Colorectal cancer (CRC) is the second leading cause of cancer death in the United States, but it can be prevented or detected early through screening. Many racial/ethnic minority groups and those who are low income or uninsured have lower rates of screening, later stage of diagnosis, and poorer survival. Given the low public awareness about CRC and screening, one way to begin addressing CRC disparities is through community engagement. We have established a colorectal cancer partnership to begin addressing the disparities in our community. This Community-Based Participatory Research (CBPR) project emerged out of discussions with the Partnership. Community members were involved in the conceptualization of the ideas and are involved in several phases of the research implementation, analysis, and dissemination. In this study, we propose to implement a Photovoice project to help understand community needs and awareness of CRC and use those findings to develop CRC awareness intervention messages. Participants in the Photovoice project will be trained to use cameras to photograph their depictions of the meaning of CRC or CRC screening in their lives. Participants develop an individual narrative describing their selected photographs and group discussions will ensue where participants can discuss the meaning and context of the images. We will separate Photovoice groups into persons who have been screened and persons who have been diagnosed with CRC so that we can gather messages about prevention as well as early detection. Screener and survivor Photovoice groups will be held in two different medically underserved neighborhoods (north city and south city) in Saint Louis. Using this rubric, a total of four Photovoice groups will be held with 12 participants each. After the Photovoice project and at the discretion of the Photovoice participants, we will use a participatory process to select some of the Photovoice products for use as potential intervention messages. Such messages will then undergo formative testing using focus groups with people who have and have not been screened. Focus groups will be held in the same neighborhood locations as were the Photovoice sessions.
The Specific Aims of this study are: (1) Engage community members in participatory research to identify relevant messages and images about colorectal cancer prevention and early detection using a Photovoice approach;and (2) Use the images and narratives from the Photovoice project as the basis for intervention messages that will be pre- tested using focus groups. Our expected long-term outcomes will be a stronger community partnership, community members empowered to advocate for their health, and a set of community-driven scientifically- evaluated CRC-intervention messages. In addressing colorectal cancer disparities, this study involves a significant public health issue and will lay the foundation for future CBPR work in the Saint Louis community.
Participants will be provided with cameras and asked to take photographs that reflect the meaning or impact of the health issue (colorectal cancer, screening) in their lives and then will meet with others to discuss the meaning and messages that they feel the photographs portray. Photographs with accompanying narrative messages will be evaluated for likability, interpretation, credibility, and salience of messages by focus groups to prepare messages for use in future intervention trials.