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Adsul P, English K, Jim C, Pankratz VS, Edwardson N, Sheche J, Rodman J, Charlie J, Pagett J, Trujillo J, Grisel-Cambridge J, Mora S, Yepa KL, Mishra SI. Participatory action research to develop and implement multicomponent, multilevel strategies for implementing colorectal cancer screening interventions in American Indian communities in New Mexico. Implement Sci Commun 2024; 5:55. [PMID: 38730301 PMCID: PMC11083750 DOI: 10.1186/s43058-024-00591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Despite the effectiveness of colorectal cancer (CRC) screening, American Indians (AIs) have low screening rates in the US. Many AIs receive care at Indian Health Services, Tribal, and Urban Indian (I/T/U) healthcare facilities, where published evidence regarding the implementation of CRC screening interventions is lacking. To address this gap, the University of New Mexico Comprehensive Cancer Center and the Albuquerque Area Southwest Tribal Epidemiology Center collaborated with two tribally-operated healthcare facilities in New Mexico with the goal of improving CRC screening rates among New Mexico's AI communities. METHODS Guided by the principles of Community Based Participatory Research, we engaged providers from the two tribal healthcare facilities and tribal community members through focus group (two focus groups with providers (n = 15) and four focus group and listening sessions with community members (n = 65)), to elicit perspectives on the feasibility and appropriateness of implementing The Guide to Community Preventive Services (The Community Guide) recommended evidence-based interventions (EBIs) and strategies for increasing CRC screening. Within each tribal healthcare facility, we engaged a Multisector Action Team (MAT) that participated in an implementation survey to document the extent to which their healthcare facilities were implementing EBIs and strategies, and an organizational readiness survey that queried whether their healthcare facilities could implement additional strategies to improve uptake of CRC screening. RESULTS The Community Guide recommended EBIs and strategies that received the most support as feasible and appropriate from community members included: one-on-one education from providers, reminders, small media, and interventions that reduced structural barriers. From the providers' perspective, feasible and acceptable strategies included one-on-one education, patient and provider reminders, and provider assessment and feedback. Universally, providers mentioned the need for patient navigators who could provide culturally appropriate education about CRC and assist with transportation, and improved support for coordinating clinical follow-up after screening. The readiness survey highlighted overall readiness of the tribal facility, while the implementation survey highlighted that few strategies were being implemented. CONCLUSIONS Findings from this study contribute to the limited literature around implementation research at tribal healthcare facilities and informed the selection of specific implementation strategies to promote the uptake of CRC screening in AI communities.
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Affiliation(s)
- Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA
| | - Cheyenne Jim
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA
| | - V Shane Pankratz
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Nicholas Edwardson
- University of New Mexico School of Public Administration, Albuquerque, NM, USA
| | - Judith Sheche
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | | | - John Pagett
- Kewa Pueblo Health Corporation, Kewa Pueblo, NM, USA
| | | | | | - Steven Mora
- Jemez Health & Human Services, Jemez Pueblo, NM, USA
| | | | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
- Department of Pediatrics, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 10 5590, Albuquerque, NM, 87131, USA.
- Department of Family and Community Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 10 5590, Albuquerque, NM, 87131, USA.
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Welch AC, London SM, Wilshire CL, Gilbert CR, Buchwald D, Ferguson G, Allick C, Gorden JA. Access to Lung Cancer Screening Among American Indian and Alaska Native Adults: A Qualitative Study. Chest 2024; 165:716-724. [PMID: 37898186 DOI: 10.1016/j.chest.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer mortality among American Indian and Alaska Native populations. American Indian and Alaska Native people use commercial tobacco products at higher rates compared with all other races and ethnicities. Moreover, they show lower adherence to cancer screening guidelines. RESEARCH QUESTION How do American Indian and Alaska Native adults perceive and use lung cancer screening? STUDY DESIGN AND METHODS We conducted a study in which we recorded and transcribed data from three focus groups consisting of American Indian and Alaska Native adults. Participants were recruited through convenience sampling at a national health conference. Transcripts were analyzed by inductive coding. RESULTS Participants (n = 58) of 28 tribes included tribal Elders, tribal leaders, and non-Native volunteers who worked with tribal communities. Limited community awareness of lung cancer screening, barriers to lung cancer screening at health care facilities, and health information-seeking behaviors emerged as key themes in discussions. Screening knowledge was limited except among people with direct experiences of lung cancer. Cancer risk factors such as multigenerational smoking were considered important priorities to address in communities. Limited educational and diagnostic resources are significant barriers to lung cancer screening uptake in addition to limited discussions with health care providers about cancer risk. INTERPRETATION Limited access to and awareness of lung cancer screening must be addressed. American Indian and Alaska Native adults use several health information sources unique to tribal communities, and these should be leveraged in designing screening programs. Equitable partnerships between clinicians and tribes are essential in improving knowledge and use of lung cancer screening.
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Affiliation(s)
- Allison C Welch
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA
| | - Sara M London
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Candice L Wilshire
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA
| | | | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Gary Ferguson
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Cole Allick
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA
| | - Jed A Gorden
- Department of Thoracic Surgery and Interventional Pulmonology, Swedish Medical Center and Cancer Institute, Seattle, WA.
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Han E(F, Srinivasa S, Gurney J, Koea J. Cancer Screening Services: What Do Indigenous Communities Want? A Systematic Review. JCO Glob Oncol 2024; 10:e2300035. [PMID: 38359371 PMCID: PMC10881110 DOI: 10.1200/go.23.00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/04/2023] [Accepted: 11/14/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Indigenous communities experience worse cancer outcomes compared with the general population partly because of lower cancer screening access. One-size-fits-all screening programs are unsuitable for reaching Indigenous communities. In this review, we summarize available evidence on the perspectives of these communities; with a view to informing the improvement of cancer screening services to achieve equitable access. METHODS We undertook a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the databases MEDLINE, Scopus, PubMed, and Google Scholar. The search terms used were "Indigenous community or Indigenous communities," "cancer screening," and "facilitators, enablers, desires, or needs." Qualitative studies published up to the August 30, 2022 investigating the perspectives of Indigenous communities on factors encouraging screening participation were included in the study. The included studies were reviewed and analyzed inductively by two independent reviewers, and key themes regarding indigenous access to cancer screening were then extracted. RESULTS A total of 204 unique articles were identified from the search. The title and abstracts of these studies were screened, and 164 were excluded on the basis of the exclusion and inclusion criteria. The full texts of the remaining 40 studies were examined and 18 were included in the review. Four key themes were identified pertaining to culturally tailored education and information dissemination, community involvement, positive relationships with health care providers, and individual empowerment and autonomy. CONCLUSION Improvements, on the basis of the key themes identified from this review, must be made at all levels of the health care system to achieve equitable screening participation in Indigenous communities. However, we recommend an investigation into the perspectives of the local Indigenous communities before the initiation of cancer screening programs.
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Affiliation(s)
| | - Sanket Srinivasa
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jonathan Koea
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
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Burningham TA, Day LW. American Indian and Alaska Native Digestive Health: Challenges, Opportunities, and a Path Forward. Clin Gastroenterol Hepatol 2023; 21:3203-3208. [PMID: 38007243 DOI: 10.1016/j.cgh.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Indexed: 11/27/2023]
Affiliation(s)
- Tyson A Burningham
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Lukejohn W Day
- Division of Gastroenterology, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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Burningham TA, Day LW. American Indian and Alaska Native Digestive Health: Challenges, Opportunities, and a Path Forward. Gastroenterology 2023; 165:1318-1322. [PMID: 37981353 DOI: 10.1053/j.gastro.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Tyson A Burningham
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Lukejohn W Day
- Division of Gastroenterology, University of California, San Francisco, and, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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Mishra SI, Adsul P, Leekity S, Rodman J, Sussman AL, Kelly K, Sheche J, Faber T, Shah V. A culturally informed model to enhance breast, cervical, and colorectal cancer screenings: perspectives of American Indian adults and healthcare providers in rural New Mexico. Cancer Causes Control 2023; 34:855-871. [PMID: 37277513 PMCID: PMC10460346 DOI: 10.1007/s10552-023-01721-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 05/16/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE American Indian/Alaska Native (AI/AN) populations have some of the lowest cancer screening rates compared to other racial/ethnic populations. Using community-based participatory research methods, we sought to characterize knowledge, attitudes, beliefs, and approaches to enhance breast, colorectal, and cervical cancer screening. METHODS We conducted 12 focus groups between October 2018 and September 2019 with 96 eligible AI adults and healthcare providers, recruited using non-probability purposive sampling methods from the Zuni Pueblo in rural New Mexico. We used the Multi-level Health Outcomes Framework (MHOF) to conduct a qualitative content analysis identifying mutable systems- and individual- level constructs important for behavior change that we crosslinked with the Community Preventive Services Task Force (CPSTF) recommended evidence-based interventions (EBIs) or approaches. RESULTS Salient systems-level factors that limited uptake of cancer screenings included inflexible clinic hours, transportation barriers, no on-demand service and reminder systems, and brief doctor-patient encounters. Individual-level barriers included variable cancer-specific knowledge that translated into fatalistic beliefs, fear, and denial. Interventions to enhance community demand and access for screening should include one-on-one and group education, small media, mailed screening tests, and home visitations by public health nurses. Interventions to enhance provider delivery of screening services should include translation and case management services. CONCLUSIONS The MHOF constructs crosslinked with CPSTF recommended EBIs or approaches provided a unique perspective to frame barriers and promoters of screening utilization and insights for intervention development. Findings inform the development of culturally tailored, theoretically informed, multi-component interventions concordant with CPSTF recommended EBIs or approaches aimed at improving cancer screening.
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Affiliation(s)
- Shiraz I. Mishra
- Departments of Pediatrics and Family and Community Medicine, and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Prajakta Adsul
- Department of Internal Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Samantha Leekity
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Joseph Rodman
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Andrew L. Sussman
- Department of Family and Community Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5040, Albuquerque, NM 87131 USA
| | - Keith Kelly
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Judith Sheche
- University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
| | - Thomas Faber
- Albuquerque Area Indian Health Service, 4101 Indian School Rd, NE, Albuquerque, NM 87110 USA
| | - Vallabh Shah
- Department of Internal Medicine and University of New Mexico Comprehensive Cancer Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 07 4025, Albuquerque, NM 87131 USA
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Pankratz VS, Kanda D, Edwardson N, English K, Adsul P, Li Y, Parasher G, Mishra SI. Colorectal Cancer Survival Trends in the United States From 1992 to 2018 Differ Among Persons From Five Racial and Ethnic Groups According to Stage at Diagnosis: A SEER-Based Study. Cancer Control 2022; 29:10732748221136440. [PMID: 36264283 PMCID: PMC9597478 DOI: 10.1177/10732748221136440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Survival following colorectal cancer (CRC) has improved in the US since 1975, but there is limited information on stage-specific survival trends among racial and ethnic subgroups. Objectives The purpose of this study was to estimate and compare trends in 1- and 5-year CRC cause-specific survival in the United States by both stage and race/ethnicity. Methods We performed a retrospective cohort study of individuals diagnosed with CRC using the 1992-2018 Surveillance, Epidemiology and End Results (SEER) database. We estimated and compared time trends in 1- and 5-year survival for CRC stage by race/ethnicity. Results Data from 399 220 individuals diagnosed with CRC were available. There were significant differences in stage-specific 1-year survival trends by race and ethnicity. Differences were most notable for distant stage CRC: survival probabilities increased most consistently for non-Hispanic American Indian/Alaska Native (AIAN) and Black (NHB) persons, but their trend lines were lower than those of Hispanic, and non-Hispanic Asian/Pacific Islander (API) and White (NHW) persons, whose initially greater gains appear to be slowing. Although the data do not support significant racial/ethnic differences in 5-year CRC survival trends by stage, AIAN and NHB persons have the lowest average survival probabilities for multiple CRC stages, and no racial/ethnic group has 5-year survival probabilities above 20% for distant-stage CRC. Conclusion Although there has been an overall improvement in adjusted CRC-specific survival probabilities since 1992, AIAN and NHB persons continue to experience worse prognosis than those of other races/ethnicities. This highlights the importance of reinvigorating efforts to understand the causes of mortality in CRC, including those which may differ according to an individual’s race or ethnicity.
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Affiliation(s)
- Vernon S. Pankratz
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA,Vernon S. Pankratz, PhD, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC 07 4025, Albuquerque, NM 87131-0001, USA.
| | - Deborah Kanda
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Nicholas Edwardson
- School of Public Administration, University of New Mexico, Albuquerque, NM, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc., Albuquerque, NM, USA
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA,University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Yiting Li
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Gulshan Parasher
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Shiraz I. Mishra
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA,Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA,Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Blanchard J, Rhoades D, Nagykaldi Z, Campbell J, Cannady T, Hopkins M, Gibson M, Lonewolf H, Doescher M. Identifying Priorities and Strategies for Improving Colorectal Cancer Screening in Tribal Clinics. Cancer Control 2022; 29:10732748221132516. [PMID: 36224082 PMCID: PMC9561646 DOI: 10.1177/10732748221132516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the 3rd most frequently diagnosed cancer and the 2nd leading cause of cancer death in the United States (US), and incidence and mortality rates in Oklahoma are higher for many American Indian (AI) populations than other populations. The AI CRC Screening Consortium addresses major regional CRC screening disparities among AIs with shared objectives to increase CRC screening delivery and uptake in AIs aged 50 to 75 years at average risk for CRC and to assess the effectiveness of implementations of the interventions. This manuscript reports environmental scan findings related to current practices and multi-stakeholder experiences with CRC screening in two Oklahoma Indian health care systems. METHOD We conducted a mixed methods environmental scan across five clinical sites and with multiple stakeholders to determine the scope and scale of colorectal cancer screening in two separate AI health care delivery systems in Oklahoma. Data collection consisted of a mixture of individual interviews and group discussions at an urban site, and four clinical care sites within a tribal health system. RESULTS Sixty-two individuals completed interviews. Data from these interviews will inform the development of evidence-based intervention strategies to increase provider delivery, community access to, and community priority for CRC screening in diverse AI health care delivery systems. Conversations with patients, providers, and clinical leadership point to individual and system-level opportunities for improvement at each site, shaped in part by differences in the delivery of services, structure of the health care system, and capacity to implement new intervention strategies. The thematic areas most central to the process of evidenced-based intervention development included: current practices, needs and recommendations, and CRC site priorities. CONCLUSION Environmental scan data indicated clear opportunities for individual and system-level interventions to enhance CRC screening and was critical for understanding readiness for EBI implementation at each site.
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Affiliation(s)
- Jessica Blanchard
- University of
Oklahoma, Norman, OK, USA,Jessica Blanchard, University of Oklahoma,
201 Stephenson Parkway, Suite 4100, Norman, OK 73019, USA.
| | - Dorothy Rhoades
- University of Oklahoma College of
Medicine, Oklahoma, OK, USA
| | - Zsolt Nagykaldi
- Family Medicine Center Building,
University
of Oklahoma Health Sciences Center,
Oklahoma, OK, USA
| | | | | | | | | | | | - Mark Doescher
- University of Oklahoma College of
Medicine, Oklahoma, OK, USA
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Pankratz VS, Kosich M, Edwardson N, English K, Adsul P, Li Y, Parasher G, Mishra SI. American Indian/Alaska Native and black colon cancer patients have poorer cause-specific survival based on disease stage and anatomic site of diagnosis. Cancer Epidemiol 2022; 80:102229. [PMID: 35872382 PMCID: PMC9482950 DOI: 10.1016/j.canep.2022.102229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Studies of race-specific colon cancer (CC) survival differences between right- vs. left-sided CC typically focus on Black and White persons and often consider all CC stages as one group. To more completely examine potential racial and ethnic disparities in side- and stage-specific survival, we evaluated 5-year CC cause-specific survival probabilities for five racial/ethnic groups by anatomic site (right or left colon) and stage (local, regional, distant). METHODS We obtained cause-specific survival probability estimates from National Cancer Institute's population-based Surveillance, Epidemiology, and End Results (SEER) for CC patients grouped by five racial/ethnic groups (Non-Hispanic American Indian/Alaska Native [AIAN], Non-Hispanic Asian/Pacific Islander [API], Hispanic, Non-Hispanic Black [NHB], and Non-Hispanic White [NHW]), anatomic site, stage, and other patient and SEER registry characteristics. We used meta-regression approaches to identify factors that explained differences in cause-specific survival. RESULTS Diagnoses of distant-stage CC were more common among NHB and AIAN persons (>22 %) than among NHW and API persons (< 20 %). Large disparities in anatomic site-specific survival were not apparent. Those with right-sided distant-stage CC had a one-year cause-specific survival probability that was 16.4 % points lower (99 % CI: 12.2-20.6) than those with left-sided distant-stage CC; this difference decreased over follow-up. Cause-specific survival probabilities were highest for API, and lowest for NHB, persons, though these differences varied substantially by stage at diagnosis. AIAN persons with localized-stage CC, and NHB persons with regional- and distant-stage CC, had significantly lower survival probabilities across follow-up. CONCLUSIONS There are differences in CC presentation according to anatomic site and disease stage among patients of distinct racial and ethnic backgrounds. This, coupled with the reality that there are persistent survival disparities, with NHB and AIAN persons experiencing worse prognosis, suggests that there are social or structural determinants of these disparities. Further research is needed to confirm whether these CC cause-specific survival disparities are due to differences in risk factors, screening patterns, cancer treatment, or surveillance, in order to overcome the existing differences in outcome.
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Affiliation(s)
- V Shane Pankratz
- Department of Internal Medicine, University of New Mexico Health Sciences Center, the United States of America; University of New Mexico Comprehensive Cancer Center, the United States of America.
| | - Mikaela Kosich
- University of New Mexico Comprehensive Cancer Center, the United States of America
| | - Nicholas Edwardson
- University of New Mexico, School of Public Administration, the United States of America
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc., the United States of America
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico Health Sciences Center, the United States of America; University of New Mexico Comprehensive Cancer Center, the United States of America
| | - Yiting Li
- Department of Internal Medicine, University of New Mexico Health Sciences Center, the United States of America
| | - Gulshan Parasher
- Department of Internal Medicine, University of New Mexico Health Sciences Center, the United States of America
| | - Shiraz I Mishra
- University of New Mexico Comprehensive Cancer Center, the United States of America; Department of Pediatrics, University of New Mexico Health Sciences Center, the United States of America; Department of Family and Community Medicine, University of New Mexico Health Sciences Center, the United States of America
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10
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Gutnik L, Bleicher J, Davis A, McLeod MC, McCrum M, Scaife C. American Indian/Alaska native access to colorectal cancer screening: Does gastroenterologist density matter? Am J Surg 2022; 224:965-970. [PMID: 35513914 DOI: 10.1016/j.amjsurg.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND American Indians/Alaska Natives (AI/AN) receive less colorectal cancer (CRC) screening than other populations. Using gastroenterologist (GI) locations as a measure of colonoscopy access, we correlate GI density and AI/AN CRC screening rates. METHODS We identified GIs from the 2016 National Provider Identifier registry, and calculated GI density per 100,000 people. We identified screening, demographic, and socioeconomic variables from the 2016 Behavioral Risk Factor Surveillance System Survey. GI density and CRC screening rates were analyzed with Multivariable Poisson regression. RESULTS In states with GI Density greater than 3.98/100,000, odds of AI/AN CRC screening are 1.27-1.37 times higher than in states below this threshold (p < 0.036). CONCLUSIONS GI density has a limited association on CRC screening, with decrease impact beyond threshold of 3.98 GI/100,000. Minimal access to GIs is important in improving AI/AN CRC screening; however, further research is required to elucidate the most critical factors contributing to CRC screening.
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Affiliation(s)
- Lily Gutnik
- University of Alabama at Birmingham, Department of Surgery, 1807 Seventh Ave South, BDB 515, Birmingham, AL, 35233, USA; University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
| | - Josh Bleicher
- University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
| | - Andrea Davis
- University of Utah, Department of Geography, 260 Central Campus Dr #4625, Salt Lake City, UT, 84112, USA.
| | - M Chandler McLeod
- University of Alabama at Birmingham, Department of Surgery, 1807 Seventh Ave South, BDB 515, Birmingham, AL, 35233, USA.
| | - Marta McCrum
- University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
| | - Courtney Scaife
- University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT, 84132, USA; Huntsman Cancer Institute at the University of Utah, Division of Surgical Oncology, 2000 Cir of Hope Dr #1950, Salt Lake City, UT, 84112, USA.
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Batai K, Sanderson PR, Hsu CH, Joshweseoma L, Russell D, Joshweseoma L, Ojeda J, Burhansstipanov L, Brown SR, Ami D, Saboda K, Harris RB. Factors Associated with Cancer Screening Among Hopi Men. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:915-923. [PMID: 33083892 PMCID: PMC8560009 DOI: 10.1007/s13187-020-01900-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 05/06/2023]
Abstract
Cancer screening rates remain low among American Indian men, and cancer screening behaviors and barriers to cancer screening among American Indian men are not well understood. This study evaluated cancer screening behaviors in 102 Hopi men who were 50 years of age or older from the Hopi Survey of Cancer and Chronic Disease. Reported cancer screening frequencies were 15.7%, 45.1%, and 35.3% for fecal occult blood test (FOBT), colonoscopy, and prostate-specific antigen (PSA) test, respectively. Among men who reported having had a FOBT, 81.2% had the test more than 1 year ago. Among men who reported a colonoscopy, 60.8% had colonoscopy within the past 3 years. Similarly, among men who reported having had PSA, 72.3% had PSA within the past 3 years. "No one told me" was the most common answer for not undergoing FOBT (33.7%), colonoscopy (48.2%), and PSA (39.4%). Men who reported having had a PSA or digital rectal exam were three times as likely to also report having a FOBT or colonoscopy (odds ratio [OR] 3.19, 95% confidence interval [CI]: 1.21-8.46). Younger age (< 65) was associated with reduced odds of ever having prostate cancer screening (OR 0.28, 95% CI: 0.10-0.77). Ever having colorectal cancer screening and previous diagnosis of cancer increased odds of ever having prostate cancer screening (OR 3.15, 95% CI: 1.13-8.81 and OR 5.28, 95% CI: 1.15-24.18 respectively). This study illustrates the importance of community cancer education for men to improve cancer screening participation.
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Affiliation(s)
- Ken Batai
- Department of Urology, University of Arizona, Tucson, AZ, USA.
- University of Arizona Cancer Center, 1515 N. Campbell Ave., PO Box 245024, Tucson, AZ, 85724, USA.
| | - Priscilla R Sanderson
- Health Sciences Department, Student & Academic Services Center, College of Health and Human Services, Northern Arizona University, 1100 South Beaver Street, PO Box #15095, Flagstaff, AZ, 86011, USA.
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Dana Russell
- HOPI Cancer Support Services, Department of Health and Human Services, Hopi Tribe, Kykotsmovi, AZ, USA
| | | | - Jordan Ojeda
- Health Sciences Department, Student & Academic Services Center, College of Health and Human Services, Northern Arizona University, 1100 South Beaver Street, PO Box #15095, Flagstaff, AZ, 86011, USA
| | | | - Sylvia R Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Delores Ami
- HOPI Cancer Support Services, Department of Health and Human Services, Hopi Tribe, Kykotsmovi, AZ, USA
| | - Kathylynn Saboda
- University of Arizona Cancer Center, 1515 N. Campbell Ave., PO Box 245024, Tucson, AZ, 85724, USA
| | - Robin B Harris
- University of Arizona Cancer Center, 1515 N. Campbell Ave., PO Box 245024, Tucson, AZ, 85724, USA
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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12
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Formative Assessment to Improve Cancer Screenings in American Indian Men: Native Patient Navigator and mHealth Texting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116546. [PMID: 35682130 PMCID: PMC9180909 DOI: 10.3390/ijerph19116546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023]
Abstract
Cancer screening rates among American Indian men remain low, without programs specifically designed for men. This paper describes the Community-Based Participatory Research processes and assessment of cancer screening behavior and the appropriateness of the mHealth approach for Hopi men's promotion of cancer screenings. This Community-Based Participatory Research included a partnership with H.O.P.I. (Hopi Office of Prevention and Intervention) Cancer Support Services and the Hopi Community Advisory Committee. Cellular phone usage was assessed among male participants in a wellness program utilizing text messaging. Community surveys were conducted with Hopi men (50 years of age or older). The survey revealed colorectal cancer screening rate increased from 51% in 2012 to 71% in 2018, while prostate cancer screening rate had not changed (35% in 2012 and 37% in 2018). Past cancer screening was associated with having additional cancer screening. A cellular phone was commonly used by Hopi men, but not for healthcare or wellness. Cellular phone ownership increased odds of prostate cancer screening in the unadjusted model (OR 9.00, 95% CI: 1.11-73.07), but not in the adjusted model. Cellular phones may be applied for health promotion among Hopi men, but use of cellular phones to improve cancer screening participation needs further investigation.
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13
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Brooks E, Islam JY, Perdue DG, Petersen E, Camacho-Rivera M, Kennedy C, Rogers CR. The Black Panther, Masculinity Barriers to Medical Care, and Colorectal Cancer Screening Intention Among Unscreened American Indian/Alaska Native, Black, and White Men. Front Public Health 2022; 10:814596. [PMID: 35462819 PMCID: PMC9019156 DOI: 10.3389/fpubh.2022.814596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To determine if masculinity barriers to medical care and the death from colorectal cancer (CRC) of actor Chadwick Boseman (The Black Panther) influenced CRC early-detection screening intent among unscreened American Indian/Alaska Native (AIAN) and Non-Hispanic-Black (Black) men compared with Non-Hispanic-White (White) men. Methods Using a consumer-panel, we surveyed U.S. men aged 18-75 years (N = 895) using the 24-item Masculinity Barriers to Medical Care (MBMC) scale. We calculated the median score to create binary exposures to evaluate associations with CRC screening intent and conducted multivariable logistic regression to evaluate independent associations stratified by race/ethnicity. Results Overall, Black respondents were most likely to have a high MBMC score (55%) compared to White (44%) and AIAN (51%) men (p = 0.043). AIAN men were least likely to report CRC screening intent (51.1%) compared with Black (68%) and White men (64%) (p < 0.001). Black men who reported the recent death of Chadwick Boseman increased their awareness of CRC were more likely (78%) to report intention to screen for CRC compared to those who did not (56%) (p < 0.001). Black men who exhibited more masculinity-related barriers to care were more likely to intend to screen for CRC (OR: 1.76, 95% CI: 0.98-3.16) than their counterparts, as were Black men who reported no impact of Boseman's death on their CRC awareness (aOR: 2.96, 95% CI: 1.13-7.67). Conversely, among AIAN men, those who exhibited more masculinity-related barriers to care were less likely to have CRC screening intent (aOR: 0.47, 95% CI: 0.27-0.82) compared with their counterparts. Conclusions Masculinity barriers to medical care play a significant role in intention to screen for CRC. While Black men were most likely to state that The Black Panther's death increased their awareness of CRC, it did not appear to modify the role of masculine barriers in CRC screening intention as expected. Further research is warranted to better understand how masculine barriers combined with celebrity-driven health-promotion interventions influence the uptake of early-detection screening for CRC. Impact Our study provides formative data to develop behavioral interventions focused on improving CRC screening completion among diverse men.
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Affiliation(s)
- Ellen Brooks
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jessica Y. Islam
- Center for Immunization and Infections in Cancer, Cancer Epidemiology Program, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, United States
| | | | - Ethan Petersen
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | - Carson Kennedy
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Charles R. Rogers
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
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14
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Rogers CR, Perdue DG, Boucher K, Korous KM, Brooks E, Petersen E, Inadomi JM, Tuuhetaufa F, Levant RF, Paskett ED. Masculinity Barriers to Ever Completing Colorectal Cancer Screening among American Indian/Alaska Native, Black, and White Men (Ages 45-75). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3071. [PMID: 35270762 PMCID: PMC8910566 DOI: 10.3390/ijerph19053071] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 12/11/2022]
Abstract
Disparities in colorectal cancer (CRC) mortality among White, Black, and American Indian/Alaska Native (AIAN) men are attributable to differences in early detection screening. Determining how masculinity barriers influence CRC screening completion is critical for cancer prevention and control. To determine whether masculinity barriers to medical care are associated with lower rates of ever completing CRC screening, a survey-based study was employed from December 2020-January 2021 among 435 White, Black, and AIAN men (aged 45-75) who resided in the US. Logistic regression models were fit to four Masculinity Barriers to Medical Care subscales predicting ever completing CRC screening. For all men, being strong was associated with 54% decreased odds of CRC screening completion (OR 0.46, 95% CI 0.23 to 0.94); each unit increase in negative attitudes toward medical professionals and exams decreased the odds of ever completing CRC screening by 57% (OR 0.43, 95% CI 0.21 to 0.86). Black men who scored higher on negativity toward medical professionals and exams had decreased odds of ever screening. Consideration of masculinity in future population-based and intervention research is critical for increasing men's participation in CRC screening, with more salience for Black men.
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Affiliation(s)
- Charles R. Rogers
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA; (K.M.K.); (E.B.); (E.P.); (F.T.)
| | | | - Kenneth Boucher
- Cancer Biostatistics Shared Resource, Huntsman Cancer Institute, Salt Lake City, UT 84112, USA;
| | - Kevin M. Korous
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA; (K.M.K.); (E.B.); (E.P.); (F.T.)
| | - Ellen Brooks
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA; (K.M.K.); (E.B.); (E.P.); (F.T.)
| | - Ethan Petersen
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA; (K.M.K.); (E.B.); (E.P.); (F.T.)
| | - John M. Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA;
| | - Fa Tuuhetaufa
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA; (K.M.K.); (E.B.); (E.P.); (F.T.)
| | - Ronald F. Levant
- Department of Psychology, The University of Akron, Akron, OH 44325, USA;
| | - Electra D. Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
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15
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Redvers N, Wilkinson M, Fischer C. Colorectal cancer community engagement: a qualitative exploration of American Indian voices from North Dakota. BMC Cancer 2022; 22:158. [PMID: 35139807 PMCID: PMC8827199 DOI: 10.1186/s12885-021-09119-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background American Indians (AI) in North Dakota present with higher rates of advanced-stage disease for screening detectable colorectal cancers and have lower overall baseline colorectal cancer screening rates than non-AIs. We sought to identify the perceived barriers and facilitators for the engagement with colorectal cancer prevention within North Dakota tribal communities. Methods Twelve semi-structured interviews were carried out across four tribal reservation communities in the state of North Dakota with American Indian adults between the ages of 30 and 75 years. We utilized purposive sampling to ensure maximum variation in age, sex, and tribal community until data saturation was achieved. The interviews were transcribed, and thematic analysis was carried out to identify consistent themes rooted within the data. Ethical approval was gained for this project from all relevant institutional review boards. Results Four main themes were identified as barriers for the engagement with colorectal cancer prevention, including: colorectal cancer screening barriers, focused on other health problems, lack of colorectal cancer tailored health promotion, and socio-cultural factors affecting colorectal cancer prevention. Three main themes were identified as facilitators for the engagement with colorectal cancer prevention, including: reasons for getting colorectal cancer screening, role of culture, and getting out into the community. Conclusion There is need for more community-rooted, strengths-based approaches to colorectal cancer prevention activities in AI communities in North Dakota. Socio-cultural factors, such as the use of storytelling, and the use of traditional knowledge have been demonstrated to be an important element of consideration for colorectal cancer tribal community engagement and prevention planning in the state. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09119-2.
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Affiliation(s)
- Nicole Redvers
- Department of Family & Community Medicine, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA. .,Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA.
| | - Mia Wilkinson
- Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA
| | - Courtney Fischer
- Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA
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16
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Thompson JA, Chollet-Hinton L, Keighley J, Chang A, Mudaranthakam DP, Streeter D, Hu J, Park M, Gajewski B. The need to study rural cancer outcome disparities at the local level: a retrospective cohort study in Kansas and Missouri. BMC Public Health 2021; 21:2154. [PMID: 34819024 PMCID: PMC8611913 DOI: 10.1186/s12889-021-12190-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Rural residence is commonly thought to be a risk factor for poor cancer outcomes. However, a number of studies have reported seemingly conflicting information regarding cancer outcome disparities with respect to rural residence, with some suggesting that the disparity is not present and others providing inconsistent evidence that either urban or rural residence is associated with poorer outcomes. We suggest a simple explanation for these seeming contradictions: namely that rural cancer outcome disparities are related to factors that occur differentially at a local level, such as environmental exposures, lack of access to care or screening, and socioeconomic factors, which differ by type of cancer. Methods We conducted a retrospective cohort study examining ten cancers treated at the University of Kansas Medical Center from 2011 to 2018, with individuals from either rural or urban residences. We defined urban residences as those in a county with a U.S. Department of Agriculture Urban Influence Code (UIC) of 1 or 2, with all other residences defines a rural. Inverse probability of treatment weighting was used to create a pseudo-sample balanced for covariates deemed likely to affect the outcomes modeled with cumulative link and weighted Cox-proportional hazards models. Results We found that rural residence is not a simple risk factor but rather appears to play a complex role in cancer outcome disparities. Specifically, rural residence is associated with higher stage at diagnosis and increased survival hazards for colon cancer but decreased risk for lung cancer compared to urban residence. Conclusion Many cancers are affected by unique social and environmental factors that may vary between rural and urban residents, such as access to care, diet, and lifestyle. Our results show that rurality can increase or decrease risk, depending on cancer site, which suggests the need to consider the factors connected to rurality that influence this complex pattern. Thus, we argue that such disparities must be studied at the local level to identify and design appropriate interventions to improve cancer outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12190-w.
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Affiliation(s)
- Jeffrey A Thompson
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA. .,University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Lynn Chollet-Hinton
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.,University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - John Keighley
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Audrey Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.,University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - David Streeter
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.,University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Jinxiang Hu
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.,University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Michele Park
- University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Byron Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.,University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
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17
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Unger-Saldaña K, Saldaña-Tellez M, Potter MB, Van Loon K, Allen-Leigh B, Lajous M. Barriers and facilitators for colorectal cancer screening in a low-income urban community in Mexico City. Implement Sci Commun 2020; 1:64. [PMID: 32885219 PMCID: PMC7427948 DOI: 10.1186/s43058-020-00055-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background Colorectal cancer (CRC) incidence and mortality are increasing in many low- and middle-income countries (LMICs), possibly due to a combination of changing lifestyles and improved healthcare infrastructure to facilitate diagnosis. Unfortunately, a large proportion of CRC cases in these countries remain undiagnosed or are diagnosed at advanced stages, resulting in poor outcomes. Decreasing mortality trends in HICs are likely due to evidence-based screening and treatment approaches that are not widely available in LMICs. Formative research to identify emerging opportunities to implement appropriate screening and treatment programs in LMICs is, therefore, of growing importance. We sought to identify potential barriers and facilitators for future implementation of fecal immunochemical test (FIT)-based CRC screening in a public healthcare system in a middle-income country with increasing CRC incidence and mortality. Methods We performed a qualitative study with semi-structured individual and focus group interviews with different CRC screening stakeholders, including 30 lay people at average risk for CRC, 13 health care personnel from a local public clinic, and 7 endoscopy personnel from a cancer referral hospital. All interviews were transcribed verbatim for analysis. Data were analyzed using the constant comparison method, under the theoretical perspectives of the social ecological model (SEM), the PRECEDE-PROCEED model, and the health belief model. Results We identified barriers and facilitators for implementation of a FIT-based CRC screening program at several levels of the SEM. The main barriers in each of the SEM levels were as follows: (1) at the social context level: poverty, health literacy and lay beliefs related to gender, cancer, allopathic medicine, and religion; (2) at the health services organization level: a lack of CRC knowledge among health care personnel and the community perception of poor quality of health care; and (3) at the individual level: a lack of CRC awareness and therefore lack of risk perception, together with fear of participating in screening activities and finding out about a serious disease. The main facilitators perceived by the participants were CRC screening information and the free provision of screening tests. Conclusions This study's findings suggest that multi-level CRC screening programs in middle-income countries such as Mexico should incorporate complementary strategies to address barriers and facilitators, such as (1) provision of free screening tests, (2) education of primary healthcare personnel, and (3) promotion of non-fear-based CRC screening messages to the target population, tailored to address common lay beliefs.
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Affiliation(s)
- Karla Unger-Saldaña
- National Council of Science and Technology - National Cancer Institute, Mexico City, Mexico
| | | | - Michael B Potter
- Department of Family and Community Medicine, UCSF School of Medicine, San Francisco, USA
| | - Katherine Van Loon
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - Betania Allen-Leigh
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | - Martin Lajous
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
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18
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D'Onise K, Iacobini ET, Canuto KJ. Colorectal cancer screening using faecal occult blood tests for Indigenous adults: A systematic literature review of barriers, enablers and implemented strategies. Prev Med 2020; 134:106018. [PMID: 32057956 DOI: 10.1016/j.ypmed.2020.106018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/02/2020] [Accepted: 02/07/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Colorectal cancer (CRC) screening using a Faecal Occult Blood Test (FOBT) is a well-established population intervention to reduce mortality and morbidity of CRC. As Indigenous people are not fully benefiting from the screening programs, a greater understanding of barriers and enablers affecting participation is needed. METHODS Searches were carried out in PubMed, Embase, Sociological Abstracts, Scopus, CINAHL, and selected websites. Both qualitative and quantitative studies related to Indigenous populations of Canada, New Zealand, Australia and the United States of America were assessed for quality and data related to FOBT were extracted and synthetised. RESULTS A total of 375 publications were identified and screened against the inclusion/exclusion criteria. Thirty-four studies were included in the review. The barriers for participation in CRC screening included the lack of culturally competent health service access, particularly access to Indigenous health service providers. Medical discrimination, long-standing distrust in Western medicine and/or health staff and screening tests were all identified as barriers for Indigenous people. There were a small number of promising interventions to improve participation, which could be considered on a broader scale to increase overall participation by Indigenous people in CRC screening. CONCLUSIONS The review identified barriers and possible enablers for Indigenous participation in the CRC screening program, some which appear to be unique to Indigenous people. Further intervention studies conducted in partnership with Indigenous communities are needed to improve participation.
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Affiliation(s)
- Katina D'Onise
- Prevention and Population Health Directorate, Wellbeing SA, Citi Centre Building, 11 Hindmarsh Square, Adelaide, South Australia, Australia. Katina.D'
| | | | - Karla Joy Canuto
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, Australia.
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19
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Frerichs L, Beasley C, Pevia K, Lowery J, Ferrari R, Bell R, Reuland D. Testing a Culturally Adapted Colorectal Cancer Screening Decision Aid Among American Indians: Results from a Pre-Post Trial. Health Equity 2020; 4:91-98. [PMID: 32258960 PMCID: PMC7133428 DOI: 10.1089/heq.2019.0095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: American Indian adults have not experienced decreases in colorectal cancer (CRC) incidence and mortality observed in other races or ethnic groups and their screening rates are low. Decision aids that explain available CRC screening options are one potential strategy to promote screening. The goal of this study was to test the effect of a culturally adapted decision aid on CRC-related outcomes among American Indian adults, including screening-related knowledge, attitudes, self-efficacy, intentions, and screening modality preferences. Methods: We recruited American Indian adults aged 50–75 years who were not current with CRC screening. Participants viewed a 9-min multimedia decision aid that used narrative vignettes to provide educational information about screening along with messages to address culturally specific barriers and values uncovered in formative research. We conducted a single-arm (pre–post) study and assessed screening-related outcomes at baseline and immediately after viewing the decision aid. Results: Among n=104 participants, knowledge scores increased from a mean of 36% correct to 76% correct. Participants also had statistically significant increases in positive attitudes, perceived social norms, self-efficacy, and intent. The proportion of participants who identified a preference for a specific CRC screening modality rose from 81% identified at pre-intervention to 93% post-intervention (p=0.013). Conclusion: Our study provides promising new findings that our culturally adapted decision aid is efficacious in educating American Indian adults about CRC screening and increases their screening intentions and ability to state modality preferences. Future research is needed to test the decision aid as a component of CRC screening interventions with American Indian adults.
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Affiliation(s)
- Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Carolina Cancer Screening Initiative, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cherry Beasley
- Department of Nursing, College of Health Sciences, University of North Carolina at Pembroke, Pembroke, North Carolina
| | - Kim Pevia
- K.A.P., Inner Prizes, Red Springs, North Carolina
| | - Jan Lowery
- American Indian Center for Health Education and Technology, Pembroke, North Carolina
| | - Renée Ferrari
- Carolina Cancer Screening Initiative, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ronny Bell
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Dan Reuland
- Carolina Cancer Screening Initiative, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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20
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Molina Y, Briant KJ, Sanchez JI, O’Connell MA, Thompson B. Knowledge and social engagement change in intention to be screened for colorectal cancer. ETHNICITY & HEALTH 2018; 23:461-479. [PMID: 28116917 PMCID: PMC5524622 DOI: 10.1080/13557858.2017.1280135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Innovative technologies have been used to promote colorectal cancer (CRC) screening among the underserved. However, the impact of these innovative technologies on knowledge and social engagement likelihood as they relate to subsequent intention to be screened across different populations has not been fully explored. DESIGN Using a pre-post-test design with an inflatable walk-through colon, we assessed changes in knowledge and social engagement likelihood across populations and their associations with intention to be screened in two community settings. One was a community setting in Washington State (WA); the other, a college campus in New Mexico (NM). Differential effects on knowledge and social engagement likelihood were examined across demographic groups (race/ethnicity, gender, age, education, insurance status, and geographic region). Finally, we assessed if changes in knowledge and social engagement likelihood were associated with CRC screening intention. RESULTS NM males had greater gains in CRC knowledge than NM females; in WA, Hispanics, younger, less educated, and uninsured participants had greater gains in knowledge. NM females and younger WA participants were more likely to discuss CRC with their social networks than NM males and older WA participants. In WA, Hispanics and older adults reported greater intention to be screened for CRC. Change in social engagement likelihood, but not knowledge, was associated with intention to be screened. CONCLUSIONS The effectiveness of health promotion technologies on knowledge and social engagement may vary across different demographic characteristics. Further, the importance of social engagement likelihood in interacting with intention to be screened was substantiated.
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Affiliation(s)
- Yamile Molina
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M3-B232, Seattle, WA 98109 USA
- University of Illinois at Chicago, Division of Community Health Sciences, School of Public Health, 649 SPHPI MC923, Chicago, IL, USA 60607-7101 USA
| | - Katherine J. Briant
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M3-B232, Seattle, WA 98109 USA
| | - Janeth I. Sanchez
- Plant and Environmental Sciences, New Mexico State University, MSC 3HLS, P.O. Box 30001, Las Cruces, NM 88003-8003 USA
| | - Mary A. O’Connell
- Plant and Environmental Sciences, New Mexico State University, MSC 3HLS, P.O. Box 30001, Las Cruces, NM 88003-8003 USA
| | - Beti Thompson
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M3-B232, Seattle, WA 98109 USA
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21
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Saab MM, Reidy M, Hegarty J, O'Mahony M, Murphy M, Von Wagner C, Drummond FJ. Men's information-seeking behavior regarding cancer risk and screening: A meta-narrative systematic review. Psychooncology 2017; 27:410-419. [PMID: 28728212 DOI: 10.1002/pon.4506] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Preventive strategies are known to reduce cancer risk and incidence and improve prognosis. Men seldom seek medical information about cancer prevention and risk reduction. The aim of this meta-narrative systematic review was to critically appraise evidence from qualitative, quantitative, and mixed-methods studies that explored men's information-seeking behaviors in relation to cancer prevention and risk reduction. METHODS MEDLINE, CINAHL Plus with Full Text, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, Education Full Text, and ERIC were systematically searched for studies published in English between January 1, 2006 and May 30, 2016. A total of 4117 titles were identified; of which, 31 studies were included (21 qualitative studies, 9 quantitative studies, and 1 mixed-methods study). The methodological quality of the studies was appraised by using different tools. RESULTS Most studies focused on screening for prostate (n = 18) and colorectal cancer (n = 7). Most men were passive information-gatherers rather than active information-seekers. Key sources of information included the Internet for active information-seekers and health care professionals for passive information-gatherers. Barriers to information-seeking included information overload, embarrassment, and fear. Low literacy and health literacy levels were addressed in 3 studies and were identified as impediments to active information-seeking. Facilitators to information-seeking included family support, media, celebrity endorsements, and targeted information. CONCLUSIONS Men's information-seeking behavior regarding cancer risk reduction, prevention, and screening is influenced by several factors. This necessitates targeted interventions aimed at raising awareness of cancer prevention and screening, while accounting for men's informational needs, preferred learning strategies, and literacy levels.
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Affiliation(s)
- Mohamad M Saab
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mary Reidy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mairin O'Mahony
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mike Murphy
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Christian Von Wagner
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Frances J Drummond
- School of Nursing and Midwifery, University College Cork, Cork, Ireland.,Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
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22
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Ramírez-Amill R, Soto-Salgado M, Vázquez-Santos C, Corzo-Pedrosa M, Cruz-Correa M. Assessing Colorectal Cancer Knowledge Among Puerto Rican Hispanics: Implications for Cancer Prevention and Control. J Community Health 2017; 42:1141-1147. [PMID: 28547033 DOI: 10.1007/s10900-017-0363-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In Puerto Rico, colorectal cancer (CRC) incidence and mortality rates are increasing. Moreover, adherence rates to CRC screening (52.2%) are still below the goals (70.5%) established by Healthy People 2020. Lack of knowledge is described as a significant barrier to adherence to CRC screening. The aim of this study was to assess CRC knowledge and screening rates among Puerto Rican Hispanics. Participants aged 40-85 years were recruited from the internal medicine outpatient clinics at the University of Puerto Rico. Demographic characteristics and knowledge about CRC, including risk factors and CRC screening tests, were obtained through face-to-face interviews. A mean CRC knowledge score was calculated based on correct responses to 13 validated questions. Mean knowledge scores were evaluated according to demographic characteristics using the Wilcoxon-Mann-Whitney test. A total of 101 participants were recruited with mean age of 63 (±10.6) years. Fifty-eight (58%) of participants were females, 59% reported ≥12 years of education, and 71% reported ever screening for CRC. The mean CRC knowledge score was significantly lower (p < 0.05) among participants with lower annual family income, those who had never received a recommendation for CRC screening by a healthcare provider, and those who had no history of CRC screening. Knowledge about CRC must be improved in Puerto Rico. Efforts must be made to promote and develop culturally appropriate CRC educational strategies. Future studies should focus on identifying other barriers and factors that may limit CRC screening in the Puerto Rican Hispanic population.
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Affiliation(s)
- Reinaldo Ramírez-Amill
- Department of Medicine, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | | | - Carla Vázquez-Santos
- Department of Medicine, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Mónica Corzo-Pedrosa
- Department of Medicine, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - Marcia Cruz-Correa
- Division of Cancer Biology, University of Puerto Rico Comprehensive Cancer Center, San Juan, PR, USA. .,Department of Medicine, Surgery and Biochemistry, School of Medicine, University or Puerto Rico Medical Sciences Campus, San Juan, PR, USA. .,University of Puerto Rico Medical Sciences Campus and Comprehensive Cancer Center, PMB 711, 89 De Diego Ave. Suite 105, San Juan, PR, 00927-6346, USA.
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23
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Roh S, Burnette CE, Lee KH, Lee YS, Goins RT. Correlates of Receipt of Colorectal Cancer Screening among American Indians in the Northern Plains. SOCIAL WORK RESEARCH 2016; 40:95-104. [PMID: 27257363 PMCID: PMC4886273 DOI: 10.1093/swr/svw006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/25/2015] [Accepted: 09/14/2015] [Indexed: 05/22/2023]
Abstract
Research has consistently documented lower colorectal cancer (CRC) screening rates for racial and ethnic minority populations, with the lowest screening rates among American Indians (AIs). Given the low CRC screening rates among AIs residing in the Northern Plains region, the objective of this research was to identify CRC screening correlates for Northern Plains AIs. With a sample of 181 AIs age 50 years or older, the authors used Andersen's behavioral model to examine the following factors related to receipt of CRC screening: (a) predisposing factors-age, education, marital status, and gender; (b) need factors-personal and family history of cancer; and (c) enabling factors-having a particular place to receive medical care, annual health checkup, awareness of the availability of CRC screening, knowledge of CRC, and self-efficacy of CRC. Nested logistic regression identified the following correlates of receipt of CRC screening: (a) predisposing factors-older age; (b) need factors-having a personal history of cancer; and (c) enabling factors-having an annual health checkup, greater awareness of CRC screening, and greater self-efficacy of CRC. Given the findings, prevention and intervention strategies, including public awareness and education about CRC screening, are promising avenues to reduce cancer screening disparities among AIs.
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Affiliation(s)
- Soonhee Roh
- is assistant professor, School of Social Work, University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069; is assistant professor, School of Social Work, Tulane University, New Orleans. is associate professor, School of Social Work, Wichita State University, Wichita, KS. is associate professor, School of Social Work, San Francisco State University. is professor, Western Carolina University, Cullowhee, NC. The data used in the study were collected with support from the University of South Dakota School of Health Sciences Research and Scholarship Seed Grants. The lead author would like to acknowledge Dr. Robin Miskimins for her mentoring on a Seed Grants for School of Health Sciences for Dr. Roh
| | - Catherine E Burnette
- is assistant professor, School of Social Work, University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069; is assistant professor, School of Social Work, Tulane University, New Orleans. is associate professor, School of Social Work, Wichita State University, Wichita, KS. is associate professor, School of Social Work, San Francisco State University. is professor, Western Carolina University, Cullowhee, NC. The data used in the study were collected with support from the University of South Dakota School of Health Sciences Research and Scholarship Seed Grants. The lead author would like to acknowledge Dr. Robin Miskimins for her mentoring on a Seed Grants for School of Health Sciences for Dr. Roh
| | - Kyoung Hag Lee
- is assistant professor, School of Social Work, University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069; is assistant professor, School of Social Work, Tulane University, New Orleans. is associate professor, School of Social Work, Wichita State University, Wichita, KS. is associate professor, School of Social Work, San Francisco State University. is professor, Western Carolina University, Cullowhee, NC. The data used in the study were collected with support from the University of South Dakota School of Health Sciences Research and Scholarship Seed Grants. The lead author would like to acknowledge Dr. Robin Miskimins for her mentoring on a Seed Grants for School of Health Sciences for Dr. Roh
| | - Yeon-Shim Lee
- is assistant professor, School of Social Work, University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069; is assistant professor, School of Social Work, Tulane University, New Orleans. is associate professor, School of Social Work, Wichita State University, Wichita, KS. is associate professor, School of Social Work, San Francisco State University. is professor, Western Carolina University, Cullowhee, NC. The data used in the study were collected with support from the University of South Dakota School of Health Sciences Research and Scholarship Seed Grants. The lead author would like to acknowledge Dr. Robin Miskimins for her mentoring on a Seed Grants for School of Health Sciences for Dr. Roh
| | - R Turner Goins
- is assistant professor, School of Social Work, University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069; is assistant professor, School of Social Work, Tulane University, New Orleans. is associate professor, School of Social Work, Wichita State University, Wichita, KS. is associate professor, School of Social Work, San Francisco State University. is professor, Western Carolina University, Cullowhee, NC. The data used in the study were collected with support from the University of South Dakota School of Health Sciences Research and Scholarship Seed Grants. The lead author would like to acknowledge Dr. Robin Miskimins for her mentoring on a Seed Grants for School of Health Sciences for Dr. Roh
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24
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Honein-AbouHaidar GN, Kastner M, Vuong V, Perrier L, Daly C, Rabeneck L, Straus S, Baxter NN. Systematic Review and Meta-study Synthesis of Qualitative Studies Evaluating Facilitators and Barriers to Participation in Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev 2016; 25:907-17. [PMID: 27197277 DOI: 10.1158/1055-9965.epi-15-0990] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/31/2016] [Indexed: 11/16/2022] Open
Abstract
Screening reduces the incidence, morbidity, and mortality of colorectal cancer, yet participation tends to be low. We undertook a systematic review and meta-study synthesis of qualitative studies to identify facilitators and barriers to colorectal cancer screening participation. We searched major bibliographic databases for records published in all languages from inception to February 2015. Included primary studies that elicited views and perceptions towards colorectal cancer screening were appraised for relevance and quality. We used a two-stage synthesis to create an interpretation of colorectal cancer screening decisions grounded in primary studies; a thematic analysis to group themes and systematically compare studies and a meta-synthesis to generate an expanded theory of colorectal cancer screening participation. Ninety-four studies were included. The decision to participate in colorectal cancer screening depended on an individual's awareness of colorectal cancer screening. Awareness affected views of cancer, attitudes towards colorectal cancer screening modalities, and motivation for screening. Factors mediating awareness included public education to address misconceptions, primary care physician efforts to recommend screening, and the influence of friends and family. Specific barriers to participation in populations with lower participation rates included language barriers, logistical challenges to attending screening tests, and cultural beliefs. This study identifies key barriers, facilitators, and mediators to colorectal cancer screening participation. Cancer Epidemiol Biomarkers Prev; 25(6); 907-17. ©2016 AACR.
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Affiliation(s)
| | - Monika Kastner
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Vincent Vuong
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Laure Perrier
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Corinne Daly
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | | | - Sharon Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Nancy N Baxter
- Department of Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
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25
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Filippi MK, Perdue DG, Hester C, Cully A, Cully L, Greiner KA, Daley CM. COLORECTAL CANCER SCREENING PRACTICES AMONG THREE AMERICAN INDIAN COMMUNITIES IN MINNESOTA. JOURNAL OF CULTURAL DIVERSITY 2016; 23:21-27. [PMID: 27188017 PMCID: PMC4990452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality. Effective prevention and early detection may be achieved through screening, but screening rates are low, especially in American Indian (AI) populations. We wanted to understand perceptions of CRC screening among AI located in the Great Lakes region. Focus groups were recorded and transcribed verbatim (N = 45). Data were analyzed using qualitative text analysis. Themes that deterred CRC screening were low CRC knowledge, fear of the procedure and results, cost and transportation issues, and a lack of quality and competent care. Suggestions for improvement included outreach efforts and culturally-tailored teaching materials.
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26
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Cruz-Correa M, Cordero F, Betancourt JP, Diaz-Algorri Y, Lopez SM, Rivera M, Mosquera R, Carlo-Chevere V, Rodriguez-Quilichini S. Implementation and Outcomes of a Community-Based Educational Program for Colorectal Cancer Prevention in Hispanics. JOURNAL OF FAMILY MEDICINE AND DISEASE PREVENTION 2016; 2. [PMID: 30288455 DOI: 10.23937/2469-5793/1510042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives Colorectal cancer (CRC) is the 2nd most diagnosed cancer and leading cause of cancer death in Puerto Rico. However, CRC screening rates remain low. The aim of this study was to test the effectiveness of a Train-the-Trainers' (TTT) program to develop trainers capable of educating others within their communities about CRC prevention. Methods The TTT program consisted of didactics and seminars to capacitate participants to become trainers in CRC prevention. This project was evaluated using three components: (1) training workshops; (2) community educational sessions; and (3) the participant's experience as a trainer. Pre - and post-tests on CRC screening knowledge were given to TTT participants. Program effectiveness was determined by the pre- and post-tests, number of workshop participants completing a community educational session within three months of training and the number of community members reached. Results Among the 115 total participants, 97 participants took the pre- and post-test. There was a significant difference in the scores for the pre-test (M = 10.56, SD = 2.57) and the post-test (M = 11.43, SD = 1.83) given; t (96) = -4.68, p < 0.001. A total of 955 community members were reached. Participants from the community educational sessions (n = 680) evaluated the program. 77.7% of those participants expressed intent to undergo colonoscopy screening in the future. Conclusions TTT was effective in preparing trainers in CRC prevention. Participants increased their knowledge about CRC prevention and successfully reached members of their community. Utilization of community trainers is an effective alternative to increase CRC education and awareness in Hispanic communities, which may positively impact CRC screening rates in this population.
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Affiliation(s)
- Marcia Cruz-Correa
- University of Puerto Rico Comprehensive Cancer Center, USA.,University of Puerto Rico School of Medicine, USA.,Puerto Rico Colorectal Cancer Coalition, USA
| | | | | | | | - Sofia M Lopez
- University of Puerto Rico Comprehensive Cancer Center, USA
| | - Mirza Rivera
- University of Puerto Rico Comprehensive Cancer Center, USA.,Graduate School of Public Health, University of Puerto Rico, USA
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27
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Decker KM, Demers AA, Kliewer EV, Musto G, Shu E, Biswanger N, Elias B, Griffith J, Turner D. Colorectal cancer screening in first nations people living in Manitoba. Cancer Epidemiol Biomarkers Prev 2014; 24:241-8. [PMID: 25336562 DOI: 10.1158/1055-9965.epi-14-1008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Because the burden of colorectal cancer (CRC) seems to be increasing in First Nations, it is important to better understand CRC screening utilization. The objective of this study was to describe CRC screening among First Nations living in Manitoba. METHODS The Federal Indian Register was linked to two provincial databases. A negative binomial model was used to compare the probability of First Nations having a fecal occult blood test (FOBT), colonoscopy, or flexible sigmoidoscopy (FS) with all other Manitobans. RESULTS First Nations who lived in Winnipeg were significantly less likely to have had a FOBT in the previous 2 years than all other Manitobans who lived in Winnipeg [rate ratio (RR) = 0.40; 95% confidence intervals (CI), 0.37-0.44]. There was no difference in the likelihood of having a colonoscopy or FS for First Nations individuals who resided in northern Manitoba compared with all other Manitobans (RR, 1.04; 95% CI, 0.91-1.19). However, First Nations who lived in the rural south or urban areas were less likely than all other Manitobans to have had a colonoscopy or FS (RR, 0.81, 95% CI, 0.75-0.87, rural south; RR, 0.86, 95% CI, 0.81-0.92, urban). CONCLUSIONS First Nations living in Winnipeg were significantly less likely to be screened for CRC using the FOBT. Colonoscopy and FS use depended on area of residence. IMPACT First Nations experience barriers that impede the use of CRC screening. Further research is needed to understand these barriers to extend the benefit of CRC screening to this population. Cancer Epidemiol Biomarkers Prev; 24(1); 241-8. ©2014 AACR.
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Affiliation(s)
- Kathleen M Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Screening Programs, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Alain A Demers
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Erich V Kliewer
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada. Cancer Control Research, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Grace Musto
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Emma Shu
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | - Brenda Elias
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jane Griffith
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Donna Turner
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
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28
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Johnson-Jennings MD, Tarraf W, Xavier Hill K, González HM. United States colorectal cancer screening practices among American Indians/Alaska Natives, blacks, and non-Hispanic whites in the new millennium (2001 to 2010). Cancer 2014; 120:3192-299. [PMID: 25123695 DOI: 10.1002/cncr.28855] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/21/2014] [Accepted: 01/27/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND The objectives of this study were to describe, examine, and compare prevalence estimates of colorectal cancer (CRC) screening practices and to determine whether disparities exist for American Indians/Alaska Natives (AIANs) and blacks compared with whites. METHODS Behavioral Risk Factor Surveillance System (2001-2010) data from respondents aged ≥ 50 years (n = 356,073) were used. The primary outcome was self-reported CRC screening according to US Preventive Services Task Force guidelines for endoscopy (colonoscopy or sigmoidoscopy), fecal occult blood test (FOBT), or mixed screening (endoscopy or FOBT). RESULTS From 2001 to 2010, endoscopy screening increased in the AIAN population by 44.8% (P < .001) compared with black respondents (51.7%) and white respondents (26.5%). AIANs were less likely to report endoscopy screening (45%) compared with both blacks (56%) and whites (55%). For mixed CRC screenings, AIAN rates increased by 34.5%, compared with 29.7% for blacks and 15% for whites. In 2010, AIANs (51%) had the lowest prevalence of mixed CRC screening compared with blacks (61%) and whites (60%; P < .001). Factors that enabled health care attenuated the lowered likelihood of CRC screenings, but disparities remained for AIAN CRC screening. In contrast, once enabling factors were controlled, the odds ratios of CRC screening among blacks were higher compared with whites. CONCLUSIONS Between 2001 and 2010, AIANs had the lowest CRC screening rates in the United States compared with blacks and whites, presenting a CRC disparity, as rigorously defined. The current findings indicate that, although considerable progress has been made to increase CRC screening for blacks and whites, progress for AIANs continues to lag behind in the first decade of 21st century.
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Affiliation(s)
- Michelle Dawn Johnson-Jennings
- Research for Indigenous Community Health (RICH) Center, College of Pharmacy, Pharmacy Practice, and Pharmaceutical Sciences/Social and Administrative Pharmacy, University of Minnesota, Duluth, Minnesota
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29
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Towne SD, Smith ML, Ory MG. Geographic variations in access and utilization of cancer screening services: examining disparities among American Indian and Alaska Native Elders. Int J Health Geogr 2014; 13:18. [PMID: 24913150 PMCID: PMC4077226 DOI: 10.1186/1476-072x-13-18] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 06/01/2014] [Indexed: 11/13/2022] Open
Abstract
Background Despite recommendations for cancer screening for breast and colorectal cancer among the Medicare population, preventive screenings rates are often lower among vulnerable populations such as the small but rapidly growing older American Indian and Alaska Native (AIAN) population. This study seeks to identify potential disparities in the availability of screening services, distance to care, and the utilization of cancer screening services for Medicare beneficiaries residing in areas with a higher concentration of AIAN populations. Methods Using the county (n =3,225) as the level of analysis, we conducted a cross-sectional analysis of RTI International’s Spatial Impact Factor Data (2012) to determine the level of disparities for AIAN individuals. The outcomes of interest include: the presence of health care facilities in the county, the average distance in miles to the closest provider of mammography and colonoscopy (analyzed separately) and utilization of screening services (percent of adults aged 65 and older screened by county). Results Counties with higher concentrations of AIAN individuals had greater disparities in access and utilization of cancer screening services. Even after adjusting for income, education, state of residence, population 65 and older and rurality, areas with higher levels of AIAN individuals were more likely to see disparities with regard to health care services related to mammograms (p ≤ .05; longer distance, lower screening) and colonoscopies (p ≤ .05; longer distance, lower screening). Conclusions These findings provide evidence of a gap in service availability, utilization and access facing areas with higher levels of AIAN individuals throughout the US. Without adequate resources in place, these areas will continue to have less access to services and poorer health which will be accelerated as the population of older adults grows.
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Affiliation(s)
- Samuel D Towne
- 1266 TAMU, Department of Health Promotion and Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX 77843-1266, USA.
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