Community Networks Program Research Articles

Culturally Appropriate Education Intervention on Biospecimen Research Participation among Chinese Americans

Chinese Americans are at increased risk for hepatitis B virus (HBV) infection. To reduce or eliminate disparities in HBV-related infection rates, participation in scientific investigations of HBV risk and treatment, including biospecimen sampling, is important. However, Asian Americans have low rates of participation in biospecimen research, and little is known about how educational interventions affect knowledge and participation in HBV-related biospecimen research. Eight Chinese community-based organizations participated in a quasi-experimental, two-group design with education assessments at pre- and postworkshop and a 3-month follow-up. Four sites were randomly assigned to receive the intervention (n = 175) and four sites to receive general health education (control; n = 240). Participant knowledge about biospecimen research increased from pre- to posteducation in the intervention but not in the control condition. Of intervention participants, 83.4% (146/175) donated one tube of blood for future HBV biospecimen research, and 50.9% (89/175) donated another tube of blood for HBV testing. In contrast, only 1.1% of participants in the control condition reported donating a blood sample at follow-up assessment. The intervention program significantly increased knowledge of and participation in HBV biospecimen research among Chinese Americans. Community-based participatory research (CBPR) methods featured active support by community leaders, a culturally specific curriculum, and convenient, immediate access to blood sampling, which resulted in high donation rates. HBV-related morbidity and mortality is an urgent problem faced by Chinese Americans. CBPR provides a model for engaging communities in early detection, vaccination, and treatment that can reduce this health threat.

Involving Disparate Populations in Clinical Trials and Biobanking Protocols: Experiences from the Community Network Program Centers

Underserved groups tend not to participate in a wide array of cancer research ranging from primary prevention to screening and treatment trials ([1–5][1]). With intensified focus on personalized medicine to target therapeutic recommendations, those groups who choose not to participate are left out

Impact of a Biospecimen Collection Seminar on Willingness to Donate Biospecimens among Chinese Americans: Results from a Randomized, Controlled Community-Based Trial

Biospecimen collection from diverse populations can advance cancer disparities research, but is currently underrepresented. We partnered with a community-based clinic serving Cantonese-speaking Chinese Americans to develop and revise an educational seminar on biospecimen collection. Through a randomized controlled trial (n = 395), the intervention seminar was compared with a control seminar (cancer prevention) on change in willingness to donate biospecimens. At baseline, many were willing to donate a biospecimen (saliva, urine, hair, toenails, blood, unused cancerous tissue) whether healthy or hypothetically had cancer. Also, many would donate because future generations would benefit, and few had concerns about donation. In logistic regression analyses, there was an intervention effect for willingness to donate: urine if had cancer [OR, 2.2; 95% confidence interval (CI), 1.3-3.7], toenails if healthy (OR, 2.1; 95% CI, 1.4-3.2) or had cancer (OR, 2.3; 95% CI, 2.0-2.7), hair if healthy (OR, 1.8; 95% CI, 1.3-2.5) or had cancer (OR, 2.8; 95% CI, 1.9-4.0), and unused cancerous tissue (OR, 1.8; 95% CI, 1.2-2.9). There was also an intervention effect for donating because future generations would benefit (OR, 2.0; 95% CI, 1.4-3.0), and this attitude was a strong independent predictor for willingness to donate all biospecimens, whether healthy or had cancer (OR, 2.9-4.2). Cantonese-speaking Chinese American participants of an educational seminar on biospecimen collection showed greater increases in willingness to donate biospecimens and donating for the benefit of future generations, than participants who attended a control seminar. Donating for the benefit of future generations is a theme that should be incorporated in messages that encourage biospecimen donation for Chinese Americans.

Association of Acculturation, Nativity, and Years Living in the United States with Biobanking among Individuals of Mexican Descent

Biobanking is the collection of human biospecimens (tissues, blood, and body fluids) and their associated clinical and outcome data. Hispanics are less likely to provide biologic specimens for biobanking. The purpose of this study was to investigate the association of acculturation, nativity status, and years living in the United States with participation in biobanking among individuals of Mexican descent. Participants were 19,212 adults of Mexican descent enrolled in an ongoing population-based cohort in Houston, TX. Participants were offered the opportunity to provide a blood, urine, or saliva sample for biobanking. Acculturation was assessed with the bidimensional acculturation scale for Hispanics and scores were categorized into "low acculturation," "bicultural," and "high-acculturation." After multivariable adjustment, we found an increased likelihood of participation in biobanking among individuals classified as "bicultural" as compared with "highly acculturated" individuals [OR, 1.58; 95% confidence intervals (CI), 1.10-2.26]. The associations of nativity status and years living in the United States with biobanking were not statistically significant. After stratifying by gender, the associations of acculturation, nativity status, and years living in the United States with biobanking were not statistically significant. Although individuals of Mexican descent who were "bicultural" were more likely to participate in biobanking than individuals who were "highly acculturated," the difference in rates of participation among acculturation categories was small. The high participation rate in biospecimen collection is likely due to extensive community-engaged research efforts. Future studies are warranted to understand individuals' participation in biobanking. Community-engaged research efforts may increase Hispanics' participation in biobanking. Cancer Epidemiol Biomarkers Prev; 23(3); 402-8. ©2014 AACR.

Effective Recruitment Strategies and Community-Based Participatory Research: Community Networks Program Centers' Recruitment in Cancer Prevention Studies

Community-based participatory research (CBPR) approaches that involve community and academic partners in activities ranging from protocol design through dissemination of study findings can increase recruitment of medically underserved and underrepresented racial/ethnic minority populations into biomedical research. Five cancer screening and prevention trials in three National Cancer Institute (Bethesda, MD)-funded Community Networks Program Centers (CNPC), in Florida, Kansas, and South Carolina, were conducted across diverse populations. Data were collected on total time period of recruitment, ratios of participants enrolled over potential participants approached, selected CBPR strategies, capacity-building development, and systematic procedures for community stakeholder involvement. Community-engaged approaches used included establishing colearning opportunities, participatory procedures for community-academic involvement, and community and clinical capacity building. A relatively large proportion of individuals identified for recruitment was actually approached (between 50% and 100%). The proportion of subjects who were eligible among all those approached ranged from 25% to more than 70% (in the community setting). Recruitment rates were very high (78%-100% of eligible individuals approached) and the proportion who refused or who were not interested among those approached was very low (5%-11%). Recruitment strategies used by the CNPCs were associated with low refusal and high enrollment ratios of potential subjects. Adherence to CBPR principles in the spectrum of research activities, from strategic planning to project implementation, has significant potential to increase involvement in biomedical research and improve our ability to make appropriate recommendations for cancer prevention and control programming in underrepresented diverse populations. CBPR strategies should be more widely implemented to enhance study recruitment.

Development and Validation of the Biobanking Attitudes and Knowledge Survey (BANKS)

No validated multiscale instruments exist that measure community members' views on biobanking and biospecimen donation. This study describes the development and psychometric properties of the English-language BANKS (Biobanking Attitudes and Knowledge Survey). The BANKS was created by item generation through review of scientific literature, focus groups with community members, and input from a community advisory board. Items were refined through cognitive interviews. Content validity was assessed through an expert panel review. Psychometric properties of the BANKS were assessed in a sample of 85 community members. The final BANKS includes three scales: attitudes, knowledge, and self-efficacy; as well as three single items, which evaluated receptivity and intention to donate a biospecimen for research. Cronbach α coefficients for two scales that use Likert response format indicated high internal consistency (attitudes: α, 0.88; self-efficacy: α, 0.95). Content validity indices were moderate, ranging from 0.69 to 0.89. Intention to donate blood and intention to donate urine were positively correlated with attitudes, knowledge, self-efficacy, and receptivity to learning more about biobanking (P values range from 0.029 to <0.001). The final BANKS shows evidence of satisfactory reliability and validity, is easy to administer, and is a promising tool to inform biospecimen research. Additional studies should be conducted with larger samples considering biospecimen donation to further assess the reliability and validity of the instrument. A valid and reliable instrument measuring community members' views about biobanking may help researchers evaluate relevant communication interventions to enhance understanding, intention, and actual biospecimen donation. A Spanish-language BANKS is under development.

Factors Influencing Breast Cancer Screening in Low-Income African Americans in Tennessee

This study examined demographic and lifestyle factors that influenced decisions and obstacles to being screened for breast cancer in low-income African Americans in three urban Tennessee cities. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American women 40 years and older (n = 334) were selected from the Meharry CNP community survey database. There were several predictors of breast cancer screening such as marital status and having health insurance (P < .05). Additionally, there were associations between obstacles to screening and geographic region such as transportation and not having enough information about screenings (P < .05). Educational interventions aimed at improving breast cancer knowledge and screening rates should incorporate information about obstacles and predictors to screening.

Modeling the sustainability of community health networks: novel approaches for analyzing collaborative organization partnerships across time

Sustainability is important if community health organizations are to be effective in collaborating to achieve long term health goals. We present a multi-method set of longitudinal analyses examining structural markers applied to a group of organizations brought together to reduce cancer disparities among older African American adults. At the overall network level, sustainability was seen in the growth of outgoing connections and multiplexity. Results of hierarchical clustering analyses identified distinct patterns of collaborative activation over time at the relationship level. Growth modeling indicated the effects of continuing network membership and participation in collaborative events on several structural markers of sustainability. Results of these analyses provide longitudinal indicators for how collaborations among partner organizations impacted their likelihood of continuing in the community network program. The strategy presented here introduces novel methods to assist with planning and evaluation of future community based public health endeavors.

Bridging the Digital Divide: Lessons from the East Palo Alto Community Network

This paper reports the efforts of the East Palo Alto Community Network (“Community Network” for short) and the success of its two programs over the past three years. The first program, Technology Access Points (TAPs), conveniently locates centers in East Palo Alto where residents may access computers, the Internet, fax machines, and copiers. The second program, EPA.net, is an online resource center for the East Palo Alto Community that allows residents to post news articles and event information relevant to the city that often cannot be found anywhere else. The site also contains numerous other online resources for residents. Plugged In outlined four outcomes at the outset of this project to track the success of the Community Network Project:1) Increased Participation of Community Residents in Online Information and Idea Exchange, Leading to Increased Sense of Commitment to the Community.2) Increased Technology Skills and Use of Technology by Staff of Community Based Organizations, Leading to Increased Efficiency and Effectiveness.3) Increased Access to Relevant Information for Community Residents, Leading to Increased Ease in Utilizing Community Services.4) Increased Technology Skills for Community Residents, Leading to Greater Educational and Employment Opportunities.In general, all four outcome goals have been met. Quantitative and qualitative data suggests that both Community Network programs have led to an increase in the number of residents who participate in online information exchange and a subsequent increase in these residents’ sense of connection to the greater East Palo Alto community. Similar data also indicate that there has been an increase in technological skills and thus educational and employment opportunities for residents. Meanwhile, qualitative evidence indicates that the second and third outcome goals, increased technology skills for staff of community based organizations and increased efficiency and effectiveness in such organizations, as well as increased access to relevant information for residents, were also met through the TAPs and EPA.net programs.Our analysis has led us to make five recommendations for improvements in the Community Network project: more aggressive advertisement of EPA.net, stronger outreach to other CBO’s, promoting unused aspects of EPA.net, designating specified places and times for adults in TAPs, and design improvements to the layout of EPA.net. This paper is an adaptation of a report that was written for the Technology Opportunitiees Program (TOP) of the U.S. Department of Commerce, evaluating the Community Network’s use of TOP funding. The plan is to evolve the paper in an academic direction, and we would appreciate comments on relevant other projects to use for comparison. As a preliminary step in this direction, we have included a list of references at the end of the main body of this paper.

Abstract FO02-01: Community-based interventions to reduce for colon cancer disparites in African Americans in South Carolina.

Abstract FO02-01: Community-based interventions to reduce for colon cancer disparites in African Americans in South Carolina.

Abstract A19: CASPER the colon: An innovative way to influence colorectal cancer screening.

Abstract Introduction: Hispanics are an underserved population in terms of cancer screening. In colorectal cancer (CRC) screening, for example, recent national data shows that only 7.8% of Hispanics have had a fecal occult blood test (FOBT) within the past year compared to 10.3% for non-Hispanic whites . Similarly, rates for CRC screening with endoscopy (sigmoidoscopy within past 5 years or colonoscopy within past 10 years) are 34.6% for Hispanics and 52.7% for non-Hispanic whites. Hispanics have lower CRC screening rates than any other minority group in the U.S. and therefore are more likely to be diagnosed with advanced stage CRC than their non-Hispanic white counterparts. As a result, Hispanics have poorer survival outcomes from CRC. Description: In the Lower Yakima Valley of Washington State, a largely rural area with an emphasis on agriculture, a high proportion of the population is Hispanic (~79%). As part of our National Cancer Institute (NCI)-sponsored Community Networks Program Center (CNPC), based on a community needs assessment, we have been emphasizing CRC screening among this population over the last year. In a series of health fairs (N=45), we used a walk-through inflatable colon with physical depictions of polyps and cancers to educate the population about CRC and the importance of early detection through regular screening. Through a collaboration with a local community hospital, we were able to distribute FOBT kits to be analyzed at no charge to the end-user to attendees aged 55 and older. Data Summary: Within less than a year, over 2000 people have walked through the colon. Over 700 have completed pre- and post-tests on knowledge about CRC as well as intention to be screened for CRC. Significant advances in knowledge were seen (from a combined knowledge score of 0.395 (low) at pre-test to 0.869 (high) at post-test). Similar results were seen for intention to be screened (64.3% likely at pre-test and 75.8% likely at post-test). To date, of the 300 FOBT kits distributed, 202 (67.3%) have been returned for analysis. Of those 7 were abnormal. Various sites in the community have offered low-cost or free colonoscopies for follow-up of the abnormal tests. Conclusions: Health fairs serve as an effective venue to reach Hispanics in this rural area of Washington State. The use of CASPER the “colossal” colon is an innovative way to attract people to learn about CRC and CRC screening modalities. The response to our distribution of FOBT kits indicates that if given the opportunity for education and access to services, this population will comply with CRC screening. Citation Format: Katherine J. Briant, Elizabeth Carosso, Avigail Galvan, Adriana Moya, Noah Espinoza, Ilda Islas, Genoveva Ibarra, Sandra Linde, Beti Thompson. CASPER the colon: An innovative way to influence colorectal cancer screening. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A19.

Creating a Cadre of Junior Investigators to Address the Challenges of Cancer-Related Health Disparities: Lessons Learned from the Community Networks Program

Community-based participatory research (CBPR) initiatives such as the National Cancer Institute's Community Networks Program (CNP) (2005-2010) often emphasize training of junior investigators from underrepresented backgrounds to address health disparities. From July to October 2010, a convenience sample of 80 participants from the 25 CNP national sites completed our 45-item, web-based survey on the training and mentoring of junior investigators. This study assessed the academic productivity and CBPR-related experiences of the CNP junior investigators (n=37). Those from underrepresented backgrounds reported giving more presentations in non-academic settings (nine vs. four in the last 5 years, p=0.01), having more co-authored publications (eight vs. three in the last 5 years, p=0.01), and spending more time on CBPR-related activities than their non-underrepresented counterparts. Regardless of background, junior investigators shared similar levels of satisfaction with their mentors and CBPR experiences. This study provides support for the success of the CNP's training program, especially effort directed at underrepresented investigators.

Enhancing life after cancer in diverse communities

Although large numbers of cancer survivors exist in every community, including minority communities, there is a significant gap in knowledge about best practices for these patients. The Community Networks Program, funded by the National Cancer Institute Center to Reduce Cancer Health Disparities, has developed and tested unique services for these communities. These programs have used community-based participatory research techniques under a framework of diffusion of innovation and communications theory. This article describes some specifically tailored interventions that may be useful to a wide range of providers working with the underserved. Enhancing life after cancer can be achieved in underserved communities by supplementing local resources.

Addressing Cancer Disparities via Community Network Mobilization and Intersectoral Partnerships: A Social Network Analysis

Community mobilization and collaboration among diverse partners are vital components of the effort to reduce and eliminate cancer disparities in the United States. We studied the development and impact of intersectoral connections among the members of the Massachusetts Community Network for Cancer Education, Research, and Training (MassCONECT). As one of the Community Network Program sites funded by the National Cancer Institute, this infrastructure-building initiative utilized principles of Community-based Participatory Research (CBPR) to unite community coalitions, researchers, policymakers, and other important stakeholders to address cancer disparities in three Massachusetts communities: Boston, Lawrence, and Worcester. We conducted a cross-sectional, sociometric network analysis four years after the network was formed. A total of 38 of 55 members participated in the study (69% response rate). Over four years of collaboration, the number of intersectoral connections reported by members (intersectoral out-degree) increased, as did the extent to which such connections were reported reciprocally (intersectoral reciprocity). We assessed relationships between these markers of intersectoral collaboration and three intermediate outcomes in the effort to reduce and eliminate cancer disparities: delivery of community activities, policy engagement, and grants/publications. We found a positive and statistically significant relationship between intersectoral out-degree and community activities and policy engagement (the relationship was borderline significant for grants/publications). We found a positive and statistically significant relationship between intersectoral reciprocity and community activities and grants/publications (the relationship was borderline significant for policy engagement). The study suggests that intersectoral connections may be important drivers of diverse intermediate outcomes in the effort to reduce and eliminate cancer disparities. The findings support investment in infrastructure-building and intersectoral mobilization in addressing disparities and highlight the benefits of using CBPR approaches for such work.

Operationalization of community-based participatory research principles: assessment of the national cancer institute's community network programs.

We examined how National Cancer Institute-funded Community Network Programs (CNPs) operationalized principles of community-based participatory research (CBPR). We reviewed the literature and extant CBPR measurement tools. On the basis of that review, we developed a 27-item questionnaire for CNPs to self-assess their operationalization of 9 CBPR principles. Our team comprised representatives of 9 of the National Cancer Institute's 25 CNPs. Of the 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles of recognizing community as a unit of identity, building on community strengths, facilitating colearning, embracing iterative processes in developing community capacity, and achieving a balance between data generation and intervention. CNPs varied in the extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging the community in research dissemination, and striving for sustainability. Although the development of assessment tools in this field is in its infancy, our findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.

Factors Influencing Colorectal Cancer Screening in Low-Income African Americans in Tennessee

This study examined demographic and lifestyle factors that influenced decisions and obstacles to being screened for colorectal cancer in low-income African Americans in three urban Tennessee cities. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African Americans 50 years and older (n=460) were selected from the Meharry CNP community survey database. There were several predictors of colorectal cancer screening such as being married and having health insurance (P< .05). Additionally, there were associations between obstacles to screening and geographic region such as transportation and health insurance (P< .05). Educational interventions aimed at improving colorectal cancer knowledge and screening rates should incorporate information about obstacles and predictors to screening.

A SOCIAL NETWORK ANALYSIS APPROACH TO UNDERSTAND CHANGES IN A CANCER DISPARITIES COMMUNITY PARTNERSHIP NETWORK

The Tampa Bay Community Cancer Network (TBCCN) is one of the Community Network Program sites funded (2005-10) by the National Cancer Institute's Center to Reduce Cancer Health Disparities. TBCCN was tasked to form a sustainable, community-based partnership network focused on the goal of reducing cancer health disparities among racial-ethnic minority and medically underserved populations. This article reports evaluation outcome results from a social network analysis and discusses the varying TBCCN partner roles-in education, training, and research-over a span of three years (2007-09). The network analysis included 20 local community partner organizations covering a tricounty area in Southwest Florida. In addition, multiple externally funded, community-based participatory research pilot projects with community-academic partners have either been completed or are currently in progress, covering research topics including culturally targeted colorectal and prostate cancer screening education, patient navigation focused on preventing cervical cancer in rural Latinas, and community perceptions of biobanking. The social network analysis identified a trend toward increased network decentralization based on betweenness centrality and overall increase in number of linkages, suggesting network sustainability. Degree centrality, trust, and multiplexity exhibited stability over the three-year time period. These results suggest increased interaction and interdependence among partner organizations and less dependence on the cancer center. Social network analysis enabled us to quantitatively evaluate partnership network functioning of TBCCN in terms of network structure and information and resources flows, which are integral to understanding effective coalition practice based on Community Coalition Action Theory ( Butterfoss and Kegler 2009). Sharing the results of the social network analysis with the partnership network is an important component of our coalition building efforts. A comprehensive baseline needs assessment for the next five-year funding phase (2010-15) of TBCCN Community Networks Program Centers (CNP Center) is under way to further evaluate the growth and sustainability of the partnership network, with an emphasis on community-based intervention research that takes into account culture and literacy. [social network, health care disparities, cancer screening].

Abstract B91: Strategies toward improving the uptake of colorectal cancer screening among underserved communities: Providers’ perspectives

Abstract Purpose: Disparities in colorectal cancer screening (CRCS) are partially rooted in reduced access to health care and screening tests. One strategy under investigation within the Tampa Bay Community Cancer Network Community Network Program Center is the promotion of the now widely available and evidence-based immunochemical fecal occult blood test (i-FOBT or FIT) in community-based federally qualified health centers (FQHC) using easy-to-understand video and photo-novella materials customized for this setting. The purposes of this qualitative study were to identify key issues from the perspectives of providers regarding common barriers that patients face regarding the i-FOBT screening test, identify successful strategies to prime patients to use the i-FOBT test, and explore the best timing sequence of patient preparatory education about CRCS. Methods: Two focus groups and three individual interviews were conducted among 17 community health care providers working with medically underserved populations in FQHCs in Hillsborough County, FL. A community-based participatory research (CBPR) methodology was used to develop the focus group guide and recruitment materials. Eighty two percent were either family medicine physicians, physician assistants or nurse practitioners. Other job titles included registered nurse (n=1) and certified nurse assistant/medical assistant (n=2). Using a semi-structured interview guide, providers were asked to discuss barriers patients may face regarding CRCS, issues related to educating patients in clinics about CRCS, and importance of communication in motivating patients to consider screening. Discussions were audio-taped and transcribed verbatim and lasted between 30–60 minutes. Transcriptions were independently hand-coded using priori codes from the guides and emergent themes were identified using a crystallized-immersion methodology, across multiple raters. Results: Results showed the majority of providers agreed their patients could benefit from more health education prior to provider discussion about CRCS. Providers described the main concerns experienced by their patients as: lack of insurance, lack of transportation, fear and embarrassment associated with colonoscopy, lack of access to screening and the need for more resources for learning about CRC and CRC related services. The most compelling concern expressed among providers was that patients often feared screening results, and perceived they would not have access to further follow-up colonoscopy if i-FOBT was abnormal or resources to treat CRC. Most providers wanted to see more cultural and literacy relevant CRC educational materials in their clinics. In addition, when patients are informed about their risks, the importance of early detection, and are given examples of people to whom they can relate, providers felt that preparatory education could increase the likelihood of following through with recommended screening with i-FOBT as an initial strategy. Conclusions: Findings from health care providers support the need for priming education to address patients’ concerns about CRC screenings. Results also reinforce the development of educational materials that address test-specific fears and how to access available resources. Timing of CRCS education of patients in clinics is crucial. Providers’ perspectives are an integral component of designing relevant educational materials and interventions. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B91.

Abstract A9: Patients’ perspectives on immunochemical fecal occult blood test (I-FOBT or FIT): Not your father's FOBT

Abstract Purpose: A promising strategy to increase colorectal cancer (CRC) screening includes the use of new generation high sensitivity-high specificity immunochemical fecal occult blood test (I-FOBT or FIT) among patients receiving primary care in Federally Qualified Health Centers (FQHC). This approach was recognized by the Tampa Bay Community Cancer Network (TBCCN) Community Network Program Center (CNPC) as a highly feasible method for impacting cancer health disparities in our community. Despite physician recommendations to increase screening uptake, finding effective ways to increase patients’ awareness about different types of CRC screening (CRCS) is needed. This study reports qualitative findings from focus groups with patients in FQHCs to inform the development of a low literacy DVD and photonovella booklet to prepare patients for provider discussions about CRCS, particularly I-FOBT use. Methods: Six focus groups were conducted with men and women, of diverse background (ages 50–75 years) with no diagnosis of CRC. In collaboration with our community partners who identified a need to increase CRCS and using community-based participatory research (CBPR) methodology to develop a focus group guide and recruitment materials, participants were recruited from partnering FQHCs in Hillsborough County, FL. The focus group guide assessed patients’ knowledge and perceptions about CRC and screening, particularly I-FOBT and colonoscopy, as well as participants’ views about in clinic CRCS preparatory education process and factors that impede CRCS uptake. All focus groups were audio taped, transcribed verbatim and reviewed by two independent coders. Thematic coding, using a crystallized-immersion framework was conducted. A combination of hand-coding and Atlas TI software were employed using content from the patient focus group guide as priori codes. Results: Thirty-nine patients participated in focus groups to date (51% male; 59% black; 36% white; 5% Hispanic/Latino; mean age = 56.18 years). Seventeen reported being up-to-date on CRCS per recommendations and 22 were not current. Consistent with previous studies, we found poor knowledge and awareness about CRC risks and different screening modalities. Commonly reported barriers included: 1) no doctor recommendation; 2) cost; 3) fear of the test or abnormal findings; and 4) a lack of symptoms. While all participants had heard of colonoscopy and traditional FOBT, very few were aware of I-FOBT. Concerns about colonoscopy included a dislike of the test prep and affordability. Most men reported feelings of embarrassment, personal invasion, and threatened masculinity regarding the colonoscopy procedure itself. Upon learning about I-FOBT the majority felt the test seemed to be simple, easy to do, and private. Most participants who had prior FOBT screening reported use of the older 3-card home test or office-based guaiac test. Reported limitations to the older version of FOBT included diet restrictions, dislike of “handling” one's own feces during sample collection and the complexity of multiple test applications. Doctor recommendation was the main reason participants completed CRCS tests. Conclusions: Our findings suggest patients’ overall receptivity to I-FOBT, and provide a basis for developing educational content for an intervention that addresses test specific barriers, and promotes the more patient-friendly IFOBT. Results also show support for a preparatory education intervention that will educate patients in clinic before their provider visit about the need for CRCS. Such preparatory materials are expected to enhance patients’ awareness about CRCS, facilitate patient-provider communication, and contribute to the overall uptake of CRCS. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A9.

Connecting community with campus to address cancer health disparities: a community grants program model.

With growing interest in the CBPR approach to cancer health disparities research, mechanisms are needed to support adherence to its principles. The Carolina Community Network (CCN), 1 of 25 Community Network Programs funded by the National Cancer Institute (NCI), developed a model for providing funds to community-based organizations. This paper presents the rationale and structure of a Community Grants Program (CGP) model, describes the steps taken to implement the program, and discusses the lessons learned and recommendations for using the grants model for CBPR. Three types of projects-cancer education, implementation of an evidence-based intervention, and the development of community-academic research partnerships-could be supported by a community grant. The CGP consists of four phases: Pre-award, peer-review process, post-award, and project implementation. The CGP serves as a catalyst for developing and maintaining community-academic partnerships through its incorporation of CBPR principles. Providing small grants to community-based organizations can identify organizations to serve as community research partners, fostering the CBPR approach in the development of community-academic partnerships by sharing resources and building capacity.