Patient Navigation Plus Tailored Digital Video Disc Increases Colorectal Cancer Screening Among Low-Income and Minority Patients Who Did Not Attend a Scheduled Screening Colonoscopy: A Randomized Trial.

BACKGROUND: Up to 50% of people scheduled for screening colonoscopy do not complete this test and no studies have focused on minority and low-income populations. Interventions are needed to improve colorectal cancer (CRC) screening knowledge, reduce barriers, and provide alternative screening options. Patient navigation (PN) and tailored interventions increase CRC screening uptake, however there is limited information comparing their effectiveness or the effect of combining them. PURPOSE: Compare the effectiveness of two interventions to increase CRC screening among minority and low-income individuals who did not attend their screening colonoscopy appointment-a mailed tailored digital video disc (DVD) alone versus the mailed DVD plus telephone-based PN compared to usual care. METHODS: Patients (n = 371) aged 45-75 years at average risk for CRC who did not attend a screening colonoscopy appointment were enrolled and were randomized to: (i) a mailed tailored DVD; (ii) the mailed DVD plus phone-based PN; or (iii) usual care. CRC screening outcomes were from electronic medical records at 12 months. Multivariable logistic regression analyses were used to study intervention effects. RESULTS: Participants randomized to tailored DVD plus PN were four times more likely to complete CRC screening compared to usual care and almost two and a half times more likely than those who were sent the DVD alone. CONCLUSIONS: Combining telephone-based PN with a mailed, tailored DVD increased CRC screening among low-income and minority patients who did not attend their screening colonoscopy appointments and has potential for wide dissemination.

Up to half of people scheduled for a screening colonoscopy do not complete this test. There is a need for interventions to improve knowledge about colorectal cancer (CRC) screening, enhance access to screening by offering alternative test options, foster skills for completing screening, and mitigate barriers. The purpose of this study was to compare the effects of two interventions aimed at increasing CRC screening­a mailed tailored digital video disc (DVD) alone versus the mailed DVD plus telephone-based patient navigation (PN)­for patients who had not completed a scheduled screening colonoscopy. We enrolled 371 patients aged 45­75 years who had no CRC risk factors other than age, who were scheduled for a screening colonoscopy but did not attend their appointment. Participants were randomized to receive either: (i) a mailed tailored DVD; (ii) the mailed DVD plus phone-based PN; or (iii) usual care. Those who received the tailored DVD plus PN were four times more likely to complete CRC screening with stool test or colonoscopy compared to usual care. Combining telephone-based PN with a mailed, tailored DVD increased CRC screening among low-income and minority patients who did not attend a scheduled screening colonoscopy appointment.

County-level correlates of completed HPV vaccination in Indiana.

The Healthy People 2030 goal is for 80% of all adolescents to complete their HPV vaccination series. Per the 2021, National Immunization Survey-Teen (NIS-Teen), 61.7% of adolescents have completed the series, and Indiana lags below the national average (55.2%). The present study estimated the 2-dose HPV vaccine series completion rates across Indiana counties among individuals aged 9-14 years who received their first dose of vaccine and determined what factors were associated with series completion at the county level. The association of county-level sociodemographic and health measures with series completion was also examined. Data were extracted from the Indiana Immunization Information System (IIS), administered by the Indiana Department of Health. All vaccine providers are required to report all immunizations to the system for any patient under age 19 years. All Indiana children ages 9-14 years at the time of first dose who had initiated HPV vaccination in 2017 or 2018 were included. Two-dose series completion was evaluated through October of 2020, allowing a minimum gap of 22 months from first dose administration. All statistical analyses were conducted at the county-level. The Indiana HPV vaccination series completion rate among individuals that received the first dose was on average 73% across counties, ranging from 55.7% to 90.4%. Higher series completion was positively associated with primary care providers per capita, participation in mammography screening among Medicare enrollees, median household income, life expectancy, percentage of residents with some college, percentage of adults up-to-date with colonoscopy screening, and percentage of adults with flu vaccine. There was wide variability in series completion across Indiana counties. HPV series completion was associated with county-level sociodemographic and health measures, particularly variables reflecting difficulties with access to care and lack of financial resources.

Development and Feasibility Testing of a Multilevel Intervention to Increase Hepatitis C Virus Screening Among Baby Boomers in Primary Care.

Chronic infection with hepatitis C virus (HCV) results in an increased risk of cirrhosis and hepatocellular carcinoma (HCC). Only 15% of baby boomers (born 1945-1965) have ever been screened. We aimed to develop a multilevel intervention to increase HCV screening for baby boomers in a primary care setting. This study included two phases: intervention development (phase 1) and feasibility testing (phase 2). In phase 1, we partnered with a Community Advisory Board and a Provider Advisory Board to develop a multilevel intervention to increase HCV screening to be delivered to both providers and patients in primary care. Phase 2 assessed intervention feasibility, acceptability, and usability by conducting Concurrent Think Aloud (CTA) interviews and surveys using previously validated scales with patients (n = 8) and providers (n = 7). Phase 1 results: The patient-level intervention included a mailed reminder letter and CDC pamphlet and a 7-min in-clinic educational video. The provider-level intervention included a 30-min educational session and monthly performance feedback e-mails. Phase 2 results: Qualitatively, both the patient and provider-level intervention were feasible, acceptable, and usable by the target audiences. Quantitatively, on a 1-4 scale, the range of patient-level scores was 3.00-4.00 and provider level was 3.50-4.00 for feasibility, acceptability, and usability. This intervention could improve HCV screening among a high-risk population and therefore reduce HCV-related morbidity and mortality. This project developed a feasible, acceptable, and usable multilevel intervention aimed at increasing HCV screening in primary care.

Development of a Computer-Tailored Intervention/Decision Aid To Increase Colorectal Cancer Screening in Health Systems.

Background Non-compliance with scheduled colonoscopy is common among patients, especially in underserved populations. High no-show and late cancelation rates result in wasted resources, increased costs, and missed opportunities for colorectal cancer (CRC) screening. Among the barriers to colonoscopy is a lack of knowledge about the benefits, fears, and limited time for patient counseling. Methodology We produced a digital video disc and a website program to enhance awareness about CRC screening and address patient barriers in a population with low screening adherence. Results Patients can be educated via an interactive computer-tailored intervention with both DVD and web versions. It details the benefits and need for CRC screening, different methods of screening, and addresses patient-related barriers. Conclusions Patient education is crucial to increase CRC screening among eligible individuals. Because online engagement is affected by attention, interest, and affect, content should be concise but comprehensive.

Partnering to Increase Colorectal Cancer Screening: Perspectives of Community Advisory Board Members.

The Patient-Centered Outcomes Research Institute (PCORI) defines engagement in research as the meaningful involvement of patients, caregivers, clinicians, insurers, and others throughout the entire research process-from planning to conducting the study to disseminating study results. The purposes of this paper are to (a) describe methods used to engage community members across the various phases of a PCORI-funded comparative effectiveness trial to increase colorectal cancer screening; and (b) report results of qualitative and quantitative evaluations of community advisory board members' experiences on this project. Decisions to join and stay engaged with the study included feeling valued and appreciated, being compensated, the opportunity to contribute to research based on their skills and expertise, and being committed to colon cancer prevention efforts. Challenges identified by advisory board members included the significant time commitment, transportation, and meeting location. Lessons learned and guidance for researchers committed to patient and community engagement are described.

County-level correlates of missed opportunities for HPV vaccination in Indiana: An environmental scan.

BACKGROUND: The goal of this study was to examine variability across the 92 Indiana counties in missed opportunities for HPV vaccination and to assess county-level correlates of missed opportunities. METHODS: The Indiana immunization registry provided county level data on 2017 missed opportunity rates for adolescents ages 11-18. A missed opportunity was an encounter when a patient eligible for HPV vaccination received one or more other recommended vaccines, but not HPV. Potential county-level correlates of missed opportunities included race, income, population density, education, primary care providers per capita, smoking rates, mammography screening, diabetes monitoring, and Pap testing. RESULTS: The missed opportunity rate ranged from 31% to 85% across Indiana counties. Higher population density, mammography screening, income inequality, and diabetes monitoring were associated with fewer missed opportunities. CONCLUSIONS: We found wide variability in missed opportunities across counties, which were associated with population density and county-level participation in other health-related behaviors. SOURCES OF SUPPORT: This study was supported by the National Cancer Institute under Award Number P30 CA082709-18S4.

Understanding lung cancer screening behavior: Racial, gender, and geographic differences among Indiana long-term smokers.

Lung cancer screening is a relatively new screening option. Inequalities related to screening behavior have been documented in other types of cancer screening. Because stage at presentation drives mortality in lung cancer, it is critical to understand factors that influence screening behavior in lung cancer screening in order to intervene. However, we must first understand where disparities exist in lung cancer screening participation in order to effectively guide intervention efforts. Therefore, the purpose of this study was to determine the association of sociodemographic (including key disparity-related variables) and knowledge with lung cancer screening behavior. This cross-sectional, descriptive study used survey methodology to collect data from 438 screening-eligible individuals in the state of Indiana between January and February 2017 and measured sociodemographic variables and knowledge about lung cancer and screening. Key sociodemographic and health status characteristics associated with screening behavior included race, geographic area of residence, income, health insurance, and family history of lung cancer. Of the variables generally reflective of disparities, key differences were noted by race and geographic area of residence with total knowledge scores as well as screening behavior, respectively. Results indicate key differences in race and geographic area of residence that may perpetuate screening behavior disparities. We have a unique opportunity at this early implementation stage in lung cancer screening to learn what variables influence screening behavior from our target patient population. This knowledge can be used to design equitable patient outreach programs, meaningful, tailored patient engagement materials, and effective patient-clinician decision support tools.

The effects of a brief educational intervention on human papillomavirus knowledge and intention to initiate HPV vaccination in 18-26 year old young adults.

OBJECTIVES: Despite the Advisory Committee on Immunization Practices (ACIP) recommendations for young adult females and males to receive the three-dose human papillomavirus (HPV) vaccine, most recent findings show that only 30% of the U.S. females aged 19-26, 2.8% of males aged 19-21, and only 1.7% of males aged 22-26 are initiating vaccination. This study evaluates the effects of a brief (5-10 min) group HPV educational intervention on knowledge and intent to vaccinate among young adults. METHODS: A sample of 131 18-26 year old females and males was recruited from the 2012 INShape Black and Minority Health Fair in Indiana. We randomized participants into one of two groups: (1) survey completion prior to education (control group) or (2) survey completion following education (intervention group). Written surveys assessed HPV knowledge, vaccination history, and vaccination intent (for unvaccinated participants). RESULTS: Respondents were primarily female (70%), single (85%), and the majority self-identified as non-Hispanic Black (77%). Thirty-seven percent had initiated HPV vaccination (≥1 dose) and 19% had completed the series. The intervention group had higher HPV knowledge scores (M=9.1; SD=1.8) than the control group (M=7.0; SD=2.9; F=22.53). Among unvaccinated individuals (n=79), the intervention group had higher HPV vaccination intent (86%) compared to the control group (67%) (OR=3.09; 95%CI=1.02-9.36). CONCLUSIONS: Despite ACIP recommendations, young adults continue to have low awareness of vaccine benefits and low vaccination rates. This study suggests that educational interventions to increase HPV awareness and vaccination may help to boost vaccination rates.

Recommendations for a national agenda to substantially reduce cervical cancer.

PURPOSE: Prophylactic human papillomavirus (HPV) vaccines and new HPV screening tests, combined with traditional Pap test screening, provide an unprecedented opportunity to greatly reduce cervical cancer in the USA. Despite these advances, thousands of women continue to be diagnosed with and die of this highly preventable disease each year. This paper describes the initiatives and recommendations of national cervical cancer experts toward preventing and possibly eliminating this disease. METHODS: In May 2011, Cervical Cancer-Free America, a national initiative, convened a cervical cancer summit in Washington, DC. Over 120 experts from the public and private sector met to develop a national agenda for reducing cervical cancer morbidity and mortality in the USA. RESULTS: Summit participants evaluated four broad challenges to reducing cervical cancer: (1) low use of HPV vaccines, (2) low use of cervical cancer screening, (3) screening errors, and (4) lack of continuity of care for women diagnosed with cervical cancer. The summit offered 12 concrete recommendations to guide future national and local efforts toward this goal. CONCLUSIONS: Cervical cancer incidence and mortality can be greatly reduced by better deploying existing methods and systems. The challenge lies in ensuring that the array of available prevention options are accessible and utilized by all age-appropriate women-particularly minority and underserved women who are disproportionately affected by this disease. The consensus was that cervical cancer can be greatly reduced and that prevention efforts can lead the way towards a dramatic reduction in this preventable disease in our country.

Successful recruitment of healthy African American men to genomic studies from high-volume community health fairs: implications for future genomic research in minority populations.

BACKGROUND: Study of genomic data obtained from patient biospecimens is frequent in research of subjects with prostate and other epithelial malignancies. Understanding of the characteristics of healthy men who participate in genomic research is limited. METHODS: Patients were identified through the Prostate Cancer Genetic Risk Evaluation of SNPs Study and the Indiana University Cancer Biomarker Study, 2 population-based biomarker and cohort studies. Between 2006 and 2010, healthy Caucasian (n = 774) and healthy African American (n = 381) men were recruited and enrolled at high-volume free community health fairs. Each participant completed a demographic questionnaire and provided a blood sample for genomic research investigations. Frequency differences between demographic features of healthy African American and Caucasian men were compared and analyzed by 2-sample t test and multivariate logistic regression after adjusting potential confounding variables with significance at the P < .05 level. Features examined included: age, body mass index (BMI), income, education, marital status, tobacco, alcohol, family history, prostate-specific antigen (PSA) level, and prior prostate cancer screening history. RESULTS: Significant differences between healthy Caucasian and African American men participating in genomic research included: marital status (married, 69% Caucasian vs 46% African American, P< < .001), mean age (years, 58 Caucasian vs 54 African American, P < .001), mean BMI (kg/m(2), 30.9 Caucasian vs 32.3 African American, P = .004), annual income (P = .038), education (P = .002), and mean PSA (ng/mL, 1.2 Caucasian vs 2.0 African American, P = .005). CONCLUSIONS: Significant demographic differences exist between healthy Caucasian and African American men choosing to participate in genomic research. These differences may be important in designing genomic research study recruitment strategies.

Barriers to recruiting urban African American women into research studies in community settings.

This qualitative study identified barriers to African American women's participation in a community-based behavioral intervention trial to increase mammography screening. Four themes emerged from focus group discussions with community agency providers and research team members. These themes were (1) going to the gatekeepers; (2) knowing the culture; (3) location is everything; and (4) protocols, policies, and possibilities. A checklist of actions that nurse researchers could consider to increase African American women's participation in community trials is provided.

The meaning of health in mammography screening for African American women.

Inadequate use of mammography screening for early detection of breast cancer is an important factor associated with the disproportionate breast cancer death rates in African American women. To improve understanding of the mammography screening experience and health for African Americans, focus groups were held with 30 African American women. Seven categories emerged: (a) the mind, body, and spirit connection: (b) living your life; (c) looking good; (d) good health-bad health; (e) prevention-detection confusion; (f) being afraid of cancer; and (g) what gets in the way. Implications for developing tailored messages and for addressing system barriers are discussed.