Online Program

Promoting colorectal cancer screening among urban American Indians and Alaska Natives using digital stories: A culturally-appropriate clinic-based educational intervention

Monday, November 4, 2013

Emily R. Van Dyke, MD, MPH, Partnerships for Native Health, Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
Deborah R. Bassett, Ph.D., Department of Epidemiology, University of Washington Partnerships for Native Health, Seattle, WA
Shin-Ping Tu, MD MPH, Department of Medicine, University of Washington, Seattle, WA
The Collaborative to Improve Native Cancer Outcomes, University of Washington School of Public Health, Seattle, WA
Among American Indians and Alaska Natives (AI/ANs), colorectal cancer (CRC) is the third leading cause of cancer-related death. AI/ANs are twice as likely to be diagnosed with advanced CRC as are non-Hispanic Whites. Few studies have tested culturally-appropriate interventions seeking to increase CRC screening among AI/ANs. The U.S. Preventive Services Task Force recommends that average-risk patients 50 to 75 years of age obtain regular CRC screening. Nationally, CRC screening rates are above 60%. However, screening rates at our Urban Indian clinic partner sites are below 25%. Our educational intervention seeks to improve screening rates through a patient education and awareness-building intervention. During this 18-month cross-over intervention, we showed digital stories in the clinic waiting area, distributed booklets with DVDs of these digital stories, and provided on-site health education. The digital stories are 3½ to 5 minutes in duration and were created by Native Elders whose lives have been directly impacted by CRC. These stories translate the tradition of Native storytelling into the format of digital media -- thereby empowering Native Elders to educate their own communities about the importance of cancer screening. Seven patient focus groups guided materials development and intervention implementation. Focus groups also examined pre-existing knowledge and barriers to increasing CRC screening rates. Descriptive content thematic analysis revealed a consistent cultural code of silence pertaining to cancer and CRC screening. Using an iterative CBPR model in which patient input guided project implementation, we created unique and compelling culturally-appropriate educational materials to promote CRC screening among AI/AN Elders.

Learning Areas:

Administer health education strategies, interventions and programs
Advocacy for health and health education
Assessment of individual and community needs for health education
Chronic disease management and prevention
Implementation of health education strategies, interventions and programs

Learning Objectives:
Describe the low colorectal cancer screening rates among American Indians and Alaska Natives Determine 3 culturally appropriate approaches to designing and implementing a colorectal cancer screening intervention for American Indians and Alaska Natives Discuss 3 barriers to colorectal cancer screening among American Indians and Alaska Natives

Keyword(s): Cancer Screening, Community-Based Health Promotion

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a Siksika MD MPH who has served as Project Lead on this study since 2011, I have led the planning, implementation, and dissemination preparation for this educational intervention. I recently gave a guest lecture at the Fred Hutchinson Cancer Research Center on intervention design -- based on lessons learned from this project. I am thus highly qualified to discuss our methodology and our pre- and post-intervention findings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.