e-Motivacion: Developing and pilot testing an app to improve Latinos screening colonoscopy rates

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PROJECT SUMMARY/ABSTRACT The risk of developing colorectal cancer (CRC) directly increases with age, with 89% of all CRC occurring in individuals over the age of 50. Among Latinos, a fast growing and underserved population, CRC is the third leading cause of cancer death. Compared to non-Latino whites, Latinos are less likely to be diagnosed with localized CRC and more likely to be diagnosed with advanced stage disease. Therefore, it is critical to improve this population’s CRC prevention efforts. Published guidelines recommend that average risk people begin screening for CRC at the age of 50. Of the recommended CRC screening tests, a colonoscopy is considered the gold standard because it allows for both the detection and removal of precancerous and cancerous polyps. Although screening colonoscopies can detect and prevent CRC, more than half of Latinos have not received a screening colonoscopy within the recommended time frame (one screening colonoscopy per ten years). It is critical to increase Latinos’ screening colonoscopy rates in order to help prevent CRC in this vulnerable and growing population. Dr. Miller’s previous research, as well as the current literature, suggests that an electronically-delivered motivational interviewing (e-MI) intervention may improve Latinos’ screening colonoscopy uptake. By eliminating the need for an on-site professional, an e-MI intervention is a potentially high reach, low cost intervention. Despite the promise of an e-MI intervention to improve Latinos’ screening colonoscopy uptake, no research to date has developed and tested such an intervention. The proposed NIA R34 aims to develop and begin to test an e-MI tablet application (app), called e-Motivación (e-Motivation). The e-Motivación app will be offered in both English and Spanish and will be delivered to participants in the primary care clinic after they receive a referral for a screening colonoscopy. The proposed project will first create and test an interactive prototype of the e-Motivación app. Four focus groups with key stakeholders will then provide their feedback on the app’s prototype (N=34). The focus group members’ feedback will guide the development and programming of the e-Motivación app. Next, the app will be field-tested, using an iterative approach, with Latinos referred for a screening colonoscopy (N=40). The field-testing results will guide the development, revisions and finalization of the e-Motivación app. Then, a pilot study will be conducted to begin to examine the efficacy of the e-Motivación app for improving screening colonoscopy uptake among Latinos. Participants (N=80) will be randomly assigned, stratified for language, to one of two groups: e-Motivación app (N=40) or general health information app (N=40). The results of the pilot study will inform power calculations for a future randomized clinical trial that will formally test the efficacy of the app. If this program of research proves the e-motivación app efficacious there is a strong argument to integrate the app into standard clinical care in order to reduce the overall burden of CRC in the growing and vulnerable Latino community.