Abstract D011: Assessing a toolkit and training community health workers to increase colorectal cancer screening rates among Hispanics in New Mexico
Authors: Baca Lila , Quezada Karen , Kano Miria , Heinz Hailey , Rodman Joesph , Boyce Tawny W. , Guest Dolores D. 
Published: September 2020

Abstract
Rationale: Colorectal cancer (CRC) is the second leading cause of cancer mortality in the US and the fourth most frequently diagnosed cancer in New Mexico (NM). CRC is the fourth most common cause of death among Hispanics in NM. NM Hispanics are more likely than non-Hispanic whites to be diagnosed with later stage CRC (71% vs 50%). Due to NM’s diverse geography and culture, combined with a statewide shortage of medical professionals, community health workers (CHWs) serve as a critical link to health information in local communities. Funded by the National Cancer Institute’s Center to Reduce Cancer Health Disparities (CRCHD), the National Outreach Network (NON) Community Health Educator (CHE) program supports direct community outreach and adapts and tests educational initiatives. We describe one such initiative here. We used the RE-AIM framework to develop a CRC-focused training and toolkit for CHWs to apply in their work. The goal of this study is to assess the effectiveness and suitability of these materials. A sub-analysis explored barriers and facilitators to toolkit implementation and CRC screening interventions in predominantly monolingual Spanish-speaking communities. Approaches: We finalized the toolkit and training through a multi-year process that incorporated community and stakeholder input. The 3-hour in-person training focused on CRC risk, screening, and prevention, and included modules on anatomy, screening methods, and barriers to screening. A subset of CHWs completed semi-structured interviews at follow-up to provide insight into practical toolkit use. We used descriptive statistics to assess participant demographics. We used paired t-tests to assess mean changes in pre/ post-training survey data in knowledge and confidence. Results: We enrolled 79 CHWs (female: 89.9%, Hispanic: 94.9%) with median CHW experience 7 years (IQR: 3,15). 59.5% reported their patients prefer speaking Spanish, 29.1% prefer English, and 11.4% prefer both equally or another language. 30.4% of CHWs report their own preference for Spanish, 45.6% prefer English, 22.8% are equally comfortable with both, and 1.3% other language. Initial analyses show improvement for knowledge (mean 16.9%; 95%CI: 13.9, 19.9; p &lt;.001), and confidence on a 1-5 point scale where 5 is extreme confidence (mean 1.6 points; 95%CI: 1.3, 1.8; p &lt;.001). All participants agreed the training will help navigate barriers related to CRC screenings, while a majority said the trainings fit with their work (89.7%), they will use the knowledge and skills (97.4%), and the toolkit will make them a more effective team member (98.7%). Qualitative data additionally support known or suspected barriers to screening for monolingual Spanish speakers. Conclusion: While the training appears effective at increasing CRC knowledge, changes in confidence and beliefs are less clear. Educating CHWs and providing them with appropriate materials addresses some gaps to improve CRC screening rates; however, other barriers to screening among NM Hispanics remain.
Citation Format: Lila Baca, Karen Quezada, Miria Kano, Hailey Heinz, MA, Joesph Rodman, MA, Tawny W. Boyce, MS, MPH, Dolores D. Guest, PhD, RD. Assessing a toolkit and training community health workers to increase colorectal cancer screening rates among Hispanics in New Mexico [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D011.