Abstract A25: A culturally-linguistically salient intervention to increase fecal immunochemical test uptake among Spanish-preferring Latino adults receiving care in community-based clinics
Authors: Chavarria Enmanuel Antonio , Abdulla Rania , Gutierrez Liliana , Klasko Lynne , Tyson Dinorah Martinez , Loi Claudia Aguado , Sanchez Julian , Meade Cathy , Gwede Clement 
Published: March 2017

Background: Among Latinos in the US, colorectal cancer (CRC) is the third leading cause of cancer-related deaths. Despite the benefits of colorectal cancer screening (CRCS) being well recognized, screening is underutilized among Latino adults, ages 50-75. The availability of language and literacy appropriate educational information paired with an accessible, easy-to-use screening tool, such as fecal immunochemical test (FIT), within community health settings is a promising way to impact cancer-related disparities for Spanish-preferring Latino older adults. Formative qualitative efforts (focus groups, key informant interviews, and learner verification interviews) produced a culturally, and linguistically salient photonovella booklet and DVD titled, Latinos Colorectal Cancer Awareness, Research, Education and Screening (CARES).

Purpose: This pilot study compared the efficacy of two intervention conditions on FIT uptake among Spanish-preferring Latino adults receiving care in community clinics. Participants were randomized to receive either the Latinos CARES intervention + FIT or CDC Brochure + FIT. We report preliminary findings at 6 months.

Methods: Participants (N=76) were Latinos, accessing care at community-based clinics, prefer to receive their health information in Spanish, aged 50-75, at average CRC risk, and non-adherent to CRCS guidelines. Consented participants were administered a baseline interview assessing awareness of CRCS tests, preventive health model constructs, health literacy (consisting of two validated items), eHealth literacy (eHEALS), and sociodemographic variables. Following the baseline questionnaire, participants were randomized (1:1 allocation) to receive Latinos CARES intervention + FIT or CDC Brochure + FIT. The primary outcome was FIT kit screening uptake at 6 months.

Results: Participants were mostly female (67.8%), median age of 55, with less than a High school diploma (61.8%), annual income of less than $10,000 (48.7%), no medical insurance (75.0%), were unemployed or retired (45.3%), self-identified as “other” for race (67.1%), and born in a country other than the US (93.4%). For those born outside the US, the mean number of years spent in the US was 23.4 years. No significant differences on baseline characteristics were found between study conditions. Accrual rate was an average 11 participants per month for 7 months. To date, FIT uptake is 87% (for both groups), a rate that exceeds the Healthy People 2020 goal of 70.5%. One participant with abnormal FIT results was referred for a colonoscopy. Results of participant's colonoscopy indicated cancer was not present.

Conclusions: Providing educational materials (print and/or video), coupled with a FIT kit to Spanish-preferring Latinos receiving care in community clinics may be a promising strategy to bolster CRC screening uptake. The successful accrual rate is reflective of a high interest for education on CRCS among Spanish-preferring Latinos. Three-month follow-up for post-intervention assessments on awareness of CRCS tests, preventive health model constructs, and intervention use is currently underway, and assessment of intervention group differences is pending. Although preliminary, the high overall screening uptake among both study conditions far exceeds national targets and provides evidence to move to a larger scale RCT.

Citation Format: Enmanuel Antonio Chavarria, Rania Abdulla, Liliana Gutierrez, Lynne Klasko, Dinorah Martinez Tyson, Claudia Aguado Loi, Julian Sanchez, Cathy Meade, Clement Gwede. A culturally-linguistically salient intervention to increase fecal immunochemical test uptake among Spanish-preferring Latino adults receiving care in community-based clinics. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A25.