Abstract B24: Salud!, por la Vida, an educational intervention to increasing colorectal cancer screening in Puerto Ricans
Authors: Colon-Lopez Vivian , Velez-Alamo Camille , Acevedo-Fontanez Adrianna , Soto-Salgado Marievelisse , Serra-Martinez Yolanda , Valencia-Torres Ileska , Fernandez Maria E. 
Published: February 2019

Introduction: Colorectal cancer (CRC) represents the second highest incidence in both men and women in Puerto Rico (PR). This cancer is the leading cause of death in PR. Although largely preventable through screening and treatment of precancerous polyps, colorectal cancer screening (CRCS) using fecal occult blood test (FOBT), sigmoidoscopy, or colonoscopy remains low for adults in PR. Data from the 2014 Behavioral Risk Factor Surveillance System indicate that only 18.5% of the PR population 50+ years has undergone an FOBT within the past two years compared to 12.8% in the United States of America (USA). Additionally, only 50.6% of age-eligible Puerto Ricans report ever having a sigmoidoscopy or colonoscopy compared to 68.8% in the USA. Therefore, given the higher burden of CRC and the low CRCS rates in the island, we developed ¡Salud!, por la Vida (SLPV), an educational program that aims to increase CRCS in nonadherent men and women 50 years and older who attend Federally Qualified Health Clinics (FQHCs) in PR.

Methods: Intervention mapping (IM) was used as the guiding framework to develop an educational intervention that is theoretically sound and grounded in evidence. For the development of SPLV, steps 1 to 4 of IM were completed: step 1: a needs assessment conducted through focus groups and face-to-face interviews with patients, medical directors, and other key informants from the FQHCs to gather quantitative and qualitative data for the development of the logic model and the program; step 2: development of a logic model of change and matrices of change objectives; step 3: selection of theory and evidence-based methods and strategies; and step 4: program production, components, and materials of a CRCS patient-education intervention.

Results: The needs assessment (step 1) data revealed five main themes: (1) limited knowledge about CRC and CRCS practices; (2) patients' fear of the CRC test results; (3) low risk perception of CRC; (4) reporting not having received a provider recommendation regarding the screening test; and (5) the importance of social support in making the decision of getting screened for CRC. Key informant interviews showed that the vast majority of the clinics offer FOBT as part of the CRCS protocol, with 74.0% of these having a clinical laboratory at their facilities. Over one half (53.0%) had already implemented electronic medical records (EMR) and 82.0% had health educators as part of their full-time staff. A logic model was developed by combining personal behaviors with behavioral determinants and identifying beliefs targeted by the intervention (step 2). Tailored interactive multimedia intervention (TIMI) and small media were selected as the practical application to deliver the intervention (step 3). Development of the program included 5 components: (1) script development for fictional videos; (2) testimonials; (3) animations; (4) written materials; and (5) newsletter. After all five components were developed, the team completed a pretesting to evaluate the usability of the program. Pretesting assessment conducted with 9 participants showed that the program was easy to use and that they understood the commands of the interactive platform.

Conclusion: Our educational program, !Salud!, por la Vida is completed and currently in implementation phase, using a randomized trial. This trial will be conducted in 10 FQHCs and is expected to recruit 710 participants between the ages of 50-75 who have no prior history of CRC and who are not adherent to CRCS guidelines. The randomization of this study is at the clinic level, in which we randomly allocated each clinic to either the intervention group (TIMI) or the control group (usual care). We aim for this intervention to significantly increase CRCS rates and provide evidence to disseminate this educational effort to FQHCs island wide.

Note: This abstract was not presented at the conference.

Citation Format: Vivian Colon-Lopez, Camille Velez-Alamo, Adrianna Acevedo-Fontanez, Marievelisse Soto-Salgado, Yolanda Serra-Martinez, Ileska Valencia-Torres, Maria E. Fernandez. Salud!, por la Vida, an educational intervention to increasing colorectal cancer screening in Puerto Ricans [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 B24.