Improving CRC Screening for Diverse Hispanics in an Urban Primary Care Setting

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DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the 2nd leading cause of cancer death among Hispanic women and men. Hispanics are more likely to be diagnosed at more advanced disease stages compared to non-Hispanic Whites and have a lower probability of survival. A key way to decrease mortality from CRC among Hispanics is to increase rates of CRC screening and thereby early detection of CRC. To address low screening rates; thereby increasing the prevention and early detection of CRC, the proposed research seeks to increase CRC colonoscopy screening among Hispanics. The primary aim is to investigate the impact of a culturally targeted print educational intervention designed to increase CRC screening via colonoscopy in a diverse group of Hispanics 50 years of age and older on: a) their participation in colonoscopy (whether or not they undergo colonoscopy) and b) their stage of readiness to undergo colonoscopy. Our long standing (since 1999) research platform has included significant community input through ongoing meetings with our Community Advisory Board (CAB) soliciting their viewpoints and concerns. In addition, we consult with key community members on an ongoing basis for additional input. There will be two phases to the study. The first will use focus group methodology with eight focus groups comprised of up to 10 Hispanics in each group. Our focus group members will be local residents and add to our understanding of the barriers and facilitators of the targeted population. Qualitative analyses of the data from the focus group will also confirm that the culturally targeted print materials are relevant and motivating to English and Spanish speaking Hispanics as well as suggest any needed revisions. The second phase features a Randomized Clinical Trial (RCT) with 400 Hispanics conducted within the context of the best clinical practices currently provided at Mount Sinai. There are three study arms; 1) best clinical practices plus culturally relevant print materials, 2) best clinical practices plus standard print materials and 3) best clinical practices alone. These three arms will allow the investigation of the addition of print materials and the comparison of culturally relevant to standard print materials to assess the differential impact of each print format. This comparison controls for the possible benefit of adding standard print materials to best clinical practices and allows for investigation of the additional benefit of targeted and culturally relevant materials over and above that of standard materials. Further, by including feedback from the community, we will be able to clearly understand the benefits of, and be able to disseminate targeted and culturally relevant materials among this rapidly growing minority group. If, as hypothesized, the addition of the culturally targeted print materials leads to higher rates of colonoscopy and later stages of readiness to undergo colonoscopy, they can then be easily disseminated among health care settings treating Hispanics. The results from this second phase will also indicate if the impacts of the intervention are moderated by socio-demographic, health care and socio- cultural factors as well as what are the active ingredients (e.g., Pros/benefits, cancer fatalism).