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Published on: August 1, 2019
Implementation and Evaluation of a Large Community-Based Colorectal Cancer Screening Program
Navkiran K Shokar1, Jessica Calderón-Mora, Rebekah Salaiz
1Author Affiliations: Departments of Population Health (Drs N. K. Shokar and Calderón-Mora) and Medical Education (Dr G. S. Shokar), Dell Medical School, University of Texas at Austin, Austin, Texas; Department of Family and Community Medicine (Ms Salaiz), Division of Gastroenterology (Dr Zuckerman), Department of Internal Medicine (Ms Casner), and Department of Molecular and Translational Medicine (Dr Dwivedi), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas; and School of Health Professions, University of Texas at Tyler, Tyler, Texas (Dr Byrd).
Context:
Colorectal cancer (CRC) screening can significantly reduce incidence and mortality; however, screening rates are suboptimal. The lowest rates are among those with no usual source of care and the uninsured.
Objective:
We describe the implementation and evaluation of a community-based CRC screening program from 2012 to 2015 designed to increase screening within a predominantly Hispanic US-Mexico border population.
Methods:
The multicomponent, evidence-based program provided in-person, bilingual, culturally tailored health education facilitated by community health workers, no-cost primarily stool-based testing and diagnostic colonoscopy, and navigation. We recruited uninsured individuals due for CRC screening from clinics and community sites. An extensive qualitative and quantitative program process and outcome evaluation was conducted.
Results:
In total, 20 118 individuals were approached, 8361 were eligible for screening; 74.8% completed screening and 74.6% completed diagnostic testing; 14 cancers were diagnosed. The mean age of participants was 56.8 years, and the majority were Hispanic, female, and of low socioeconomic status. The process evaluation gathered information that enabled effective program implementation and demonstrated effective staff training, compliance with processes, and high patient satisfaction.
Conclusions:
This program used a population-based approach focusing on uninsured individuals and proved successful at achieving high fecal immunochemical test kit return rates and colonoscopy completion rates. Key factors related to its success included tailoring the intervention to our priority population, strong partnerships with community-based sites and clinics, expertise in clinical CRC screening, and an active community advisory board. This program can serve as a model for similar populations along the border to increase CRC screening rates among the underserved.
