Abstract A19: Haitian Creole photo-novella for communicating on colorectal cancer screening and early detection to reduce cancer health disparities
Authors: Gwede Clement K. , Jean-Francois Emmanuel , Quinn Gwendolyn P. , Wilson Shaenelle , Vadaparampil Susan T. , Noel-Thomas Shalewa , Meade Cathy D. 
Published: December 2010

Abstract
Purpose: The purpose of this study was to develop a culturally and linguistically targeted Haitian Creole photo-novella (PN) booklet on colorectal cancer screening (CRCS) to address disparities in the targeted population. Previous research examining self-reported CRCS across ethnic subgroups of blacks (African Americans, English-speaking Caribbeans, and Haitians) found both similarities and unique differences in levels of knowledge, risk perception, perceived benefits, and communication preferences. The Haitian-born subgroup reported lower knowledge, lower use of FOBT and sigmoidoscopy or colonoscopy, and recall of physician recommendation for screening compared to the other two subgroups. These suggested the need to examine the Haitian subgroup, address potential literacy and language differences, and adapt materials for use in our future CRCS programs.
Methods: An English-language CRCS photo-novella was developed using key tenets of the community-based participatory research (CBPR) framework for community engagement. The development process included interactions among researchers, cultural advisors, and community members to create a photo-novella that incorporated the health beliefs of the target groups, socio-drama, and surface structure through inclusion of characters (actors) from the three ethnic subgroups. Next, using a process called transcreation, we took a message that was originally intended for a specific culture and adapted it for a different audience. In our case, the goal was to adapt the original English-language version to address the needs of Haitian-speaking men and women about the topic of CRCS. This allowed further cultural adaptation focusing on other linguistic and literacy considerations that go beyond the simple translation process. Learner verification interviews to assess understandability and acceptability of the photo-novella were conducted with 20 monolingual Haitian Creole-speaking individuals.
Results: Results showed that participants found the storyline, family-centeredness, content, and call to action of the photo-novella compelling and salient to their ethnic subgroup. 75% of the participants found the photo-novella easy to read and understand, 95% indicated the photographs of people in the photo-novella were “real people” like them, and 100% noted that the photo-novella would influence them to take action regarding CRCS screening by talking to their doctor, telling others, and seeking more information. Additional data from learner verification interviews will be presented, and long-term implications for addressing CRC-related disparities in this ethnic subgroup will be discussed.
Conclusions: We have developed a promising low-literacy, culturally and linguistically targeted photo-novella in Haitian Creole to address CRCS. Additional research to further test broader acceptability and effectiveness of photo-novella for CRCS to address disparities in this population is underway.
Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A19.