Online Program

"Sorry for laughing, but it's scary": Humor and silence as cultural codes among American Indian and Alaska Native patients discussing colorectal cancer

Tuesday, November 5, 2013 : 5:30 p.m. - 5:50 p.m.

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, Seattle, WA
Among American Indians and Alaska Natives (AI/ANs), colorectal cancer (CRC) is a leading cause of cancer-related death. AI/ANs are twice as likely to be diagnosed with advanced CRC as are non-Hispanic Whites. 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%. We designed an 18-month educational intervention and tailored it to our target community by examining ways of speaking about colorectal cancer (CRC) and CRC screening among urban American Indian/Alaska Native (AI/AN) Elders. Seven focus groups with 46 participants were conducted in two urban clinics in the Pacific Northwest with the goal of adapting an evidence-based CRC screening intervention for AI/AN patients through the use of digital stories and a booklet. Facilitators used field guides based on The Health Behavior Framework to discuss awareness and knowledge about CRC, CRC screening and perceptions and concerns about the topics. These focus groups led to the development of culturally-appropriate educational digital stories and booklets to promote patient self-efficacy with respect to willingness to be screened for colorectal cancer. Our analyses describe culturally-appropriate ways of talking about issues related to CRC and CRC screening among urban AIAN populations to encourage health literacy and utilization of preventative medicine. Using speech codes theory, we suggest how uses of humor indicate norms that govern when, and how, to talk about colorectal cancer among Native 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
Diversity and culture
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
Describe 3 potential causes of low colorectal cancer screening rates among American Indians and Alaska Natives. Describe legacy of historical trauma that has led to distrust of Western Medicine. Describe 3 strategies for reducing the barriers and objections to cancer screening modalities among urban AI/ANs.

Keyword(s): American Indians, Cancer Screening

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a Siksika (Northern Blackfoot) research scientist with an MD and an MPH, I have served as the Project Lead on the "Using Digital Stories to Improve Colorectal Cancer Screening in Native Americans." As such, I have led the planning, implementation, and dissemination preparation for this educational intervention. 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.