Abstract
Purpose: American Indian adults have not experienced decreases in colorectal cancer (CRC) incidence and mortality observed in other races or ethnic groups and their screening rates are low. Decision aids that explain available CRC screening options are one potential strategy to promote screening. The goal of this study was to test the effect of a culturally adapted decision aid on CRC-related outcomes among American Indian adults, including screening-related knowledge, attitudes, self-efficacy, intentions, and screening modality preferences.Methods: We recruited American Indian adults aged 50–75 years who were not current with CRC screening. Participants viewed a 9-min multimedia decision aid that used narrative vignettes to provide educational information about screening along with messages to address culturally specific barriers and values uncovered in formative research. We conducted a single-arm (pre–post) study and assessed screening-related outcomes at baseline and immediately after viewing the decision aid.Results: Among n=104 participants, knowledge scores increased from a mean of 36% correct to 76% correct. Participants also had statistically significant increases in positive attitudes, perceived social norms, self-efficacy, and intent. The proportion of participants who identified a preference for a specific CRC screening modality rose from 81% identified at pre-intervention to 93% post-intervention (p=0.013).Conclusion: Our study provides promising new findings that our culturally adapted decision aid is efficacious in educating American Indian adults about CRC screening and increases their screening intentions and ability to state modality preferences. Future research is needed to test the decision aid as a component of CRC screening interventions with American Indian adults.
Highlights
Colorectal cancer (CRC) is a leading cause of death in the United States.[1]
We found that viewing a CRC screening decision aid with cultural adaptations increased CRC screening knowledge, positive attitudes, perception of social norms, self-efficacy, identified preferences, and intent among American Indian adults
Our research adds to this evidence and provides new evidence that CRC screening decision aids are associated with increased knowledge and intentions among American Indian adults, a population not represented in the previous research
Summary
Colorectal cancer (CRC) is a leading cause of death in the United States.[1] It is a leading cause of morbidity and mortality among American Indian and Alaska. American Indians and Alaska Native adults have not experienced decreases in CRC incidence and mortality observed in other races or ethnic groups,[1] and screening rates are disproportionately low in this population.[3] There are multiple screening modalities recommended for adults aged 50–75 years There is a significant need to improve CRC screening among American Indian and Alaska Native adults
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