Abstract
BackgroundCompared with non-Latinos, Latinos in the US have low rates of colorectal cancer (CRC) screening and low rates of knowledge regarding CRC screening tests and guidelines. Spanish speaking Latinos have particularly low CRC screening rates and screening knowledge. Our purpose was twofold: (1) to evaluate the effect of a computer-based, Spanish-language CRC screening decision aid on screening knowledge, intent to obtain screening, and screening self-efficacy in a community sample of Latinos with limited English proficiency (LEP); and (2) to survey these decision aid viewers at four months to determine their rates of CRC discussions with a health care provider as well as their rates of screening test completion.MethodsWe recruited 50-75 year old Latinos with LEP who were not current with CRC. Participants screening viewed a 14 minute multimedia decision aid that addresses CRC screening rationale, recommendations, and options. We conducted an uncontrolled (pre-post) study in which we assessed screening knowledge, self-efficacy, and intent at baseline and immediately after decision aid viewing. We also conducted a follow-up telephone survey of participants at four months to examine rates of patient-provider screening discussions and test completion.ResultsAmong n = 80 participants, knowledge scores increased from 20% (before) to 72% (after) decision aid viewing (absolute difference [95%CI]: 52% [46, 59]). The proportion with high screening self-efficacy increased from 67% to 92% (25% [13, 37]); the proportion with high screening intent increased from 63% to 95% (32% [21, 44]). We reached 68 (85%) of 80 participants eligible for the follow-up survey. Of these 36 (53%) reported discussing screening with a provider and 13 (19%) completed a test.ConclusionViewing a Spanish-language decision aid increased CRC screening knowledge, self-efficacy, and intent among Latinos with LEP. Decision aid viewing appeared to promote both CRC screening discussions with health care providers and test completion. The decision aid may be an effective tool for promoting CRC screening and reducing screening disparities in this population.
Highlights
Compared with non-Latinos, Latinos in the US have low rates of colorectal cancer (CRC) screening and low rates of knowledge regarding CRC screening tests and guidelines
We found that viewing a Spanish-language decision aid for CRC was associated with increased screening-related knowledge, self-efficacy, and intent among Latinos with limited English proficiency (LEP), demonstrating that the information provided by the decision is accessible and compelling to this target population
These findings suggest that such a decision aid may be useful as an effective means of communicating this relatively complex message content about evidencebased cancer screening guidelines to a vulnerable population outside of an actual health care provider encounter
Summary
Compared with non-Latinos, Latinos in the US have low rates of colorectal cancer (CRC) screening and low rates of knowledge regarding CRC screening tests and guidelines. CRC screening rates in Hispanic/Latino populations, the nation’s largest and fastest growing racial/ethnic minority group, are among the lowest nationally [3,4]. Compared with Latinos who are proficient in English, LEP Latinos tend to have lower levels of formal education and literacy, experience challenges to communication in health care settings, and lack awareness of CRC screening guidelines [7,8,9,10,11,12,13,14]. Latinos with LEP have lower CRC screening rates than Latinos who are proficient in English, [9,10] and having LEP is an independent risk factor for lack of screening even after accounting for multiple socio-economic and healthcare access factors [8,11,15]
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