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Perceived risk is a common component of health decision making theory. When affective components of risk are assessed as predictors of a behavior, they are usually examined separately from cognitive components. Less frequently examined are more complex interplays between affect and cognition. We hypothesized that cognitive and affective risk components would both have direct effects on colonoscopy behavior/intentions and that affective components would mediate the relationship of cognitively-based perceived risk to colonoscopy screening. In two secondary analyses, participants reported their cognitive and affective perceived risk for colorectal cancer, past colonoscopy behavior, and future screening intentions. In both studies, cognitive and affective risk components were associated with increased screening behavior/intentions and cognitive risk components were mediated through affective risk. Given the impact of early detection on colorectal cancer prevention, educational strategies highlighting both components of risk may be important to increase screening rates., Author(s): Lynne B. Klasko-Foster [sup.1] , Marc T. Kiviniemi [sup.2] , Lina H. Jandorf [sup.3] , Deborah O. Erwin [sup.4] Author Affiliations: (1) grid.273335.3, 0000 0004 1936 9887, Department of [...]

Background: Screening colonoscopy (SC) for colorectal cancer (CRC) is underused by Latino individuals. The current randomized clinical trial examined the impact of 3 interventions: 1) patient navigation; 2) patient navigation plus standard Centers for Disease Control and Prevention print materials; and 3) patient navigation plus culturally targeted print materials for Latinos referred for SC. Demographic, personal and health history, and psychometric factors associated with SC also were examined.Methods: A total of 344 urban Latino individuals aged 50 to 85 years with no personal and/or immediate family history of CRC diagnosed before age 60 years, no personal history of a gastrointestinal disorder, no colonoscopy within the past 5 years, with insurance coverage, and with a referral for SC were consented. Participants were randomized to patient navigation (20%), patient navigation plus standard Centers for Disease Control and Prevention print materials (40%), and patient navigation plus culturally targeted print materials (40%). The completion of SC was assessed at 12 months.Results: The interventions had an overall SC rate of 82%. Counterintuitively, patients with an average income of <$10,000 were found to have higher SC rates (87%) than those with a greater income (75%).Conclusions: The addition of standard or culturally targeted print materials did not appear to increase SC rates above those for patient navigation. Indeed, after controlling for other variables, culturally targeted print materials were found to be associated with lower SC rates among Puerto Rican individuals. [ABSTRACT FROM AUTHOR]

Background: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial., Objective: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests., Methods: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a "think aloud" exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website's acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website., Results: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website's content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home., Conclusions: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool's usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs., (©Leah C Savage, Luz Estefhany Soto-Cossio, Francesca Minardi, Matthew Beyrouty, Julie Schoonover, Jay Musella, Michaela Frazier, Cristina N Villagra, Jamilia R Sly, Joel Erblich, Steven H Itzkowitz, Lina H Jandorf, Neil S Calman, Ashish Atreja, Sarah J Miller. Originally published in JMIR Formative Research (https://formative.jmir.org), 25.09.2024.)

Background: Colorectal cancer is a common cause of screening preventable death in Chinese immigrants, but colorectal cancer screening rates remain low in this population. This study evaluated factors associated with colorectal cancer screening behaviors in Chinese Americans living in New York City., Methods: Participants were foreign-born Chinese Americans, aged 50 years or older, who completed internet surveys between November 2020 and May 2021 regarding their colorectal cancer screening behaviors. Data were collected on demographics, health care utilization, participants' levels of health literacy, English proficiency, colorectal cancer perceptions and current colorectal cancer screening behaviors. Bivariate analyses using chi-square or t-tests were performed to examine associations between colorectal cancer screening behaviors and participant characteristics., Results: 103 participants were surveyed with a mean age of 71.3 years. Most participants experienced high rates of socioeconomic disadvantage (i.e., less than a high school education, annual household income <$20,000, limited health literacy, and poor English proficiency). 92% were ever screened, 81% were up-to-date on screening, and 85% expressed intention to screen in the future. Almost all participants had a primary care provider and a language concordant provider. Individuals who intended to screen were more fearful of developing colorectal cancer (3.2 vs 2.8, p=0.02) and perceived a colorectal cancer diagnosis with greater severity (3.0 vs 2.7, p=0.07) than those without intention to screen., Conclusions: In our sample, Chinese immigrants were adversely impacted by multiple social determinants of health but reported high colorectal cancer screening rates. Community-based outreach is critical to ensuring cancer-screening engagement in medically vulnerable populations.