Research article

BMC Medical Informatics and Decision Making

, 12:53

Open Access This content is freely available online to anyone, anywhere at any time.

Testing a Spanish-language colorectal cancer screening decision aid in Latinos with limited English proficiency: Results from a pre-post trial and four month follow-up survey

  • Daniel S ReulandAffiliated withDivision of General Medicine and Clinical Epidemiology, University of North CarolinaCecil G. Sheps Center for Health Services Research, University of North CarolinaLineberger Comprehensive Cancer Center, University of North Carolina Email author 
  • , Linda K KoAffiliated withLineberger Comprehensive Cancer Center, University of North CarolinaFred Hutchinson Cancer Research Center, University of Washington
  • , Alicia FernandezAffiliated withDivision of General Internal Medicine, University of California
  • , Laura C BraswellAffiliated withCecil G. Sheps Center for Health Services Research, University of North Carolina
  • , Michael PignoneAffiliated withDivision of General Medicine and Clinical Epidemiology, University of North CarolinaCecil G. Sheps Center for Health Services Research, University of North CarolinaLineberger Comprehensive Cancer Center, University of North Carolina

Abstract

Background

Compared with non-Latinos, Latinos in the US have low rates of colorectal cancer (CRC) screening and low rates of knowledge regarding CRC screening tests and guidelines. Spanish speaking Latinos have particularly low CRC screening rates and screening knowledge. Our purpose was twofold: (1) to evaluate the effect of a computer-based, Spanish-language CRC screening decision aid on screening knowledge, intent to obtain screening, and screening self-efficacy in a community sample of Latinos with limited English proficiency (LEP); and (2) to survey these decision aid viewers at four months to determine their rates of CRC discussions with a health care provider as well as their rates of screening test completion.

Methods

We recruited 50-75 year old Latinos with LEP who were not current with CRC. Participants screening viewed a 14 minute multimedia decision aid that addresses CRC screening rationale, recommendations, and options. We conducted an uncontrolled (pre-post) study in which we assessed screening knowledge, self-efficacy, and intent at baseline and immediately after decision aid viewing. We also conducted a follow-up telephone survey of participants at four months to examine rates of patient-provider screening discussions and test completion.

Results

Among n = 80 participants, knowledge scores increased from 20% (before) to 72% (after) decision aid viewing (absolute difference [95%CI]: 52% [46, 59]). The proportion with high screening self-efficacy increased from 67% to 92% (25% [13, 37]); the proportion with high screening intent increased from 63% to 95% (32% [21, 44]). We reached 68 (85%) of 80 participants eligible for the follow-up survey. Of these 36 (53%) reported discussing screening with a provider and 13 (19%) completed a test.

Conclusion

Viewing a Spanish-language decision aid increased CRC screening knowledge, self-efficacy, and intent among Latinos with LEP. Decision aid viewing appeared to promote both CRC screening discussions with health care providers and test completion. The decision aid may be an effective tool for promoting CRC screening and reducing screening disparities in this population.

Keywords

Decision aid Latinos Limited English proficiency Colorectal cancer screening