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Co-Development, Evaluation, and Dissemination of a Lung Cancer Screening Digital Outreach Intervention: A Multiphase
Jordan M Neil1, Nathaniel D Mercaldo2, Keenae Tiersma3
1Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, Oklahoma; Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Brigham Hospital, Boston, Massachusetts; Chair, Communication and Promotion Workgroup, Oklahoma Lung Cancer Roundtable.
Purpose:
Individuals from low-socioeconomic status (SES) communities experience worse lung cancer outcomes and multilevel barriers to lung cancer screening (LCS). Digital interventions may bridge LCS barriers. In this study, a three-phase design was used to rigorously develop, evaluate, and disseminate a digital outreach intervention to promote LCS among individuals from low-SES communities.
Methods:
In phase 1, focus groups were conducted with primary care providers (n = 12), patient advocates (n = 8), and patients who had (n = 7) and had not undergone LCS (n = 8). Focus groups explored barriers and facilitators to LCS and guided the development of three LCS outreach videos, which differed by message source (radiologist, patient, or both). In phase 2, LCS-eligible individuals from a national sample (n = 315) were randomized 1:1:1 to evaluate the videos. Logistic regression analyses were conducted to quantify the association between outreach video and intent to talk to a provider about LCS. In phase 3, 636 participants due for LCS with Medicaid received the outreach video via patient portal or text or email. Reach of the intervention and 12-month LCS follow-up rates were measured.
Results:
In phase 1, participants cited fear of lung cancer and confusion about LCS eligibility criteria. In phase 2, there were no significant differences in intent to speak to a provider about LCS by outreach video type. In phase 3, a significantly greater proportion of participants reached by the intervention had scheduled or completed LCS than those not reached (32.4% vs 23.2%, P = .041).
Conclusions:
Participants who were reached by the digital outreach intervention codeveloped and disseminated to patients from low-SES communities were more likely to complete LCS.
