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

PROJECT SUMMARY ABSTRACTPoverty has a myriad of pernicious effects on healthincluding higher incidence and mortality for most forms of cancerColorectal cancerCRCthe second overall leading cause of cancer deathis no exceptionCRC is diagnosedmore often in those lower in socioeconomic statusSESIn the United Statesrace and SES are inextricably linkedleading to profound health disparitiesIndeedCRC is particularly burdensome for Black peoplemost notably African American menCRC incidence ishigher in Black men as compared to white men with death rateshigherAfrican American men have the lowest survival rates at all CRC stagesBecause the precancerous polyps that cause most CRCs grow slowlyadherence to CRC screening can prevent most cases from becoming invasive cancerUnfortunatelyuse of screening tests is inadequateespecially among low SES African American menIndeedof the racial disparity in CRC incidence andof the mortality differences can be attributed to lack of screeningBeing Blackmaleand low SES in the United States intersect to form a complex set of institutionalproviderand patient level barriers that lead to these differential screening ratesMost existing approaches to increase CRC screening in this group utilize inperson or telephone based education and patient navigationWhile effectivethese approaches are costly and resource intensivelimiting their adoption among organizations that primarily serve low SES African American mensuch as Federally Qualified Health CentersFQHCsTo address the need for an effectiveaffordableand scalable intervention to increase CRC screening among medically underserved African American menthis project will develop a theory basedtailoredand culturallytargeted CRC screening mHealth intervention for this groupThe proposed intervention will be based on the health belief modelHBMand delivered via mobile phoneIt will include text messages designed to improve CRC knowledge and health beliefsAdditionallythe program will present three web based video componentsscripted vignettesunscripted peer narrativesand educational instructionAll program content will be designed to reduce health literacy barriers and promote adherence to CRC screening recommendationsFinallyit will be culturally targeted by contextualizing HBM constructs with the health beliefs most relevant to low SES African American men and by integrating genderand race congruent imagerylanguageand valuesEight FQHC staff members andAfrican American men will be recruited for focus group discussions to shape the proposed interventionWhen a prototype version of the program is completedAfrican American men who are nonadherent to CRC screeningi etarget end userswill be recruited for usability testingThe usability test will include a series of tasks intended to highlight the different features of the proposed interventionThree usability metrics will be assessedefficiencyaccuracyand subjective satisfaction PROJECT NARRATIVE This project aims to develop a mobile phone based program designed to eliminate colorectal cancer disparities among medically underserved African American menThe proposed intervention is designed for use in Federally Qualified Health Centers and other clinics serving underinsured or uninsured patientsIt can be integrated with electronic health records to identify primary care patients not compliant with colorectal cancer screening or deployed in the community via outreach workers