Reducing Colorectal Cancer Health Disparities: An mHealth Intervention to Improve Screening among African American Men

PROJECT SUMMARY/ABSTRACT Poverty has a myriad of pernicious effects on health, including higher incidence and mortality for most forms of cancer. Colorectal cancer (CRC), the second overall leading cause of cancer death, is no exception. CRC is diagnosed 40% more often in those lower in socioeconomic status (SES). In the United States, race and SES are inextricably linked, leading to profound health disparities. Indeed, CRC is particularly burdensome for Black people, most notably African American men. CRC incidence is 20% higher in Black men as compared to white men with death rates 52% higher. African American men have the lowest survival rates at all CRC stages. Screening (e.g., colonoscopy, stool-based tests) can prevent most cases of invasive CRC. However, uptake is inadequate, especially among low SES African American men. Indeed, 40% of the racial disparity in CRC incidence and 20% of mortality differences can be attributed to lack of screening. Being Black, male, and low SES in the U.S. intersect to form a complex set of institutional, provider, and patient-level barriers that lead to differential screening rates. Most efforts to increase CRC screening in this group utilize in-person or telephone- based education and navigation. While effective, these approaches are resource intensive, limiting their adoption by organizations that serve low SES Black men, such as Federally Qualified Health Centers (FQHCs). To address the need for an effective, affordable, and scalable strategy to increase CRC screening among medically underserved African American men, this project will develop a mobile colorectal cancer screening intervention (m-CRCSI) for this group. m-CRCSI will be based on the health belief model (HBM) and delivered via mobile phone. It will include text messages designed to improve CRC knowledge and health beliefs. Some text messages will include links to one of three types of videos: educational instruction, scripted vignettes, and unscripted peer narratives. Program content will reduce health literacy barriers and promote CRC screening adherence. Finally, it will be culturally targeted by contextualizing HBM constructs with the health beliefs most relevant to low SES Black men and by integrating gender- and race-congruent imagery, language, and values. A prototype m-CRCSi was developed in Phase I. This development was informed by formative research with community-based care providers and target end-users. The results of Phase I far exceeded the proposed benchmarks and strongly support the usability, acceptability, and potential effectiveness of the intervention. During Phase II we will complete development of the m-CRCSi. Then, in collaboration with Family and Medical Counseling Service (our partner FQHC), we will examine the effectiveness of the m-CRCSi to increase CRC screening in African American men. Participants will be randomly assigned to either the intervention condition or to a matched control condition. Secondary measures will assess health beliefs, medical mistrust, cancer fatalism, patient-provider interaction, and knowledge.