Early screening and detection can be highly successful in preventing and improving outcomes of colorectal cancer, but require individuals and communities to be aware of their screening options. Unfortunately, disparities in knowledge, screening, and burden of colorectal cancer exist across populations of different race/ethnicity, gender, age, socioeconomic status, and geographic region. Reducing these disparities is an important public health priority, particularly as they relate to improving colorectal cancer screening compliance. To this end, innovative educational interventions using alternative audio and visual formats can be useful in improving knowledge and intention to be screened. In a recent issue of Ethnicity & Health, Drs. Yamile Molina and Beti Thompson and Ms. Katherine Briant in the Public Health Sciences Division, collaborated with Dr. Mary O’Connell and Ms. Janeth Sanchez under the National Cancer Institute (NCI) funded U54 partnership with New Mexico State University to compare the effectiveness of an inflatable colon exhibit in two community settings. The authors report demographic differences in how groups within these communities responded, which may be informative for future interventions.
To emphasize the importance of colorectal cancer screening, the authors purchased two inflatable colon displays that could be brought directly to communities. These walk-through models of a human colon, each a 20-foot-long tunnel 12 feet wide and 10 feet high, provide an innovative, visual, and interactive educational tool for health education. The wall of the colon depicts normal tissue, polyps, malignant polyps, four stages of colorectal cancer, and advanced colorectal cancer, with both English and Spanish descriptions. Touring through the colon also provides information about risk factors, recommended lifestyle changes, screening options, and the importance of early detection.
Image provided by Ms. Katherine Briant
To test the effectiveness of this inflatable innovation, the authors interviewed participants before and after they walked through. These questions focused on measuring the participants’ awareness and knowledge of colorectal cancer and screening, their intention to get screened, and their likelihood to discuss colorectal cancer with others. The authors performed these assessments when taking the colon to communities in two settings: 3 rural counties in eastern Washington state (WA) and the campus of New Mexico State University (NM). This allowed for a comparison of the intervention’s impact on knowledge, intention, and social engagement measures across geographically and socio-demographically distinct populations.
Overall, the authors found that the inflatable colon seems to be an effective educational tool among diverse populations. However, the relative efficacy of the intervention varied by geographic region. There were greater changes in knowledge among the less educated in WA; this differential effectiveness was hypothesized to be due to higher baseline levels of knowledge among those with higher education in WA, which consisted of more advantaged groups who were generally less affected by CRC. In this context, the inflatable colon may be acting as a tool to even the knowledge level of colorectal cancer across groups of individuals in different geographic regions.
Individual demographic factors were also related to the effectiveness of the intervention, though this again varied by geographic region. In WA, greater gains in knowledge were reported among Hispanics, younger, less educated, and uninsured participants, while in NM greater gains were seen in males than females. Likelihood of social engagement was related to age in WA and gender in NM, with younger and female participants respectively reporting they were more likely to discuss colorectal cancer with their social networks. Interestingly, in both communities the authors found that an increase in social engagement likelihood, but not knowledge, was associated with higher intention to be screened. An explanation for this finding is that increased social engagement may be a useful proxy for the relevance and importance a person perceives colorectal cancer screening to be, which then influences their motivation and future screening.
Beyond improving individual knowledge and engagement, the inflatable colon may also improve the spread of colorectal cancer information across communities through increased social engagement. Future research could investigate the dissemination of colorectal cancer information through social networks after visiting the inflatable colon. This work highlights the importance of considering both individual- and community-level factors when designing cancer disparities interventions, and of taking unconventional and innovative approaches to increase knowledge and improve health.
Molina Y, Briant KJ, Sanchez JI, O'Connell MA, Thompson B. Knowledge and social engagement change in intention to be screened for colorectal cancer. Ethn Health 2017:1-19. doi: 10.1080/13557858.2017.1280135.
Funding for this study was provided by the NCI.