JMIR Publications

ABSTRACT

Background:

In the US colorectal cancer (CRC) is the third leading cause of cancer death among Black men. Compared to men of all other race/ethnicities Black men have the lowest rates of CRC screening participation which contributes to later stage diagnoses and greater mortality. Despite CRC screening being a critical component of early detection and increased survival, few interventions have been tailored for Black men.

Objective:

The purpose of this study was to report on the multi-step process used to translate formative research including prior experiences implementing a national CRC education program, community advisory and preliminary survey results into a culturally tailored mHealth intervention.

Methods:

A theoretically and empirically informed translational science public health intervention was developed using the Behavioral Design Thinking Approach. Data to inform how content should be tailored was collected from empirical literature and a community advisory board of Black men (n=7) and reinforced by the preliminary results of n=98 survey respondents.

Results:

A community advisory board identified changes for delivery that was private, self-paced, and easily accessible and content that addressed medical mistrust, access delays for referrals and appointments, lack of local information, misinformation and the role of families. Empirical literature and survey results identified the need for local health clinic involvement as critical to screening uptake, leading to a partnership with local FQHC’s to connect participants directly to clinical care. Men surveyed who live or work in the study area were an average of 59 years old, held high levels of mistrust of healthcare institutions. In the last 12 months 25% did not see a doctor and 17% did not have a regular doctor. Cost was a major barrier to CRC screening for 42% of participants; 30.6% were enrolled with Medicaid and 8% were uninsured. Regarding CRC; 26% and 39% had never had a colonoscopy or blood stool test, respectively.

Conclusions:

Working with a third-party developer a prototype mHealth application that is downloadable, optimized for iPhone and android users, and uses familiar sharing, video and text messaging modalities was created. Guided by our results we created four short videos (1:30-2 mins) including a survivor vignette, animated videos about CRC and the type of screening tests, a message from a community clinic partner. Men will also receive tailored feedback and direct navigation to local FQHC partners including via school-based family clinics. These content and delivery elements of the mHealth intervention were the direct result of the multi-pronged, theoretically informed approach to translate an existing but generalized CRC knowledge based intervention into an interactive, self-paced, tailored intervention with links to local community clinics. Clinical Trial: Nct05980182