Colorectal cancer (CRC) is a leading cause of cancer-related deaths among American Indian and Alaska Native (AI/AN) populations. Northern Plains tribes have a 39% higher incidence of CRC than non-Hispanic Whites, and Alaska Natives have one of the worid's highest rates of CRC. Despite these alarming statistics, AI/AN populations have low rates of screening. Fewer than 30% of Als over age 50 ser /ed by the Indian Health Sen/ice are current with CRC screening guidelines. These rates are less than half those for non-Hispanic Whites. Further, while CRC screening has increased in other races, it decreased among Al/ANs. Al/ANs are often unaware of CRC screening benefits, have inaccurate beliefs atjout the risks and discomfort of screening and may harbor cultural views of cancer that conflict with screening paradigms. Although few studies have tested culturally appropriate interventions to increase CRC screening among Al/ANs, digital media are potentially rich resources to address this need. They can use cultural themes, incorporate visual images to overcome literacy and numeracy barriers, and efficiently provide health education through modes (e.g., storytelling) that are most relevant to knowledge acquisition in target populations. Using a community-based participatory research approach, we have developed Technical Aims to 1) develop a CRC screening intervention that transmits culturally appropriate information about CRC to AI/ANs using computerized digital stories with an accompanying educational pamphlet;2) implement an experimental trial at 4 partner community sites that compares an intervention group receiving CRC digital stories and an educational pamphlet to a control group receiving only the pamphlet;3) administer a brief survey to patients receiving CRC screening during the study to assess influence of the digital stories and pamphlet on the decision to be screened;4) conduct a post-intervention chart audit to identify individuals who are adherent to recommended CRC screening guidelines;and 5) conduct qualitative Interviews with a random sample of patients who were exposed to the digital stories intervention. These data will inform our Scientific Aims, which are to 1) verify baseline CRC screening rates in the 4 participating communities;2) determine the effectiveness of digital stories in improving CRC screening rates beyond that of an educational pamphlet;3) evaluate the influence of the digital stories and pamphlet on patients who are screened for CRC;and 4) qualitatively assess patient perception of the digital stories intervention and dissemination into the greater community. Culturally tailored community efforts such as the one proposed are needed to increase CRC screening among Al/ANs.

Public Health Relevance

An Institute of Medicine report states that racial/ethnic minorities frequently do not receive appropriate healthcare, and this lack of care results in adverse outcomes such as high rates of morbidity and mortality. Other recent publications demonstrate that racial/ethnic inequities are widespread and pertain to cancer screening, diagnosis, treatment, and survival. Our proposed study will include rural and urban AI/AN populations, use innovative interventions selected by the communities, and target systemic and institutional contributions to healthcare disparities.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center--Cooperative Agreements (U54)
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Special Emphasis Panel (ZCA1)
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University of Washington
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