Improving Routine Asymptomatic Cancer Screening among Federally Qualified Health Center Users in Florida: Application of a Health Literacy Framework

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ABSTRACT As a recently appointed tenure-track Assistant Professor of Public Health, my long-term career goal is to make a meaningful contribution to the elimination of cancer disparities. In doing this, I wish to establish myself as a nationally-recognized independent investigator with expertise in the use of health communication to address cancer disparities. I have substantial training in behavioral research, primarily focused on understanding the role of various social and cultural factors on cancer disparities. Building on this foundation, I require additional training to fill gaps related to the design, implementation, and evaluation of health communication interventions. My Mentorship Team and I have prepared a comprehensive career development plan that consists of mentorship, coursework, expert consultations, workshops, experiential learning, and an innovative research project. My proposed research plan aligns with my overarching career goal in seeking to improve routine cancer screening within federally qualified health centers (FQHCs), where the burden of cancer is greater compared to the general population, but screening rates are much lower than national averages. Despite the significant contribution of routine screening in the reduction of breast, cervical, and colorectal cancer (CRC) incidence and mortality, disparities persist among racial/ethnic minority and low socioeconomic (SES) populations who continue to underutilize screening. FQHCs can be invaluable partners in reducing these disparities due to their sliding-fee pay structure and location in medically underserved areas. The goal of the proposed K01 research project is to understand how current FQHC users perceive routine asymptomatic cancer screening, and develop and pre- test an eHealth tool that promotes screening among FQHC users. The specific aims are to: (1) Conduct formative research with FQHC users to understand how they perceive and make decisions about routine asymptomatic cancer screening; (2) Design and pre-test an eHealth tool that addresses each domain of the health literacy framework, and incorporates key decision criteria of asymptomatic cancer screening among FQHC users; and (3) Pilot test an eHealth intervention within an FQHC setting aimed at delivering literacy appropriate, “decision- relevant” information about routine asymptomatic cancer screening to FQHC users. This Mentored Research Award would provide the necessary protected time to achieve the following training goals: (1) Develop expertise in the application of decision analysis to health communication, within a health literacy framework; (2) Become familiar with clinic operations, user profiles, and service delivery within FQHCs, along with successful research collaboration with FQHCs; (3) Build competence in health communication intervention design, implementation, and evaluation; and (4) Develop the necessary skills to translate communication research into practice, specifically within an FQHC setting. This research would set the stage for a larger R01-level health communication intervention study. Findings might inform not only cancer screening, but also other health promotion interventions in FQHCs, which are increasingly becoming medical homes for low SES populations.