Feasibility of a Multi-Channel Intervention to Promote Colorectal Cancer Screening among American Indians in Oklahoma

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PROJECT SUMMARY Colorectal cancer (CRC) is the second-leading cause of cancer death in both men and women in the United States. Compared to national averages, American Indians (AI) endure a disproportionate burden of CRC incidence and CRC-specific mortality. Screening is an effective early detection strategy to decrease preventable CRC-related deaths, but AI have some of the lowest CRC screening rates. In Oklahoma, only 51% of AI are up to date with screening compared to nearly two-thirds of eligible US adults. Efforts to improve screening rates have focused on increasing access to home stool screening (i.e.. fecal immunochemical test; FIT), as many AI live in rural communities and must drive long distances to access screening services. Tribal community health educators (TCHE) are an effective strategy to promote FIT screening within AI communities as they can overcome historical mistrust, health literacy gaps, and provide culturally concordant educational messaging. However, success of TCHE is limited by their reach as they cannot logistically engage with all necessary AI communities. Virtual human technology, which can create photorealistic, interactive virtual TCHE (v-TCHE) offer a scalable strategy to overcome the logistical barriers inherent with in-person delivered health education. Therefore, the overall objective of this proposal is to leverage existing relationships with Indian Health Service Clinton Service Unit and the Cheyenne and Arapaho Tribes to examine the feasibility of co-developing and disseminating a v-TCHE as part of a multi-channel communication intervention. The intervention will be disseminated across two channels: (1) Social Media (i.e., accessed via online study adverts) and (2) Clinic (i.e., direct messaging to patients via a study link in a SMS text). Across both channels, we will examine reach (primary outcome) of the intervention and its potential efficacy (on improving CRC knowledge and completing a FIT kit) via a randomized controlled trial. Once participants click on the study link they will be randomized 1:1 to one of two intervention conditions: (1) watch a Narrative Testimonial Video of a real-life Tribal community health educator (control) or (2) an interaction with a v-TCHE. Participants will then complete a post-intervention survey, in which they can click to order a FIT kit afterwards. The first study aim will co-develop a multi-channel communication intervention with AI in Oklahoma. The second study aim will determine its reach and potential efficacy. This proposal is highly responsive to Track 2 in the PA-20-272 as it attempts to address inequities in CRC outcomes among AI populations. We examine the feasibility of co-developing and disseminating a multi- channel communication intervention to promote a United States Preventive Services Taskforce recommended cancer screening test. If successful, findings will support a first-of-its-kind, highly scalable approach to overcome the reach limitations that Tribal community health educators face. A future R01 will determine the efficacy of different v-TCHE to promote FIT screening across other Tribal healthcare systems.