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We critically reviewed the motivations, processes, and implementation methods underlying a faculty-driven diversity, equity, and inclusion (DEI) curriculum self-reflection project in the Rutgers School of Public Health. This case study offers guidance on a curriculum self-reflection tool that was developed through the school's Curriculum Committee to promote DEI throughout the school's curricula. We review the key steps in this process and the unique aspects of developing and implementing such evaluations within higher education. The study draws on faculty experience, was informed by students and staff within the Curriculum Committee, and builds on existing knowledge and tools. A flexible 6-step framework-including guiding principles and strategic approaches to planning, developing, and implementing a DEI curriculum self-assessment-is provided to assist instructors, curriculum committees, DEI groups, and academic leaders at schools of public health interested in refining their courses and curricula. Academic units experience contextual challenges, and while each is at a different stage in curriculum reform, our findings provide lessons about integrating the assessment of DEI in school curriculum in a systematic and iterative way. Our approach can be applied to diverse academic settings, including those experiencing similar implementation challenges.
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BACKGROUND: Understanding patients' perspectives regarding drug tolerability, in addition to effectiveness, provides a complete picture of the patient experience and supports more informed therapeutic decision-making. The item library of the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) was developed to measure patient-reported frequency, severity, and interference of adverse events (AEs) associated with cancer therapies. This qualitative interview study assessed the suitability of items selected from the PRO-CTCAE library for assessing tolerability of selexipag, a medication targeting the prostacyclin pathway for patients with pulmonary arterial hypertension (PAH). METHODS: Two rounds of 10 qualitative, web-assisted telephone interviews following a semi-structured guide were conducted in individuals with recent experience taking oral selexipag for PAH. Each interview included concept elicitation to gather participants' perspectives on symptomatic AEs (type, frequency, severity, and interference) and cognitive debriefing of PRO-CTCAE items addressing the most frequently reported AEs of oral selexipag. RESULTS: Interviews were conducted with 20 participants with PAH (mean [range] age 50 [24-68] years; 75% female; 85% in World Health Organization Functional Class II-III), comprising different races/ethnicities, levels of education, and employment status. Fifteen participants were currently treated with selexipag; five had taken selexipag for ≥ 6 months before discontinuing. The most frequently reported AEs included headache, jaw pain, and nausea (n = 15, 12, and 10 participants, respectively). Diarrhea and headache were identified as the most bothersome AEs by 5 and 4 participants, respectively. Some AEs were transitory (e.g., jaw pain); others were long-lasting (e.g., muscle pain). Based on findings from Round 1 interviews, a flushing item was added and the PRO-CTCAE general pain item was modified to be specific to jaw pain for testing in Round 2. Interview findings identified the following AEs as relevant to assess in a PAH clinical trial: nausea, vomiting, diarrhea, flushing, jaw pain, headache, aching muscles, and aching joints. CONCLUSIONS: The PRO-CTCAE items selected in this study and the additional symptomatic AEs identified as patient-relevant have the potential to be included in assessments capturing the patient perspective on tolerability in future studies of selexipag and possibly other PAH therapies.
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Neoplasias , Hipertensão Arterial Pulmonar , Estados Unidos , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , National Cancer Institute (U.S.) , Hipertensão Pulmonar Primária Familiar , Dor , Diarreia , Cefaleia/induzido quimicamente , NáuseaRESUMO
Larger vehicles, such as sports utility vehicles, consume more energy than cars. Their increasing popularity runs contrary to the goal of fuel economy regulations to reduce fossil fuel consumption and greenhouse gas emissions and can be explained by consumer preference and lower regulation stringency, which is due to footprint, truck classification, and the omission of heterogenous lifetime vehicle distance traveled among vehicle classes. This study shows that, for both the US and China, large vehicles travel more, last longer, and are owned by higher income consumers. This means large vehicles and their high-income owners use more fuel and emit more pollutants than represented by current policy and thus raises both policy effectiveness and energy equity concerns. We propose and estimate Sales Adjustment Factors that weigh fuel economy standards based on vehicle lifetime usage and demonstrate the resultant significant improvements in the effectiveness and equity of fuel economy regulations.
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We describe an iterative three-phase approach used to develop a cancer survivorship health-coaching intervention to guide self-management and follow-up care for post-treatment breast, colorectal, and prostate cancer survivors. Informed by theory (e.g., Cognitive-Social Health Information Processing Model (C-SHIP)), relevant literature, and clinical guidelines, we engaged in a user-centered design process. In phase I, we conducted depth interviews with survivors of breast (n = 34), prostate (n = 4), and colorectal (n = 6) cancers to develop a health coaching prototype. In phase II, we utilized user-testing interviews (n = 9) to test and refine the health coaching prototype. For both phases, we used a template analysis independently coding each interview. In phase I, majority (n = 34, 81%) of survivors were positive about the utility of health coaching. Among these survivors (n = 34), the top areas of identified need were emotional support (44%), general health information (35.3%), changes in diet and exercise (29.3%), accountability and motivation (23.5%), and information about treatment effects (17.7%). The prototype was developed and user-tested and refined in phase III to address the following concerns: (1) the amount of time for calls, (2) density of reading materials, (3) clarity about health coaches' role, (4) customization. Collectively, this resulted in the development of the Extended Cancer Educational for Long-Term Cancer Survivors health-coaching (EXCELSHC) program, which represents the first cancer survivorship follow-up program to support follow-up care designed-for-dissemination in primary care settings. EXCELSHC is being tested in a clinical efficacy trial. Future research will focus on program refinement and testing for effectiveness in primary care.
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Sobreviventes de Câncer , Neoplasias Colorretais , Tutoria , Neoplasias da Próstata , Assistência ao Convalescente , Neoplasias da Mama , Sobreviventes de Câncer/psicologia , Feminino , Seguimentos , Humanos , MasculinoRESUMO
Understanding information seeking behaviors and experiences is essential for designing educational and supportive interventions to promote survivor's self-management post treatment. This study examined health and cancer information seeking, use of internet to find cancer information, and information seeking experiences among breast, colorectal, and prostate cancer survivors. Nationally representative data collected in 2017-2018 from 2 cycles of the Health Information National Trends Survey (HINTS 5, cycles 1 and 2 were merged with combined replicate weights using the jackknife replication method (n = 373). Regression analysis for three information seeking behaviors (i.e., health information, cancer information, and internet for cancer information) were modeled, including sociodemographic and clinical factors as predictors. In addition, separate regression analysis predicted three experiences of information seeking (effort, quality, and hard to understand) with sociodemographic and clinical factors. A majority of survivors (84.7%) sought health information. Factors significantly associated with seeking health information were gender (p = 0.024), education (p = 0.0021), and income (p = 0.018). Only 38% of survivors used the internet to seek cancer-related information. The only factor significantly associated with using the internet to seek cancer-related information was time since diagnosis (p = 0.0002). The factor significantly associated with difficulty understanding information was annual household income (p = 0.026). This study fills an important gap by identifying sociodemographic and cancer-related factors associated with information seeking behaviors and experiences. These findings highlight a need to tailor information for low socioeconomic status survivors to account for the lack of skills, resources, and motivation to seek information about health and cancer related topics independently.
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Sobreviventes de Câncer , Neoplasias , Neoplasias da Próstata , Adulto , Humanos , Comportamento de Busca de Informação , Internet , Masculino , Neoplasias/terapia , Inquéritos e Questionários , SobreviventesRESUMO
OBJECTIVES: Individuals with limited health literacy often experience suboptimal health outcomes. This study examined the frequency of limited health literacy and demographic and psychosocial factors associated with limited health literacy in a sample of older Black Americans. METHODS: Participants (nâ¯=â¯330) enrolled in a community-based intervention to promote colorectal cancer (CRC) screening completed baseline surveys assessing health literacy with the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) test, CRC awareness, cancer fatalism, Preventive Health Model (PHM) constructs, and demographics. RESULTS: Approximately 52% of participants had limited health literacy, the REALM-R score was 5.4 (SDâ¯=â¯2.7). Univariable correlates of limited health literacy were gender, employment, income, prior screening, cancer fatalism, CRC awareness, and PHM constructs (religious beliefs, salience/coherence, perceived susceptibility). Multivariable correlates of limited health literacy were male gender (ORâ¯=â¯2.3, CIâ¯=â¯1.4-3.8), unable to work (ORâ¯=â¯2.8, CIâ¯=â¯1.3-6.1), lower household income (ORâ¯=â¯3.0, CIâ¯=â¯1.6, 5.5), and higher PHM religious beliefs (ORâ¯=â¯1.1, CIâ¯=â¯1.0-1.2). CONCLUSION: Limited health literacy was associated with multiple complex factors. Interventions should incorporate patient health literacy and low-literacy materials that can be delivered through multiple channels. PRACTICE IMPLICATIONS: Future studies are needed to understand the role of health literacy in an individual's health behavior and the provision of effective healthcare.
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Neoplasias Colorretais/diagnóstico , Discriminação Psicológica , Comportamentos Relacionados com a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Letramento em Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Programas de Rastreamento/estatística & dados numéricos , Negro ou Afro-Americano , Idoso , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/psicologia , Pesquisa Participativa Baseada na Comunidade , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Religião , Fatores Socioeconômicos , ConfiançaRESUMO
Objective: Colorectal cancer (CRC) screening efforts have effectively reduced CRC morbidity and mortality, yet screening remains relatively low among Latinos. The study's purpose was to document the awareness/knowledge of Fecal Immunochemical Test (FIT) among Latinos, gain better understanding of patient and health care provider perceptions about FIT, and explore the feasibility of adoption/uptake.Design/Methods: The study was guided by qualitative, ethnography design and methods. Eight focus groups (FG) with patients who self-identified as Hispanic/Latino between 50-75 years of age and key informant interviews with providers (N = 10) were conducted followed by a brief demographic questionnaire.Results: Awareness levels varied based on prior screening experiences among patients and providers. Both patients and providers believed the FIT is simple and easy to use; although, a minority of patients expressed doubts about the efficacy of the FIT when compared to colonoscopy.Conclusions: Despite the increasing acceptance of the FIT among the health care community, a significant lag time still exists among our study's populations. Study findings speak to novelty of the FIT test among underserved populations and the health disparity gap between health innovations/discoveries. Increased awareness and education efforts about the efficacy coupled with information about its accessibility, ease, and user instructions may increase the adoption of FIT.
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Conscientização , Neoplasias Colorretais , Detecção Precoce de Câncer , Hispânico ou Latino , Sangue Oculto , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Antropologia Cultural , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Feminino , Grupos Focais , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The aim of this study is to describe a user-centered (e.g., cancer survivors and clinicians) development process of an eHealth tool designed to facilitate self-management of cancer survivorship follow-up care. METHODS: Guided by Cognitive-Social Health Information Processing (C-SHIP) model and informed by core self-management skills, we engaged in a user-centered design process. In phase I, we conducted in-depth interviews with survivors of breast (n = 33), prostate (n = 4), and colorectal (n = 6) cancers, and (n = 9) primary care providers to develop content and design of the web tool. Phase II utilized iterative user testing interviews (n = 9) to test the web-based tool prototype. Data from both phases were independently coded using a template/content analytic approach. RESULTS: The top 5 functions identified in phase I for the web-based platform included: (a) educational materials to learn and prepare for health encounters (80%); (b) questions for health providers (74%); (c) ability to track contact information of providers (67%); (d) provide general information (64%); and, (e) support information (62%). Users of the prototype reported patient burden, tool fatigue, introduction timing of the tool, relevance, and security/privacy as concerns in phase II. CONCLUSIONS: This study demonstrates the value of using a theoretically informed and user-centered design process to develop relevant and patient-centered eHealth resources to support cancer survivorship. A larger study is needed to establish the efficacy of this eHealth tool as an intervention to improve adherence to follow-up care guidelines.
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Assistência ao Convalescente/psicologia , Sobreviventes de Câncer/psicologia , Neoplasias/psicologia , Preferência do Paciente/psicologia , Sobrevivência , Telemedicina/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/reabilitação , Autogestão , Interface Usuário-ComputadorRESUMO
Objective: Two longitudinal studies examined whether effects of subjective norms on secondary cancer prevention behaviors were stronger and more likely to non-deliberative (i.e., partially independent of behavioral intentions) for African Americans (AAs) compared to European Americans (EAs), and whether the effects were moderated by racial identity. Design: Study 1 examined between-race differences in predictors of physician communication following receipt of notifications about breast density. Study 2 examined predictors of prostate cancer screening among AA men who had not been previously screened.Main Outcome Measures: Participants' injunctive and descriptive normative perceptions; racial identity (Study 2); self-reported physician communication (Study 1) and PSA testing (Study 2) behaviors at follow up. Results: In Study 1, subjective norms were significantly associated with behaviors for AAs, but not for EAs. Moreover, there were significant non-deliberative effects of norms for AAs. In Study 2, there was further evidence of non-deliberative effects of subjective norms for AAs. Non-deliberative effects of descriptive norms were stronger for AAs who more strongly identified with their racial group. Conclusion: Subjective norms, effects of which are non-deliberative and heightened by racial identity, may be a uniquely robust predictor of secondary cancer prevention behaviors for AAs. Implications for targeted screening interventions are discussed.
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Negro ou Afro-Americano/psicologia , Detecção Precoce de Câncer/psicologia , Prevenção Secundária/estatística & dados numéricos , Identificação Social , Normas Sociais/etnologia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Neoplasias da Mama/etnologia , Neoplasias da Mama/prevenção & controle , Comunicação , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Intenção , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/prevenção & controle , População Branca/psicologia , População Branca/estatística & dados numéricosRESUMO
BACKGROUND: Breast, colorectal, and prostate cancer survivors are at increased risk for late and long-term effects post-treatment. The post-treatment phase of care is often poorly coordinated and survivors navigate follow-up care with minimal information or guidance from their healthcare team. This manuscript describes the Extended Cancer Education for Longer-term Survivors (EXCELS) in Primary Care protocol. EXCELS is a randomized controlled trial to test the efficacy of patient-level self-management educational strategies on adherence to preventative health service use and cancer survivorship follow-up guidelines. METHODS: The EXCELS trial compares four conditions: (1) EXCELS-website (e.g., a mobile-optimized technology platform); (2) EXCELS-health coaching; (3) EXCELS-website and health coaching; and (4) a print booklet. Approximately 480 breast, colorectal, and prostate survivors will be recruited through the New Jersey Primary Care Research Network (NJPCRN) and New Jersey State Cancer Registry (NJSCR). Eligible survivors (diagnosed stages 1-3) must have completed active treatment, access to a phone and a computer, smartphone or tablet with internet access, and be able to speak and read English. Patient assessments occur at baseline, 6, 12, and 18 months. The primary outcomes are increased engagement in preventive health services and monitoring for cancer recurrence and treatment-related late effects. DISCUSSION: The EXCELS trial is the first to test cancer survivorship educational self-management interventions for cancer survivors in a primary care context. Findings from this trial will inform successful implementation and engagement strategies for longer-term, post-treatment cancer survivors managed in primary care settings. TRIAL REGISTRATION: Registered August 1, 2017 at ClinicalTrials.gov , trial # NCT03233555.
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Sobreviventes de Câncer , Protocolos Clínicos , Educação de Pacientes como Assunto , Projetos de Pesquisa , Sobreviventes , Humanos , Monitorização Fisiológica , Avaliação de Processos e Resultados em Cuidados de Saúde , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Recidiva , Autogestão , SobrevivênciaRESUMO
The current study examines changes in awareness and health beliefs from baseline to 12 months post-intervention following receipt of one of two colorectal cancer (CRC) educational interventions that aimed to promote CRC screening among a racially and ethnically diverse and medically underserved population. Participants (N = 270) were enrolled in a randomized controlled trial to increase CRC screening and completed both baseline and 12-month follow-up assessments. Participants were aged 50-75, at average CRC risk, not up-to-date with CRC screening guidelines, and receiving care at one of three community-based clinics. Participants were randomized to receive either a targeted, low-literacy intervention informed by the Preventive Health Model [PHM] (photonovella and DVD plus fecal immunochemical test [FIT]) or a non-targeted intervention (standard educational brochure plus FIT). Changes in CRC awareness and health beliefs from baseline to 12 months were examined both within and between intervention groups using Student's t tests. Participants in both intervention conditions demonstrated an increase in CRC awareness, PHM social influence, and trust in the healthcare system (all p's < .0001), with no significant between-group differences. Among those receiving the targeted intervention, there also was an increase in PHM salience (p < .05). Among individuals receiving the non-targeted intervention, there was an increase in PHM response efficacy (p < .01) and PHM self-efficacy (p < .0001). Both CRC screening interventions promoted positive changes in awareness and several health beliefs from baseline to 12 months, suggesting important benefits of CRC education. Regardless of whether education was targeted or non-targeted, providing CRC screening education successfully promoted durable changes in awareness and health beliefs.
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Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Idoso , Feminino , Florida , Humanos , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Sangue OcultoRESUMO
BACKGROUND: To reduce colorectal cancer (CRC) screening disparities, it is important to understand correlates of different types of cancer worry among ethnically diverse individuals. OBJECTIVES: The current study examined the prevalence of three types of cancer worry (i.e., general cancer worry, CRC-specific worry, and worry about CRC test results) as well as sociodemographic and health-related predictors for each type of cancer worry. METHODS: Participants were aged 50-75, at average CRC risk, nonadherent to CRC screening guidelines, and enrolled in a randomized controlled trial to increase CRC screening. Participants completed a baseline questionnaire assessing sociodemographics, health beliefs, healthcare experiences, and three cancer worry measures. Associations between study variables were examined with separate univariate and multivariable logistic regression models. RESULTS: Responses from a total of 416 participants were used. Of these, 47% reported experiencing moderate-to-high levels of general cancer worry. Predictors of general cancer worry were salience and coherence (aOR = 1.1, 95% CI [1.0, 1.3]), perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3), and social influence (aOR = 1.1, 95% CI [1.0, 0.1]). Fewer (23%) reported moderate-to-high levels of CRC-specific worry or CRC test worry (35%). Predictors of CRC worry were perceived susceptibility (aOR = 1.4, 95% CI [1.3, 1.6]) and social influence (aOR = 1.1, 95% CI [1.0, 1.2]); predictors of CRC test result worry were perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3) and marital status (aOR = 2.0, 95% CI [1.1, 3.7] for married/partnered vs. single and aOR = 2.3, 95% CI [1.3, 4.1] for divorced/widowed vs. single). DISCUSSION: Perceived susceptibility consistently predicted the three types of cancer worry, whereas other predictors varied between cancer worry types and in magnitude of association. The three types of cancer worry were generally predicted by health beliefs, suggesting potential malleability. Future research should include multiple measures of cancer worry and clear definitions of how cancer worry is measured.
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Ansiedade/psicologia , Neoplasias Colorretais/diagnóstico , Programas de Rastreamento/psicologia , Idoso , Ansiedade/etiologia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/psicologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Florida , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento/normas , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Recruiting ethnically diverse Black participants to an innovative, community-based research study to reduce colorectal cancer screening disparities requires multipronged recruitment techniques. OBJECTIVES: This article describes active, passive, and snowball recruitment techniques, and challenges and lessons learned in recruiting a diverse sample of Black participants. METHODS: For each of the three recruitment techniques, data were collected on strategies, enrollment efficiency (participants enrolled/participants evaluated), and reasons for ineligibility. RESULTS: Five hundred sixty individuals were evaluated, and 330 individuals were enrolled. Active recruitment yielded the highest number of enrolled participants, followed by passive and snowball. Snowball recruitment was the most efficient technique, with enrollment efficiency of 72.4%, followed by passive (58.1%) and active (55.7%) techniques. There were significant differences in gender, education, country of origin, health insurance, and having a regular physician by recruitment technique (p < .05). DISCUSSION: Multipronged recruitment techniques should be employed to increase reach, diversity, and study participation rates among Blacks. Although each recruitment technique had a variable enrollment efficiency, the use of multipronged recruitment techniques can lead to successful enrollment of diverse Blacks into cancer prevention and control interventions.
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Negro ou Afro-Americano , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer , Seleção de Pacientes , Neoplasias Colorretais/diagnóstico , Pesquisa Participativa Baseada na Comunidade , Escolaridade , Emigrantes e Imigrantes , Feminino , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Estados UnidosAssuntos
Complicações na Gravidez/terapia , Diagnóstico Precoce , Feminino , Humanos , Mortalidade Materna , Valor Preditivo dos Testes , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/mortalidade , Complicações na Gravidez/fisiopatologia , Prognóstico , Medição de Risco , Fatores de RiscoRESUMO
Beaver reintroductions and beaver dam structures are an increasingly utilized ecological tool for rehabilitating degraded streams, yet beaver dams can potentially impact upstream fish migrations. We collected two years of data on Arctic grayling movement through a series of beaver dams in a low gradient mountain stream, utilizing radio-telemetry techniques, to determine how hydrology, dam characteristics, and fish attributes impeded passage and movement rates of spawning grayling. We compared fish movement between a "normal" flow year and a "low" flow year, determined grayling passage probabilities over dams in relation to a suite of factors, and predicted daily movement rates in relation to the number of dams each fish passed and distance between dams during upstream migration to spawning areas. We found that the average passage probability over unbreached beaver dams was 88%, though we found that it fell below 50% at specific dams. Upstream passage of grayling was affected by three main characteristics: (a) temperature, (b) breach status, and (c) hydrologic linkages that connect sections of stream above and below the dam. Other variables influence passage, but to a lesser degree. Cumulative passage varied with distance upstream and total number of dams passed in low versus normal flow years, while movement rates upstream slowed as fish swam closer to dams. Our findings demonstrate that upstream passage of fish over beaver dams is strongly correlated with hydrologic conditions with moderate controls by dam- and fish-level characteristics. Our results provide a framework that can be applied to reduce barrier effects when and where beaver dams pose a significant threat to the upstream migration of fish populations while maintaining the diverse ecological benefits of beaver activity when dams are not a threat to fish passage.
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The current study examined the sociodemographic and psychosocial variables that predicted being at risk for low health literacy among a population of racially and ethnically diverse patients accessing primary care services at community-based clinics. Participants (N = 416) were aged 50-75 years, currently not up-to-date with colorectal cancer (CRC) screening, at average CRC risk, and enrolled in a randomized controlled trial (RCT) aimed at promoting CRC screening. Participants completed a baseline interview that assessed health literacy as measured by Rapid Estimate of Adult Literacy in Medicine-Revised, sociodemographic factors, and psychosocial variables (e.g., health beliefs) prior to randomization and receipt of an intervention. Thirty-six percent of the participants were found to be at risk for low health literacy. Sociodemographic and psychosocial variables were assessed as predictors of being at risk for low health literacy using logistic regression. In the final model, predictors were male gender, being from a racial/ethnic minority group, being unable to work, having higher social influence scores, and having higher religious belief scores. These findings suggest several patient characteristics that may be associated with low health literacy, and highlight the importance of supporting all patients through simplified and clear communications and information to improve understanding of CRC screening information.
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Serviços de Saúde Comunitária/estatística & dados numéricos , Letramento em Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Idoso , Neoplasias Colorretais/prevenção & controle , Estudos Transversais , Demografia , Detecção Precoce de Câncer/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Grupos Raciais/estatística & dados numéricos , Religião , Fatores de Risco , Fatores SocioeconômicosRESUMO
BACKGROUND: The objective of the current study was to improve colorectal cancer (CRC) screening uptake with the fecal immunochemical test (FIT). The current study investigated the differential impact of a multicomponent, targeted, low-literacy educational intervention compared with a standard, nontargeted educational intervention. METHODS: Patients aged 50 to 75 years who were of average CRC risk and not up-to-date with CRC screening were recruited from either a federally qualified health center or a primary care community health clinic. Patients were randomized to the intervention condition (targeted photonovella booklet/DVD plus FIT kit) or comparison condition (standard Centers for Disease Control and Prevention brochure plus FIT kit). The main outcome was screening with FIT within 180 days of delivery of the intervention. RESULTS: Of the 416 participants, 54% were female; the participants were racially and ethnically diverse (66% white, 10% Hispanic, and 28% African American), predominantly of low income, and insured (the majority had county health insurance). Overall, the FIT completion rate was 81%, with 78.1% of participants in the intervention versus 83.5% of those in the comparison condition completing FIT (P = .17). In multivariate analysis, having health insurance was found to be the primary factor predicting a lack of FIT screening (adjusted odds ratio, 2.10; 95% confidence interval, 1.04-4.26 [P = .04]). CONCLUSIONS: The multicomponent, targeted, low-literacy materials were not found to be significantly different or more effective in increasing FIT uptake compared with the nontargeted materials. Provision of a FIT test plus education may provide a key impetus to improve the completion of CRC screening. The type of educational material (targeted vs nontargeted) may matter less. The findings of the current study provide a unique opportunity for clinics to adopt FIT and to choose the type of patient education materials based on clinic, provider, and patient preferences. Cancer 2017;123:1390-1400. © 2016 American Cancer Society.
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Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Detecção Precoce de Câncer , Fezes/química , Educação de Pacientes como Assunto , Idoso , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Razão de Chances , Fatores de RiscoRESUMO
Medical guidelines do not recommend prostate cancer screening, particularly without informed and shared decision making. This study investigates undisclosed opportunistic screening using prostate specific antigen (PSA) testing in black immigrant and African American men. Participants (N = 142) were insured urban men, 45- to 70-years old. Patients' reports of testing were compared with medical claims to assess undisclosed PSA testing. Most (94.4 %) men preferred to share in screening decisions, but few (46.5 %) were aware PSA testing was performed. Four factors predicted being unaware of testing: low formal education, low knowledge about prostate cancer, no intention to screen, and no physician recommendation (all p's < .05). Undisclosed PSA testing was common. Both patient and provider factors increased risk of being uninformed about prostate cancer screening. Interventions combining patient education and physician engagement in shared decision making may better align practice with current prostate cancer screening guidelines.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Emigrantes e Imigrantes/estatística & dados numéricos , Antígeno Prostático Específico/análise , Neoplasias da Próstata/etnologia , Idoso , Tomada de Decisões , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente , Neoplasias da Próstata/diagnóstico , Fatores SocioeconômicosRESUMO
BACKGROUND: Intervention studies among individuals in diverse community settings are needed to reduce health disparities in colorectal cancer (CRC) screening and mortality rates. The current study compared the efficacy of 2 intervention conditions promoting CRC screening among black individuals. METHODS: Black individuals ages 50 to 75 years (N = 330) were recruited in community settings in 4 Tampa Bay counties. After obtaining consent and conducting a baseline interview to assess sociodemographic and health-related variables, participants received either a culturally targeted CRC photonovella booklet plus a fecal immunochemical test (FIT) kit or a standard CRC screening brochure plus an FIT kit. The primary outcome was FIT kit screening uptake. RESULTS: FIT screening uptake at 6 months was 86.7% overall (90.3% in the brochure group and 81.9% in the photonovella group). Controlling for baseline between-group differences, there was no influence of intervention on FIT kit uptake (P = .756). Significant predictors of not returning an FIT kit included being unable to work (P = .010), having higher religious belief scores (P = .015), and living farther from the cancer center (P = .015). CONCLUSIONS: Providing FIT kits and educational print materials to black individuals in community settings resulted in high rates of CRC screening. The study also identified subgroups of participants who were less likely to return an FIT kit and provides insight for future interventions. Cancer 2016;122:3288-3296. © 2016 American Cancer Society.