Promoting colorectal cancer screening among urban American Indians and Alaska Natives using digital stories: A culturally-appropriate clinic-based educational intervention

Among American Indians and Alaska Natives (AI/ANs), colorectal cancer (CRC) is the third leading cause of cancer-related death. AI/ANs are twice as likely to be diagnosed with advanced CRC as are non-Hispanic Whites. Few studies have tested culturally-appropriate interventions seeking to increase CRC screening among AI/ANs. The U.S. Preventive Services Task Force recommends that average-risk patients 50 to 75 years of age obtain regular CRC screening. Nationally, CRC screening rates are above 60%. However, screening rates at our Urban Indian clinic partner sites are below 25%. Our educational intervention seeks to improve screening rates through a patient education and awareness-building intervention. During this 18-month cross-over intervention, we showed digital stories in the clinic waiting area, distributed booklets with DVDs of these digital stories, and provided on-site health education. The digital stories are 3½ to 5 minutes in duration and were created by Native Elders whose lives have been directly impacted by CRC. These stories translate the tradition of Native storytelling into the format of digital media -- thereby empowering Native Elders to educate their own communities about the importance of cancer screening. Seven patient focus groups guided materials development and intervention implementation. Focus groups also examined pre-existing knowledge and barriers to increasing CRC screening rates. Descriptive content thematic analysis revealed a consistent cultural code of silence pertaining to cancer and CRC screening. Using an iterative CBPR model in which patient input guided project implementation, we created unique and compelling culturally-appropriate educational materials to promote CRC screening among AI/AN Elders.