Abstract A025: Tailoring a culturally relevant and age-specific colorectal cancer screening education intervention for CHamoru and Filipinos in guam
Authors: Diaz Tressa P. , Sy Angela , Elmore Elizabeth , Camacho Santino , Rollon Marc 
Published: December 2022

Background. Colorectal cancer (CRC) is the 2nd leading cause of cancer death in Guam, a U.S. unincorporated territory where CHamoru (Chamorro) and Filipinos comprise over 60% of the population. CHamoru have higher age-adjusted mortality rates (23.2) than the U.S. (14.2) and the overall population in Guam (17.3). Only 53.9% of persons aged 50 and above have met USPSTF screening standards compared to 74.3% in the U.S. In addition, CRC diagnoses occur in the late stages; 75.0% at Stage 3, while 18.0% occur at Stage 1. Research on early CRC onset among Pacific Island peoples are limited; data from the Guam Tumor Registry indicates 10% of colorectal cancer cases from 2013 – 2017 were diagnosed before age 50. Specific aims of this pre-pilot study are to examine cognitive and cultural beliefs associated with CRC and screening, recommendations for culturally relevant prevention, and age-specific education interventions. Methods: Qualitative methods were employed via focus groups (FG) and in-depth key informant interviews (KII) to allow for participant perspectives and facilitate storytelling, a practice in the Pacific that creates a familiar and safe space for expression. A 3-member community council comprised of a CRC surgeon, community-based organization representative, and CRC survivor advised on recruitment, data analysis, and reporting. Purposive and snowball sampling was utilized due to stigma/sensitivity related to screening. Focus groups were age and gender specific, e.g., men in their 40s, women aged 50+, etc. KII were conducted with cultural experts and cancer survivors. Data on knowledge, attitudes, and beliefs and screening education recommendations was collected. Three levels of qualitative coding for thematic codes were performed and included input from community council and KIs. Translations from CHamoru to English were applied as necessary. Results: Five FGs and four KIIs (N=29) were conducted with persons aged 40 and above. Focus group participants were CHamoru (60%), Filipino (32%), mixed ethnicity (8%), female (56%), male (44%), and had a primary care provider (84%). Mean age was 55.0. Overall, 24.0% reported ever having had a FIT/FOBT test and 56.0% ever having had a colonoscopy. Data analysis for FGs and KIIs will be finalized in September. Initial reviews indicate mixed methods of delivery for community health educator interventions, e.g., use of a culturally relevant video, storytelling from CRC survivors, and efforts to educate families as a whole, as opposed to limiting education to screening-age adults. Conclusion: This study explores culturally relevant components of an education intervention providing a pre-emptive look at screening education for persons aged 40 and above. Findings may give insight toward age-specific and culturally-tailored CRC screening education with use of community health educators as a novel intervention for CHamoru and Filipino families and to create a pilot education intervention to improve CRC screening participation in these underserved minority populations.

Citation Format: Tressa P. Diaz, Angela Sy, Elizabeth Elmore, Santino Camacho, Marc Rollon. Tailoring a culturally relevant and age-specific colorectal cancer screening education intervention for CHamoru and Filipinos in guam [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer; 2022 Oct 1-4; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;82(23 Suppl_1):Abstract nr A025.