Implementation and Outcomes of a Community-Based Educational Program for Colorectal Cancer Prevention in Hispanics

Abstract

Objectives: Colorectal cancer (CRC) is the 2nd most diagnosed cancer and leading cause of cancer death in Puerto Rico. However, CRC screening rates remain low. The aim of this study was to test the effectiveness of a Train-the-Trainers’ (TTT) program to develop trainers capable of educating others within their communities about CRC prevention. Methods: The TTT program consisted of didactics and seminars to capacitate participants to become trainers in CRC prevention. This project was evaluated using three components: (1) training workshops; (2) community educational sessions; and (3) the participant’s experience as a trainer. Pre - and post-tests on CRC screening knowledge were given to TTT participants. Program effectiveness was determined by the pre- and post-tests, number of workshop participants completing a community educational session within three months of training and the number of community members reached. Results: Among the 115 total participants, 97 participants took the pre- and post-test. There was a significant difference in the scores for the pre-test (M = 10.56, SD = 2.57) and the post-test (M = 11.43, SD = 1.83) given; t (96) = −4.68, p < 0.001. A total of 955 community members were reached. Participants from the community educational sessions (n = 680) evaluated the program. 77.7% of those participants expressed intent to undergo colonoscopy screening in the future. Conclusions: TTT was effective in preparing trainers in CRC prevention. Participants increased their knowledge about CRC prevention and successfully reached members of their community. Utilization of community trainers is an effective alternative to increase CRC education and awareness in Hispanic communities, which may positively impact CRC screening rates in this population.

Assessing Colorectal Cancer Knowledge Among Puerto Rican Hispanics: Implications for Cancer Prevention and Control

“…The mean CRC knowledge score obtained in our study is similar to those reported in two previous studies in PR using the same questionnaire. Cruz-Correa et al reported a 9.4 ± 0.5 mean CRC knowledge score among the 115 healthcare professionals that participated in the Train the trainers (TTT) program [23]. Portilla-Skerrett et al obtained a slightly higher mean CRC knowledge score (10.3 ± 0.10) among 154 participants recruited in health fairs in PR [27].…”

“…These results correlate with the findings of Ma et al [32], who reported that Koreans and Chinese individuals with limited knowledge about CRC were less likely to undergo CRC screening. Also, Tseng et al [23] showed that African Americans who had more CRC knowledge were more likely to undergo CRC screening. However, due to the nature of our study, we cannot determine whether having more knowledge increases adherence to CRC screening or if having undergone CRC screening tests increases CRC knowledge.…”

“…The validated survey contained questions about general sociodemographic data (age, sex, years of education, annual family income, and health insurance), clinical data (including family history of CRC and history of CRC cancer screening), and 13 items that addressed knowledge about CRC in general, including risk factors and screening tests. These questions have been previously validated in a study in Puerto Rico that aimed to test the effectiveness of a Train-the-Trainers' (TTT) program to develop trainers capable of educating others within their communities about CRC prevention [23]. The internal consistency of the scale in this previous study reflected a Cronbach's alpha statistic = 0.97, which is an acceptable value.…”