Colorectal Cancer Educational Intervention Targeting Latino Patients Attending a Community Health Center

Abstract

Objective Colorectal cancer (CRC) is the third leading cause of cancer death for Latino men and women; and Latinos are more likely to be diagnosed at a later stage, which is most likely due to underutilization of CRC preventive screening. The purpose of this study was to determine whether a brief, clinic-based intervention by a community health advisor (CHA) would increase CRC knowledge compared with traditional educational methodologies (eg, use of print materials). Methods Latino adults 50 years and older attending a San Diego community health center were recruited while waiting for their primary care provider routine visit and were randomly assigned to receive 1 of 3 CRC educational interventions: community health advisor (CHA) plus CRC educational brochure (CHA intervention group), CRC educational brochure (minimal intervention group), or 5-a-day nutrition brochure (usual care). CRC knowledge was assessed before and after the primary care provider visit for 130 participants. Results Results demonstrate that the CRC educational brochure (minimal intervention group) was effective at increasing CRC screening knowledge as compared to usual care. Conclusions Future research is needed to explore innovative health education strategies that improve knowledge and subsequent CRC screening behaviors among low-income, low-literacy, unacculturated Latinos.

Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review

“…Of 67 articles, thirty studies involved CBHWs for cancer prevention for specific cancer types (cervical, 28,32,33,35-39,41-44,49-52 breast, 26,27,31,33,36,37,[39][40][41]46,48,50,[53][54][55] colorectal, 29,30,34,36,45 and oral 47 ). Twenty six studies focused on cardiovascular disease (CVD), [56][57][58][59]62,64,67,73,80 , and key risk factors such as diabetes, 63,69,70,[76][77][78][79]81 and hypertension.…”

“…39,52,82 Eight studies involved more than one comparison group (e.g., usual care and minimal intervention). 26,[28][29][30]61,68,75,80 34,36,42,62 Some studies relied solely on telephone contact for CBHW interventions. 27,37,53,74 …”

“…28 In 36 articles, CBHWs delivered counseling sessions to address barriers in adopting target behaviors and to reinforce benefits of behavior change. 26,27,[30][31][32]37,[43][44][45][46]49,[51][52][53][54][55][57][58][59][60][61][62][63][64]66,67,72,[75][76][77]79,81,83,85,86 CBHWs communicated with participants via telephone calls, home visits, or regular meetings to assess and problemsolve personal and environmental barriers throughout the intervention. In one study, 36 CBHWs provided theory-based scripted messages for each barrier, including personal belief, fear, healthcare provider, personal need, and management barriers.…”

“…36,43,[87][88][89][90][91][92] Cancer prevention-Of the 30 studies which tested the effect of a CBHW-led intervention on cancer control, 21 studies (70%) found improvements in cancer screening behaviors. 26,28,[30][31][32][33]35,37,38,[40][41][42][43][44][45][46][47][48][49][50][51] Positive changes in mammogram uptake (6% to 33% increase) 26,31,37,40,41,43,46,48,50 were noted in nine of the sixteen studies focusing on breast cancer. The trial with the largest increase in mammogram screening (33%) employed a multi-faceted intervention designed for African American women that included 4 monthly CBHW-led culturally-tailored counseling sessions and mailing of a postcard message tailored to the participant's barriers .…”

“…Of the three studies focused on colorectal cancer, only one yielded a significant increase in colorectal cancer screening in the CBHW-led education group compared with usual care (27% vs. 12%, p<0.001). 45 The studies without significant changes in mammogram, 27,36,53,55 Pap test, 27,30,32,34 or colorectal cancer screening 21,27 tended to compare one type of CBHW intervention to another (e.g., education vs social support group) 27 or to a less intensive intervention (as opposed to no intervention). 27,53 In addition, some of these studies included a high proportion of participants who were up-to-date for screening 41 or had significantly different demographic characteristics between the two groups at baseline.…”