This research explores ways in which communities can connect their knowledge of space and place with observed spatial patterns of disease to increase their abilities to both understand underlying processes that create these patterns and to implement effective interventions. Overall, there is surprisingly little research on the intersection of GIScience, community engagement, and health. This research focuses on colorectal cancer, a focus of cancer prevention and control efforts because early diagnosis greatly improves prognosis. However, screening rates remain low and differences in screening rates are associated with race, ethnicity and geography, among other factors. Using colorectal cancer incidences reported to the Iowa Health Registry, the research will create maps of colorectal cancer incidence, late-stage, mortality and screening as continuously varying surfaces using the method of adaptive spatial filtering, whereby a grid is laid over the study area and rates are computed for each grid point using overlapping circular filters that expand until they have pulled in enough information to calculate a stable rate. Statistical analyses will confirm the locations of higher than expected rates. These maps will provide context for community discussions of colorectal cancer. Community residents will be invited to generate information about the community's colorectal cancer experiences and barriers to screening and treatment. Participants and researchers will determine focal questions, such as "why are late-stage colorectal cancer rates high in Storm Lake?" and then generate responses to this question, sort the responses into categories, and rate them according to importance.
The results of this study will contribute to a better understanding of health disparities. In addition, the researchers will engage communities in discussions of why local differences in cancer burdens are occurring and what they can do to lower the burden in their local areas. This research can contribute to a long-standing debate in geography about the relative merits, and the potential for integration, of quantitative and qualitative data, exploring the value of different types of space and place knowledge and the potential for integrating these types of knowledge to tell more of the story that contributes to health disparities. This research also will be important to the developing research area of translational research, which is just in its infancy in the discipline of geography, and will thereby contribute to increasing the relevance of health geography as a sub-discipline in the years to come. By improving the quality of geographic information through integration of empirical, quantitative spatial data and qualitative, community-generated knowledge, this research will move society toward not only a more nuanced understanding of the roots of disparity, but also toward more effective strategies to combat disparity. As a Doctoral Dissertation Research Improvement award, this award also will provide support to enable a promising student to establish a strong independent research career.
