Abstract A13: Using boot camp translation to design a system-based intervention to improve rates of colon cancer screening using fecal immunochemical testing among Latino patients in community health centers
Authors: Thompson Jamie , Davis Melinda , Michaels LeAnn , Rivelli Jennifer , Castro Marta , Escaron Anne , Younger Brittany , Castillo Melissa , Reich Sacha , Coronado Gloria 
Published: February 2019

Abstract
Introduction: Colon cancer is the second-leading cause of cancer death in the United States, and screening rates are disproportionately low among Latinos. In 2015, only 63% of eligible adults, and 50% of Latinos, were up to date with colon cancer screening recommendations. One factor thought to contribute to the low screening rate is that patient-facing health information for Latinos is difficult to understand and patients face challenges in taking appropriate health action. As part of the Participatory Research to Advance Colon Cancer Prevention (PROMPT) study that seeks to raise rates of colon cancer screening in a Latino-serving community health center in California, we used boot camp translation (BCT), a validated community-based participatory strategy, to elicit input from diverse stakeholders and refine the messages and format of colon cancer screening reminders for a clinic-based direct mail fecal immunochemical test (FIT) program.
Methods: We adapted BCT to engage Latino patients and clinic staff in this research. Eligible patient participants were Latino, aged 50 to 75 years, able to speak English or Spanish, and willing to participate in a 6-hour in-person meeting and three 30-minute follow-up phone calls. Materials were developed in English and Spanish, and separate sessions were held for English- and Spanish-speaking participants. As part of the in-person sessions, a national bilingual colon cancer expert delivered a presentation on colon health, cancer screening, and messages to improve screening participation, specific to Latino populations. Following the presentation, BCT experts facilitated brainstorming sessions to obtain feedback on the presented information, followed by an interactive small-group session where participants reviewed sample written materials and reminder messages using various modalities (e.g., text, letter, automated and live calls). We asked participants to consider what information about colon cancer screening is important to share with other patients, what the best methods are to share these messages, and the frequency with which these messages should be delivered to patients to encourage FIT completion. Participants then engaged in a hands-on exercise to share input about the timing and frequency of reminder delivery. Results from the exercise were used to define the intervention for the PROMPT pilot.
Results: A total of 25 adults participated in an in-person session (12 in the English-language session; 13 in the Spanish-language session). Participants were mostly clinic patients (84%) and the majority were female (80%). Among the patient participants, 57% were enrolled in Medicaid, and 67% reported an annual household income of less than $20,000. Key themes from the sessions included increasing awareness about colon cancer and screening options, stressing the urgency of screening, and using personalized messages such as “I” statements in letters or human voices on automated phone call reminders. Both sessions noted the importance of receiving an alert (automated or live) before the FIT kit is mailed, and of receiving a reminder within 2 weeks of FIT kit mailing.
Conclusions: Our BCT process allowed English- and Spanish-speaking Latino patients to directly inform which approaches get tested in the pilot study by refining message content and selecting their modality and timing to encourage patients who are mailed a FIT to complete it and mail it back. Using BCT, we successfully incorporated participant feedback to design culturally relevant health messages to promote FIT testing among patients served by community clinics.
Citation Format: Jamie Thompson, Melinda Davis, LeAnn Michaels, Jennifer Rivelli, Marta Castro, Anne Escaron, Brittany Younger, Melissa Castillo, Sacha Reich, Gloria Coronado. Using boot camp translation to design a system-based intervention to improve rates of colon cancer screening using fecal immunochemical testing among Latino patients in community health centers [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 A13.