, 95% CI [1.35, 3.84]) of talking to a doctor/nurse in the past year about F&Vs compared to those who did not see the billboards. Participants who reported campaign exposure lived closer to the billboards compared to those who did not report campaign exposure (mean distance in miles from home to billboard: 8.8 vs. 10.9; p < .01). Most participants reported campaign messages were clear and important. Results suggest that partnering with community members to develop campaign materials is important to ensure cultural appropriateness and that exposure to the intervention components may affect health-related outcomes.

Recall and Effectiveness of Messages Promoting Smoke-Free Policies in Rural Communities

INTRODUCTION

Low-cost media campaigns increase demand for smoke-free policies in underserved rural areas. The study examined the impact of loss- and gain-framed smoke-free print ads on recall and perceived effectiveness in rural communities, controlling for personal characteristics.

METHODS

Following 6- to 9-month print media campaigns in three rural counties, recall and perceived effectiveness of loss-framed (ie, targeting dangers of secondhand smoke [SHS]) and gain-framed (ie, highlighting positive aspects of smoke-free air) ads were assessed using random-digit-dial phone surveys. Respondents were asked if they remembered each ad, whether they liked it, whether they were prompted to contact a smoke-free coalition, whether the ad made them think, and whether it prompted emotion. Mixed modeling assessed whether personal factors predicted ad recall or perceived effectiveness.

RESULTS

Loss-framed ads were less likely to be recalled but more likely to prompt emotion. For ads of both frame types, females reported greater recall and perceived effectiveness than males. Those with less education reported higher perceived effectiveness of the ads but lower recall. Nonsmokers were more likely than smokers to perceive the ads as effective. Knowledge of SHS risk and support for smoke-free workplaces were positively associated with recall and effectiveness.

CONCLUSIONS

Ad recall and perceived effectiveness were associated with framing and demographic and personal characteristics. Smoke-free efforts in rural areas may be bolstered by continuing to promote benefits of smoke-free workplace policies and educate on SHS risks. Rural areas may need to provide a combination of ad types and framing strategies to appeal to a wide audience.

IMPLICATIONS

Rural communities are disproportionately affected by SHS and less likely to be protected by smoke-free policies. This study adds evidence-based guidance for tailoring rural smoke-free media campaigns using different framing: gain-framed messages (ie, benefits of smoke-free environments) to promote recall and loss-framed content (ie, dangers of SHS) to prompt emotion. Further, gain-framed messages that are localized to the rural community may be especially effective. Findings support designing smoke-free campaigns in rural communities with the audience in mind by tailoring messages to age, sex, and education level.

Canadian cancer screening disparities: a recent historical perspective

Across Canada, introduction of the Pap test for cervical cancer screening, followed by mammography for breast cancer screening and, more recently, the fecal occult blood test for colorectal cancer screening, has contributed to a reduction in cancer mortality. However, another contribution of screening has been disparities in cancer mortality between certain populations. Here, we explore the disparities associated with breast and cervical cancer screening and preliminary data concerning disparities in colorectal cancer screening. Although some disparities in screening utilization have been successfully reduced over time (for example, mammography and Pap test screening in rural and remote populations), screening utilization data for other populations (for example, low-income groups) clearly indicate that disparities have existed and continue to exist across Canada. Organized screening programs in Canada have been able to successfully engage 80% of women for regular cervical cancer screening and 70% of women for regular mammography screening, but of the women who remain to be reached or engaged in regular screening, those with the least resources, those who are the most isolated, and those who are least culturally integrated into Canadian society as a whole are over-represented. Population differences are also observed for utilization of colorectal cancer screening services. The research literature on interventions to promote screening utilization provides some evidence about what can be done to increase participation in organized screening by vulnerable populations. Adaption and adoption of evidence-based screening promotion interventions can increase the utilization of available screening services by populations that have experienced the greatest burden of disease with the least access to screening services.

Empowerment in the process of health messaging for rural low-income mothers: an exploratory message design project

Rural, low-income mothers face challenges to their health equal to or greater than those of low-income mothers from urban areas. This study put health message design into the hands of low-income rural mothers. The current study filled a research gap by analyzing a participatory process used to design health messages tailored to the everyday lives of rural low-income mothers. A total of forty-three mothers participated in nine focus groups, which were held from 2012 to 2013, in eight states. The mothers were from different racial and ethnic backgrounds. Participants discussed food security, physical activity, and oral health information. They created messages by considering several elements: visuals, length of message, voice/perspective, self-efficacy and personal control, emotional appeals, positive and negative reinforcements, and steps to health behavior change. This study was innovative in its focus on empowerment as a key process to health message design.

Increasing screening mammography among immigrant and minority women in Canada: a review of past interventions

Screening mammograms are important to detect breast cancer at earlier and more treatable stages. Immigrant and minority women report low participation rates due to barriers related to cultural beliefs and norms, privacy/modesty, and language. This review examines whether screening mammogram interventions in Canada and other countries with comparable health-care systems have addressed the needs of these women. Our systematic literature search identified studies that focused on increasing screening mammogram participation among immigrant and/or minority women. We used the Health Belief Model and the PRECEDE-PROCEED Model to guide our critical synthesis of the reviewed interventions and the recommendations for the future. Eight studies met the search criteria. Overall, interventions showed some increase in mammogram participation rates. The barriers targeted were relatively similar across studies and there was a focus on increasing cues to screening. This review illustrates that it is essential to develop and implement programs to overcome the unique barriers to screening mammography if we are to increase participation among immigrants and minority women. We suggest other potentially effective health promotion strategies as a starting point for discussion and future research.

Perceptions about organ donation among African American, Hispanic, and white high school students

We applied the Health Belief Model (HBM) to better understand perceptions of organ donation among African American, Hispanic, and White high school students. We conducted 14 focus groups with 18-year-old students to identify strategies to reach this audience when promoting the First-Person Consent Registry (FPCR) for organ donation. We found that African American, Hispanic, and White high school students are largely unaware of the need for organ donors, and are unfamiliar with how to join the FPCR. Participants identified more barriers to joining the FPCR than benefits. Two aspects of self-efficacy emerged related to joining the FPCR: decisional and task efficacy. Overall, few differences were found with respect to organ donation myths across the three ethnic groups. The results are discussed, with an emphasis on how the findings compare and contrast with previous organ donation research. We focus on message design and dissemination strategies for practitioners targeting 18-year-old high school students with organ donation promotional materials.

A formative evaluation of shared family mealtime for parents of toddlers and young children

Shared family mealtime offers numerous health benefits for young children. Unfortunately, only a few studies examine the benefits and barriers to eating together as a family. The present study seeks to fill this gap in the literature by applying the health belief model to understand parents' perceptions about the challenges of preparing and executing family mealtime for toddlers and young children. Six focus groups were conducted with parents of toddlers and/or young children (n = 24). Results revealed that parents identified several benefits to shared family mealtime, including good teaching moments for their children, enhanced family connectedness, and encouraging nutritious meals. Parents also identified barriers to eating together as a family, including child behavioral issues, scheduling difficulties, and ill-prepared husbands. The risks associated with not eating together as a family were seldom mentioned; however, parents highlighted several issues related to self-efficacy, such as difficulty in selecting meals and challenges with cooking. Potential cues to action include print materials encouraging parents by emphasizing the benefits of eating together as a family. Results are discussed with an emphasis on message design strategies for health practitioners interested in advocating this important yet under-studied phenomenon.

Perspectives on Pap test follow-up care among rural Appalachian women

Approximately one- to three-quarters of women notified of abnormal Pap test results do not receive appropriate follow-up care, dramatically elevating their risk for invasive cervical cancer. We explored barriers to and facilitators of follow-up care for women in two counties in Appalachian Kentucky, where invasive cervical cancer incidence and mortality are significantly higher than the national average. In-depth interviews were conducted among 27 Appalachian women and seven local health department personnel. Those who had been told of an atypical Pap test result tended to have one of three reactions: (1) not alarmed and generally did not obtain follow-up care; (2) alarmed and obtained follow-up care; or (3) alarmed, but did not obtain care. Each of these typologies appeared to be shaped by a differing set of three categories of influences: personal factors; procedure/provider/system factors; and ecological/community factors. Recommendations to increase appropriate follow-up care included pursuing research on explanations for these typologies and developing tailored interventions specific to women in each of the response types.

Could it be asthma? Using social marketing strategies to increase parent and caregiver knowledge of asthma symptoms in children in a rural community

Many parents and caregivers do not recognize the symptoms of asthma in children, and consequently children may not receive the appropriate diagnosis and treatment for this potentially fatal disease. This article describes how Steps to a HealthierNY used social marketing strategies to design a media campaign called "Could It Be Asthma?" to educate parents and caregivers about the symptoms of asthma. The campaign used television advertising, brochures, and posters to educate parents and caregivers in rural Jefferson County, New York, about asthma symptoms. The campaign ran in March and April 2005. A follow-up survey was conducted among 756 parents and caregivers in collaboration with four local pediatricians' offices. Results showed that approximately 60% of participants were familiar with "Could It Be Asthma?" Of those participants, approximately 68% indicated that the ads had a positive impact and 46% indicated that they had learned the symptoms of asthma. The campaign and survey were repeated in the fall of 2005. Results were consistent, with a significant increase in the percentage of people who were familiar with the campaign. This social marketing campaign was successful in reaching parents in a rural community with important educational messages; similar strategies should be considered in educating the public about asthma and other health issues.