Impact of Targeted Education on Colorectal Cancer Screening Knowledge and Psychosocial Attitudes in a Predominantly Hispanic Population

Molokwu, Jennifer; Shokar, Navkiran K.; Dwivedi, Alok

doi:10.1097/fch.0000000000000165

Cited by 8 publications

(15 citation statements)

References 17 publications

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“…We examined fatalism as a specific type of barrier because of its importance among Hispanics and other minorities and demonstrated its significant role in mediating the intervention effect in this Hispanic sample. Previous work has demonstrated that fatalism may not be an intractable cultural belief, since it can be influenced by intervention [16] suggesting it could be an intervention target. We, like others [9,41] did not observe the negative influence of barriers on subsequent CRC screening that many have observed [5,19].…”

Section: Discussionmentioning

confidence: 99%

“…All HBM construct measures were previously validated and had high internal consistency reliability in this population [16,25]. We assessed: perceived susceptibility (perceptions about the likelihood of developing CRC, four item scale, Cronbach's α = 0.73), perceived benefits (beliefs about the advantages of screening, 10 items, Cronbach's α = 0.89), and perceived barriers (beliefs about obstacles to screening, 11 items, Cronbach's α = 0.88).…”

Section: Psychosocial (Hbm) Constructsmentioning

confidence: 99%

“…This type of understanding will help to optimize CRC screening and address CRC screening disparities. The primary aim of this study therefore to use a structural equation modelling approach to examine these questions using data from an effective CRC screening intervention designed to promote CRC screening test completion in a predominantly Hispanic community [15,16].…”

Section: Introductionmentioning

confidence: 99%

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Mediators of screening uptake in a colorectal cancer screening intervention among Hispanics

2022

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Background Colorectal cancer (CRC) is the second leading cause of cancer deaths in the USA. Although a number of CRC screening tests have been established as being effective for CRC prevention and early detection, rates of CRC screening test completion in the US population remain suboptimal, especially among the uninsured, recent immigrants and Hispanics. In this study, we used a structural equation modelling approach to identify factors influencing screening test completion in a successful CRC screening program that was implemented in an uninsured Hispanic population. This information will enhance our understanding of influences on CRC screening among historically underscreened populations. Methods We used generalized structural equation models (SEM) utilizing participant reported information collected through a series of surveys. We identified direct and indirect pathways through which cofactors, CRC knowledge and individual Health Belief Model constructs (perceived benefits, barriers, susceptibility, fatalism and self-efficacy) and a latent psychosocial health construct mediated screening in an effective prospective randomized CRC screening intervention that was tailored for uninsured Hispanic Americans. Results Seven hundred twenty-three participants were eligible for inclusion; mean age was 56 years, 79.7% were female, and 98.9% were Hispanic. The total intervention effect was comparable in both models, with both having a direct and indirect effect on screening completion (n = 715, Model 1: RC = 2.46 [95% CI: 2.20, 2.71, p < 0.001]; n = 699, Model 2 RC =2.45, [95% CI: 2.18, 2.72, p < 0.001]. In Model 1, 32% of the overall effect was mediated by the latent psychosocial health construct (RC = 0.79, p < 0.001) that was in turn mainly influenced by self-efficacy, perceived benefits and fatalism. In Model 2, the most important individual mediators were self-efficacy (RC = 0.24, p = 0.013), and fatalism (RC = 0.07, p = 0.033). Conclusion This study contributes to our understanding of mediators of CRC screening and suggests that targeting self-efficacy, perceived benefits and fatalism could maximize the effectiveness of CRC screening interventions particularly in Hispanic populations.

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Section: Discussionmentioning

confidence: 99%

Section: Psychosocial (Hbm) Constructsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mediators of screening uptake in a colorectal cancer screening intervention among Hispanics

2022

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“…Although health care components were most common, the findings suggested greatest effectiveness for interventions that considered SDOH in several domain areas. The greatest improvements in screening were among the subset of interventions that addressed transportation to screening appointments among other components 27,36,41,58,63,112,113,141,142,144,155,163 important finding given that transportation is a well documented barrier to health care access. 175,176 Despite these results, limitations of the current intervention evidence base and SDOH evaluation approaches are discussed below.…”

Section: Intervention Effectivenessmentioning

confidence: 99%

Social determinants of health and US cancer screening interventions: A systematic review

Korn

Walsh‐Bailey

Correa-Mendez

et al. 2023

CA A Cancer J Clinicians

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There remains a need to synthesize linkages between social determinants of health (SDOH) and cancer screening to reduce persistent inequities contributing to the US cancer burden. The authors conducted a systematic review of US‐based breast, cervical, colorectal, and lung cancer screening intervention studies to summarize how SDOH have been considered in interventions and relationships between SDOH and screening. Five databases were searched for peer‐reviewed research articles published in English between 2010 and 2021. The Covidence software platform was used to screen articles and extract data using a standardized template. Data items included study and intervention characteristics, SDOH intervention components and measures, and screening outcomes. The findings were summarized using descriptive statistics and narratives. The review included 144 studies among diverse population groups. SDOH interventions increased screening rates overall by a median of 8.4 percentage points (interquartile interval, 1.8–18.8 percentage points). The objective of most interventions was to increase community demand (90.3%) and access (84.0%) to screening. SDOH interventions related to health care access and quality were most prevalent (227 unique intervention components). Other SDOH, including educational, social/community, environmental, and economic factors, were less common (90, 52, 21, and zero intervention components, respectively). Studies that included analyses of health policy, access to care, and lower costs yielded the largest proportions of favorable associations with screening outcomes. SDOH were predominantly measured at the individual level. This review describes how SDOH have been considered in the design and evaluation of cancer screening interventions and effect sizes for SDOH interventions. Findings may guide future intervention and implementation research aiming to reduce US screening inequities.

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“…Prior studies examining the utility of interventions aimed at improving culturally appropriate health care delivery recommend three areas of focus: (1) provider education, (2) enhanced patient–provider interaction, and (3) culturally tailored interventions (Butler et al, 2016). Literature examining the effects of cultural competency training for clinicians working with culturally and linguistically diverse populations identified a significant association between such training and the outcomes of patient retention and mutual understanding of treatment plans while finding mixed results for improvements in patient-reported experience of care (Molokwu et al, 2017). Culturally adapted programs for health education and promotion in the Hispanic population have demonstrated increased knowledge and perceived benefit of colorectal cancer screening (Aragones et al, 2010), increases in patient-reported physical activity and cardiovascular health knowledge (Spinner and Alvarado, 2012), and increased postpartum visit participation (Marsiglia et al, 2010).…”

Section: Fertile Ground For Care Delivery Innovationmentioning

confidence: 99%

A Culturally Relevant Care Model to Reduce Health Disparities Among Medicaid Recipients

Johnson

Murcko

Thompson

et al. 2021

Hisp Health Care Int

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Health disparities among Hispanics are associated with poorer health status across multiple health conditions, greater use of high-acuity services, and lower use of care continuity and preventive services. A new integrated delivery organization (IDO) designed around culturally responsive care aims to reduce health disparities and improve health outcomes among the Hispanic community by deploying a multifeatured approach. The IDO combines the universal administration of a culturally sensitive health risk screening tool, the delivery of culturally appropriate medical, behavioral and spiritual health, and creative support of provider practices with training and informational resources, financial incentives, actionable data, technology, and cultural sensitivity training for providers and staff. The IDO further distinguishes its unique approach by partnering with a university informatics program to establish a local learning health care system destined to enrich the evidence base for culturally appropriate interventions that reduce health disparities. Longitudinal research is currently underway that focuses on the impact of culturally motivated interventions on resource utilization, retention, and quality.

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Impact of Targeted Education on Colorectal Cancer Screening Knowledge and Psychosocial Attitudes in a Predominantly Hispanic Population

Cited by 8 publications

References 17 publications

Mediators of screening uptake in a colorectal cancer screening intervention among Hispanics

Mediators of screening uptake in a colorectal cancer screening intervention among Hispanics

Social determinants of health and US cancer screening interventions: A systematic review

A Culturally Relevant Care Model to Reduce Health Disparities Among Medicaid Recipients

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