Background Colorectal cancer is the third most common cancer in American Samoa Although screening such as FOBT flexible sigmoidoscopy and colonoscopy are available on island only have 7 have reported receiving screening ID: 911288
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Pilot Testing a Colorectal Cancer Screening Intervention in American Samoa
Background:
Colorectal cancer is the third most common cancer in American Samoa. Although screening, such as FOBT, flexible sigmoidoscopy, and colonoscopy are available on island only have 7% have reported receiving screening.
No studies have identified the contribution of health literacy, knowledge of risk factors and subsequent colorectal cancer screening within the indigenous Samoan population.
In 2018, the Indigenous Samoan Partnership to Initiate Research Excellence (INSPIRE) conducted a pilot study to determine colorectal cancer (CRC) health literacy levels within the adult population age 45 years or older; measures were provided in both English and Samoan
Results indicated 81% of the Samoan speaking (N=293) and 44% of the English speaking (N=418) participants demonstrated “inadequate” health literacy.
Accordingly, these groups are most likely to have difficulty reading, understanding, and interpreting health materials, directions for their health care and, may be at greater risk of non-adherence to prescribed diets and/or treatment regimens.
Therefore, modifications must be made to CRC screening materials in order to better enable understanding of CRC and promote the appropriate screening behaviors among American Samoans.
Slide2Pilot Testing a Colorectal Cancer Screening Intervention in American Samoa
Objective:
Our goal was to test the influence of literacy-tailored materials on timely and accurate completion of CRC screening using an
FOBT
.
Methods:
We conducted a randomized controlled trial of Indigenous Samoan participants (N=312), age≥ 50 recruited using Respondent-Driven Sampling. We compared use of non-tailored instructions for completing
ColoCare
FOBT home-kits versus the experimental condition, using a
ColoCare
FOBT home-kit with instructions tailored to inadequate health literacy levels using video-based instructions and a modified instruction sheet.
We performed a logistic regression analysis with an accurate
FOBT
Completion as the outcome variable. The predictors were experimental vs. control Group, Literacy level and the Group and Literacy interaction.
Results:
We recruited 277 participants, with 258 completing Short-Test of Functional Health Literacy with random stratification into control or experimental groups. There were 164 Samoan speaking participants with the remainder 94, completing the study in English.
Slide3Pilot Testing a Colorectal Cancer Screening Intervention in American Samoa
Results:
Only 39 participants (14%) reported using the
FOBT
homekits
, with 16/21 participants in the control group and 14/18 participants in the experimental group reporting accurate outcomes from use of the home-kits.
No significant associations were found between groups. (Table 1) However, there was a trend towards accurate completion in the experimental group. (Figure 1)
Figure 1
Table 1
Slide4Pilot Testing a Colorectal Cancer Screening Intervention in American Samoa
Discussion:
This is a first ever
RCT
to test a cancer prevention education intervention in American Samoa. Results revealed that Indigenous Samoans’ health literacy, knowledge, and willingness to complete a CRC home test kit requires more study on evidence-based and culturally appropriate strategies to increase uptake colon cancer screening. Future studies may test use of clinically-based screening options for Samoans to improve screening rates.
Conclusions:
Use of literacy-level tailored and self-administered home tests for colon screening were marginally effective in supporting uptake of colon cancer screening in American Samoans.
More study on innovative culturally-appropriate screening methods including the use of clinical screening is warranted to improve colon cancer screening rates in American SamoaAuthors and Contacts:Va’atausili Tofaeono, MBA: vtofaeono@cancercoalition.asKevin Cassel, DrPH: Kevin@cc.hawaii.edu Lana Ka’opua, PhD: lskaopua@hawaii.edu
Angela Sy, PhD: sya@hawaii.edu
Katherine Tong, PhD:
katherine.tong@vanguard.edu
Luana Scanlan, MBA:
lmyscanlan@gmail.com
Victor Tofaeono, MD:
victor.tofaeono@gmail.com