Identifying multi-level barriers and facilitators to digital health use in federally qualified health centers

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PROJECT SUMMARY/ABSTRACT Colorectal cancer (CRC) is a leading cause of cancer death in the United States. National guidelines recommend that average risk people receive regular CRC screenings. Community health centers, such as federally qualified health centers (FQHCs), provide high quality affordable healthcare to underserved populations across the nation. Among patients treated at FQHCs, only 44% have completed a CRC screening within the recommended timeframe (e.g., one colonoscopy per ten years). Patient navigation has proven effective for improving CRC screening completion rates and screening quality. The effects of patient navigation are robust across socioeconomic status and racial/ethnic group. Furthermore, extensive research has proven its efficacy in FQHC settings. Although efficacious, patient navigation requires staffing and economic resources limiting its ability to be widely disseminated, particularly in low-resourced settings like FQHCs. The proposed study aims to refine and test a digital health solution, called the eNav Toolkit, designed to improve CRC screening uptake among patients treated at FQHCs. The eNav Toolkit will be a web app that will assist with CRC screening decision making, appointment reminders, preparation instructions/reminders, education, motivational interviewing support, and linkage to follow up care. In order to maximize reach, the eNav Toolkit will be accessible on any smartphone, tablet, or computer devise. For Aim 1, the eNav Toolkit 1.0 will be field tested on 10 participants. Participants will be FQHC patients eligible for CRC screening. The field test results be applied to refine the eNav content and improve the user-experience. The second iteration of the intervention, eNav Toolkit 2.0, will then be field tested on a new set of 10 participants. The results from the second field test will be applied to refine and finalize the eNav Toolkit. Aim 2 will conduct a multi-site randomized clinical trial to evaluate the efficacy of the eNav Toolkit for improving CRC screening uptake among patients treated at FQHCs. Patients (N=400) will be randomly assigned to one of two conditions: eNav Toolkit group (N=200) or usual care group (N=200). Participants in the eNav Toolkit group will engage with the eNav Toolkit to assist in preparing for and completing the CRC screening. Participants in the usual care group will receive usual care. Primary outcomes (CRC screening completion) and secondary outcomes (CRC screening quality, follow up adherence) will be evaluated at six months after study enrollment. Aim 3 will evaluate theoretical mechanisms of change (e.g., perceived benefits, perceived barriers, perceived susceptibility, self-efficacy), guided by the health belief model. If proven efficacious, the eNav Toolkit will be integrated in the electronic health record (EHR) and disseminated across FQHCs nationwide, with the ultimate goal of decreasing the burden of CRC among patients treated at FQHCs.