Abstract
Problem Significance Colorectal cancer occurs when cells of the rectum and colon divide uncontrollably and metastasize to other body areas. Colorectal cancer presents a significant burden in the United States, accounting for nearly 8% of all new cancer diagnoses. At the national and state levels, colorectal cancer disproportionately affects Black Americans with higher incidence rates than their White counterparts. In Sacramento County, colorectal cancer incidence rates and age-adjustable death rates are higher than the state average.
Analysis The Social Ecological Model explores the individual, interpersonal, community, and policy determinants of colorectal cancer in Black Americans. At the individual level, genetic factors, health literacy, and socioeconomic status influence an individual’s risk of developing colorectal cancer. At the interpersonal level, patient-provider communication is underrecognized as a contributor to colorectal cancer among ethnic minorities. Community-level factors, including food availability, physical activity, and mistrust of the medical system due to systemic inequities, may increase colorectal cancer risk factors. At the policy level, cost avoidance due to inflated healthcare costs and poor health literacy can delay critical care.
Intervention (Solution) It Takes Guts is a theory-informed intervention focusing on Black Americans aged 25-44 residing within the 95823 ZIP code. The program goals aim to increase colorectal cancer knowledge, increase awareness of the Affordable Care Act, and decrease colorectal cancer incidence rates among participants. In partnership with the South Sacramento Christian Center, this intervention will educate participants about colorectal cancer risk factors, patient-provider communication strategies, and insurance utilization.
Implementation and Evaluation The study will use a quasi-experimental evaluation design with a comparison group, and fidelity to the implementation will be assessed through pre-test, post-test, follow-up survey, and process survey results. An eligibility survey will establish experimental and comparison groups, and summative and formative evaluation measures will be used. A coalition will provide its collective expertise and professional networks to It Takes Guts, leveraging its influence to help guide implementation.