Reducing Colorectal Cancer Health Disparities: An mHealth Intervention to Improve Screening among African American Men - PROJECT SUMMARY/ABSTRACT
Poverty has a myriad of pernicious effects on health, including higher incidence and mortality for most
forms of cancer. Colorectal cancer (CRC), the second overall leading cause of cancer death, is no exception.
CRC is diagnosed 40% more often in those lower in socioeconomic status (SES). In the United States, race and
SES are inextricably linked, leading to profound health disparities. Indeed, CRC is particularly burdensome for
Black people; most notably African American men. CRC incidence is 20% higher in Black men as compared to
white men with death rates 52% higher. African American men have the lowest survival rates at all CRC stages.
Because the precancerous polyps that cause most CRCs grow slowly, adherence to CRC screening can
prevent most cases from becoming invasive cancer. Unfortunately, use of screening tests is inadequate,
especially among low SES African American men. Indeed, 40% of the racial disparity in CRC incidence and
20% of the mortality differences can be attributed to lack of screening. Being Black, male, and low SES in the
United States intersect to form a complex set of institutional, provider, and patient-level barriers that lead to
these differential screening rates. Most existing approaches to increase CRC screening in this group utilize in-
person or telephone-based education and patient navigation. While effective, these approaches are costly and
resource intensive, limiting their adoption among organizations that primarily serve low SES African American
men, such as Federally Qualified Health Centers (FQHCs).
To address the need for an effective, affordable, and scalable intervention to increase CRC screening among
medically underserved African American men, this project will develop a theory-based, tailored, and culturally-
targeted CRC screening mHealth intervention for this group. The proposed intervention will be based on the
health belief model (HBM) and delivered via mobile phone. It will include text messages designed to improve
CRC knowledge and health beliefs. Additionally, the program will present three web-based video components:
scripted vignettes, unscripted peer narratives, and educational instruction. All program content will be
designed to reduce health literacy barriers and promote adherence to CRC screening recommendations.
Finally, it will be culturally targeted by contextualizing HBM constructs with the health beliefs most relevant to
low SES African American men and by integrating gender- and race-congruent imagery, language, and values.
Eight FQHC staff members and 20 African American men will be recruited for focus group discussions to
shape the proposed intervention. When a prototype version of the program is completed, 20 African American
men who are nonadherent to CRC screening (i.e., target end-users) will be recruited for usability testing. The
usability test will include a series of tasks intended to highlight the different features of the proposed
intervention. Three usability metrics will be assessed: efficiency, accuracy, and subjective satisfaction.
