Abstract B105: Providing colorectal cancer screening interventions at Federally Qualified Health Centers (FQHCs): Addressing the issues of language, culture, and health literacy through culturally tailored education and navigation
Authors: Glaser Kathryn M. , Flores Tessa , Lynch Miranda , Mossop Jessie , Abrams Alyssa , Johnson Carolyn , Erwin Deborah O. , Reid Mary 
Published: August 2020

Background: Colorectal cancer (CRC) screening is effective in preventing and detecting cancer at an early stage, yet CRC continues to be the second leading cause of cancer death, and populations served by Federally Qualified Health Centers (FQHCs) are screened at lower rates (39%) than the national average (67%), with the lowest screening rates recent immigrants (34%). Time constraints impede providers from discussing CRC screening; insufficient access to screening facilities and patients' fear regarding colonoscopy preparation and procedure are just some of the challenges CHCs face. These issues are only compounded by significant language and cultural barriers.

Methods: This quality improvement (QI) initiative measured CRC screening rates from August 2016 to April 2018 at an urban FQHC providing primary care services to diverse, low-income, and predominantly non-English speaking population with two clinic locations (intervention and control site). The patient navigator assigned to the intervention site provided both provider and patient education, developed culturally tailored patient education materials (visual), assisted in scheduling and coordinating services (transportation, interpreters, obtaining prep solution for colonoscopy) and distributed fecal immunochemical testing (FIT) for those refusing or ineligible for a colonoscopy. Our rationale for the project, supported by preliminary data, was that FQHC providers want to increase screening rates, particularly in non-English speaking patients, but need tools and support to implement change.

Results: Between August 2016 and April 2018, the intervention site increased from 32% to 59% of eligible patients screened for CRC, with the most notable change in the non-English speaking patients, primarily Burmese, Nepali and Spanish speaking. The change in CRC screening rates at the intervention from baseline is highly significant (p &lt; 0.001), although the change from baseline in control site is also significant (p=0.020), but only in the second year. One year post intervention, there was a 24% increase in odds of participating in screening for a person at the intervention center compared to the control center. By April 2018, this effect increased significantly and the odds of participating in CRC screening are 86% higher for a person at the intervention center compared to the control center. In August 2018, intervention efforts will expand to the control site, piloting a culturally tailored educational video targeting the predominantly African American population served at the site.

Conclusions: Specialized and tailored education plus navigation are effective in increasing CRC screening rates at FQHCs, particularly in non-English speaking populations. Understanding how different populations think about CRC screening informs navigation strategies on how to better promote screening in diverse populations and develop more targeted interventions.

Citation Format: Kathryn M. Glaser, Tessa Flores, Miranda Lynch, Jessie Mossop, Alyssa Abrams, Carolyn Johnson, Deborah O. Erwin, Mary Reid. Providing colorectal cancer screening interventions at Federally Qualified Health Centers (FQHCs): Addressing the issues of language, culture, and health literacy through culturally tailored education and navigation [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B105.