African Americans have the highest colorectal cancer (CRC) incidence and mortality of any ethnic/racial group. While screening, and particularly colonoscopy, is effective in reducing the incidence of CRC, adherence is low. In fact, a newly released modeling study suggests that disparities in screening accounts for over 40 percent of incidence disparities and almost 20 percent of mortality disparities. This is particularly true for African Americans;further, they are less likely to receive influential physician referrals for screening. There is a critical need to improve our understanding of adherence and the factors which influence African Americans'decisions about engaging in CRC screening, as well as efficacious intervention strategies. Behavioral research has shown links to cognitive decision-making factors (perceived benefits and barriers) and affective decision-making factors (fear and worry) in predicting CRC screening and intentions to screen. However, little or no work has systematically examined these factors in African Americans;this creates significant gaps in knowledge about the role of these factors in predicting (and potentially increasing) CRC screening for minorities. The goal of the proposed application is to understand factors influencing the decisions of African Americans to engage in (or not engage in) screening for CRC and the ability to positively impact these factors through intervention strategies at a community level. The central hypotheses are: a) that decisions to engage in CRC screening will be a function of both cognitive and affective factors;and b) that educational interventions can effectively alter both affective and cognitive factors and therefore increase CRC screening rates for African Americans.
The Specific Aims proposed to test our hypotheses are:
Aim 1 : Examine the impact of two randomized community interventions on cognitive and affective factors and their resulting influence on health care seeking and CRC screening behaviors for African Americans.
Aim 2 : Examine and explore contextual factors that may influence the process of behavior change to better understand CRC screening and health care seeking behaviors at the community level. This study will significantly increase our understanding of factors which influence African Americans'decisions about health care seeking and CRC screening behavior and whether a community-based intervention can positively impact these factors and behaviors to reduce disparities. Expected outcomes: the work proposed in these aims will provide crucial information about behavioral change specific to health care seeking and CRC screening by African Americans.
The proposed study is relevant to public health because it studies the factors which influence African Americans'decisions about engaging in colorectal cancer (CRC) screening and the potential effectiveness of community-based outreach interventions to impact these decisions for African Americans who have an excess incidence and mortality rate from this disease. The proposed study is relevant to the NIH mission pertaining to support of knowledge and research that will help reduce colorectal cancer health disparities.