Abstract C68: Addressing negative cognitive and affective factors to increase colorectal cancer screening for African Americans
Authors: Erwin Deborah O. , Kiviniemi Marc , Klasko Lynne , Rodriguez Elisa M. , Saad-Harfouche Frances G. , Ellis Erin , Jandorf Lina 
Published: February 2019

Introduction/Background: Given the lower colorectal cancer (CRC) screening rates and higher mortality for African Americans in the U.S., there is a critical need for effective interventions–especially at the community level (due to lower physician referrals)--to encourage appropriate CRC screening. Prior research on decision making for CRC screening has shown that both cognitive (e.g., expected utility beliefs) and affective factors (e.g., embarassment, fear, disgust about screening tests) influence screening behavior and intentions. The purpose of this study was to test the effectiveness of a community-based intervention to address cognitive and affective determinants of screening in order to positively influence behavior change and increase CRC screening. This presentation reports the contextual factors reported in interviews in response to the educational program and video that influenced the understanding and behavior change of participants to seek CRC screening.

Methods: This study used a randomized experimental design with pre-post assessments of key dependent variables, plus qualitative interviews of a subsample of participants at one-week and six-months post intervention. African American male and female participants &gt;50 years of age from Buffalo and New York, New York were randomized by program session to receive either a one-time, narrative communication or fact-based, didactic video and educational session about CRC and screening using colonoscopy. Qualitative findings were organized and analyzed using NVivo and the PEN-3 framework.

Results: A total of 333 study eligible African Amercian men and women from the two sites were randomized, and 1-week (n=39) and 6-month (n=26) interviews were completed. There were no significant demographic or screening intention differences in this qualitative sample between attendees of the didactic (n=31) and narrative (n=34) programs at baseline. Reported changes in awareness and feelings about colonoscopy in response to the videos demonstrated positive influences on the “Perceptions,” affective associations, and cognitive factors related to colonoscopy with the highest number (30 v. 23 responses) and the most dramatic responses reported by participants in the Narrative Communication video sessions. Participant responses in the Narrative group included discussion of how the video and program increased comfort level with the test; reduced anxiety, fear, and stress related to the test; increased understanding of the test itself, why and how it is done; and provided a basis for understanding how colonoscopy actually prevents CRC. Presentation of response examples within the PEN-3 framework will elucidate how qualities in the videos may have served to change and influence participants' feelings and knowledge to positively impact CRC screening.

Conclusion: Discourse analysis findings from this study suggest that this community-based intervention using culturally targeted, racially concordant videos is an effective tool to convert existing negative cognitive and affective factors that are recognized barriers to CRC screening. Pertinent to these findings, prior baseline analysis (manuscript under review) of the total study sample showed greater need to address knowledge, perceived benefits, and negative feelings about colonoscopy, particularly among African Americans with lower income and education. Therefore, these qualitative findings further support and explain how the video and educational intervention, especially the narrative video, may be especially impactful in addressing social determinants of screening disparities among less educated and lower income African Americans.

Citation Format: Deborah O. Erwin, Marc Kiviniemi, Lynne Klasko, Elisa M. Rodriguez, Frances G. Saad-Harfouche, Erin Ellis, Lina Jandorf. Addressing negative cognitive and affective factors to increase colorectal cancer screening for African Americans [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C68.