Grant Number:	1R21CA281135-01A1 Interpret this number
Primary Investigator:	Neil, Jordan
Organization:	University Of Oklahoma Hlth Sciences Ctr
Project Title:	Improving Rates of Diagnostic Colonoscopy in Native Americans Through a Culturally Sensitive Digital Outreach Intervention
Fiscal Year:	2024

PROJECT SUMMARY Native Americans (NA) endure a disproportionate burden of colorectal cancer (CRC) incidence and CRC-specific mortality. Screening is an effective early detection strategy to decrease preventable CRC-related deaths, but NA have some of the lowest CRC screening rates. In Oklahoma, only 51% of NA are up to date with screening compared to nearly two-thirds of eligible US adults. Efforts to reduce disparities in screening rates have focused on increasing access to home stool screening. However, approximately one-half of NA in Oklahoma with an abnormal home stool test do not complete a required follow-up diagnostic colonoscopy. As time to colonoscopy after an abnornal home stool test is associated with greater diagnosis of late-stage disease and CRC mortality, innovative strategies are needed to increase rates of timely diagnostic colonoscopy follow up among NA in Oklahoma. The proposed study leverages an existing relationship with the Cheyenne and Arapaho Tribes to co- develop and pilot test two digital outreach interventions to increase rates of diagnostic colonoscopy. First, mobile health outreach (mHealth; SMS text and video messages) will attempt to increase motivation to schedule a diagnostic colonoscopy. In addition to receiving informational texts about how and why to schedule a colonoscopy, participants will also receive culturally sensitive videos that use personal narratives from NA patients and other high-status Cheyenne and Arapaho Tribal members (e.g., elders). Second, current clinic workflow requires Cheyenne and Arapaho patients to visit the colonoscopy clinical facilities for both a pre-visit appointment and the actual procedure. This process requires a minimum of two round trips to a colonoscopy facility of over 90 miles for most patients. We will test whether a pre-visit telehealth consultation reduces transportation barriers. Our overarching hypothesis is that culturally sensitive digital outreach intervention will increase motivation, reduce structural barriers, and, thus, improve rates of diagnostic colonoscopy. The first study aim will co-develop and integrate culturally sensitive digital outreach intervention strategies into clinic workflows, guided by NA patients and a community advisory board. Among 140 NA patients, the second aim will determine reach, feasibility, and potential efficacy of intervention strategies using a 2 x 2 factorial design: (Outreach Type, Factor 1) mHealth outreach vs. informational pamphlet; (Consultation Type, Factor 2) telehealth vs. in-person pre-visit colonoscopy consultation. The primary outcome is potential efficacy, measured as rates of diagnostic colonoscopy 60 days post-randomization. The third aim will explore penetration, acceptability, and scalability of digital outreach intervention strategies. If effective, this first-of-its-kind and highly scalable approach offers a substantial public health impact to reduce avoidable CRC morbidity and mortality among NA patients by increasing rates of diagnostic colonoscopy. Findings will support an R01 Hybrid Type 1 effectiveness- implementation trial to determine clinical effectiveness and better understand context for implementation of culturally sensitive digital outreach interventions across our Tribal partners in Oklahoma.





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