Preventive Care - Key Activity 10

KEY ACTIVITY #10:

Use Culturally Appropriate Educational Materials for Cancer Screening

 

This key activity involves the following elements of person-centered population-based care: operationalize clinical guidelines; proactive patient; care coordination; address social needs.

 

Overview

This activity provides guidance on how practices can curate and use existing educational materials to increase the rate of patients who complete recommended colorectal cancer, breast cancer and cervical cancer screening.

Numerous studies[1][2][3][4][5][6][7] have demonstrated that patient education – both self-directed and guided by a member of the care team – is an effective and efficient strategy for getting patients screened for colorectal, breast and/or cervical cancer. Patient education about their risk of cancer, the recommended screening tests, the risks and benefits of the testing methods, and how the tests are performed help to support informed decision-making. Education is more likely to be followed, if it is delivered in ways that are meaningful to the patient, culturally relevant and linguistically appropriate.

See also Key Activity 20: Develop Customized, Culturally Appropriate Educational Materials for guidance on how to develop new materials for one or more subpopulations.

Many EHR platforms allow for the development or customization of embedded patient education material. Those tools can then be available for all care team members to share with patients in one of several modalities: at the health center, by mail, or via patient outreach and engagement technologies. Patient outreach and engagement technologies can assist the care team in assessing screening hesitancy, as well as delivering education. These technologies can be programmed to deliver scripted responsive interactions that can extend the ability of the care team to spend time addressing concerns and questions. Care dashboards and quality reports can be utilized with data analytics to identify trends that might suggest population-level strategies. Clinical templates and/or prompts in the EHR and care coordination applications can guide provider and care team discussions.

Action steps and roles

1. Understand the patient population(s) at your practice eligible for screening.

The first step is to understand the patient population eligible for colorectal cancer, breast cancer and cervical cancer screening at your practice.

Suggested team member(s) responsible: Panel manager or data analyst and multidisciplinary team for cancer screening.

This information can be found in your practice’s care gap reports for colorectal cancer screening, breast cancer screening and cervical cancer screening. See Key Activity 6: Conduct Proactive Outreach to Patients Due for Screening for more details.

 

2. Compile, curate, evaluate and adapt existing educational materials.

Suggested team member(s) responsible: Multidisciplinary team, MA, nurses, health educators.

Based on your patient population, compile, curate, evaluate and adapt your practice’s existing educational material for colorectal cancer, breast cancer and cervical cancer screening.

Assess the materials to determine if they address population needs and are understandable by the patient populations for your practice. Review reliable sources for educational materials that have been developed and tested by reputable sources.

See the Resources section of this Activity for reputable sources of educational materials.

It may be useful to categorize the educational materials by topic, by the intended primary user (e.g., provider guides for patients, patient self-use) and by type of material.

  • Materials for patients to use to educate themselves should contain the following information:
    • The importance of screening.
    • Type of screening tests, if options exist, such as in colorectal cancer screening, and how the test is done. Materials may also focus on a single type of test.
    • Frequency of screening.
    • The benefits and potential risks of screening.
    • Likelihood of out-of-pocket costs.
    • Common misperceptions on cancer screening.
  • Materials may be organized by type:
    • Printed materials, including photo novellas and graphic materials.
    • Materials for mail-based outreach and education.
    • Materials for social media-based outreach and education.
    • Web-based materials, including downloadable materials.
    • Video-based materials.
    • Other materials.

 

3. Tailor your approach using culturally appropriate materials, messages and messengers.

It is useful to remind the team of the common elements and approaches involved in tailoring educational content and messaging for any population of focus. This includes:

Language and tone:

  • Developing materials in language(s) spoken by the population of focus.
  • Using simple language free from medical jargon. Ensure readability and comprehension of material for all education levels.
  • Ensuring that the tone is empathic, respectful and culturally sensitive.
  • Using familiar concepts for the population of focus, including incorporating familiar symbols, metaphors and analogies that resonate with their culture(s).

Use of visuals: Use images, familiar symbols, graphics, illustrations, video and/or other visual media that are culturally relevant to the population of focus.

Incorporate storytelling:

  • Use personal stories from members of the population of focus who have undergone screenings to emphasize the benefits.
  • Share success stories of community members who have undergone screenings to encourage others.

Identify the most appropriate messengers and mechanisms: This includes asking and answering the following questions:

  • Who are the best people or groups to get the message across? Who can speak to our subpopulations in their primary language? Should we partner with others for this?
  • What communication mechanisms are most appropriate for the population of focus?
  • Are there culturally significant events or holidays to convey the message of prevention and care?
  • Where should we distribute these materials (e.g., practice waiting areas, community events, local organizations trusted by the population of focus, etc.)?

Accuracy and alignment with clinical guidelines: This involves having changes to materials reviewed by experts to ensure the changes adhere to clinical guidelines.

 

4. Put formal and informal feedback loops with patients and the care team in place.

Suggested team member(s) responsible: QI lead or their designee.

To help ensure that educational materials are meeting the needs of patients and the processes involved are consistently feasible for the care team, it is important to have both formal and informal feedback loops.

For patients, feedback loops might include:

  • Sharing materials with the population of focus to gather feedback and ensure accuracy before testing.
  • Getting feedback from patients directly after testing materials or a new approach with them, and incorporate their feedback into your next test.
  • Patient satisfaction surveys (or similar).
  • Follow-up calls with a subset of patients to understand what works well and what could be improved.
  • Patient focus groups.
  • Having the practice’s patient advisory board (or similar) provide feedback.

For the care team, feedback loops might include:

  • Existing or new staff satisfaction and feedback mechanisms.
  • Regularly scheduled meetings and calls to get staff feedback on processes, methods and tools.

Implementation tips

  • Borrow from other health centers but be sure to test aspects in your own community. Language, materials and techniques may resonate better in one community than another.
  • See also Appendix D: Peer Examples and Stories from the Field to learn about how others are implementing this activity.

Endnotes

  1. Cooper CP, Gelb CA. Opportunities to Expand Colorectal Cancer Screening Participation. J Womens Health (Larchmt). 2016 Oct;25(10):990-995. doi: 10.1089/jwh.2016.6049. PMID: 27749190; PMCID: PMC6066278. 
  2. Gwede CK, Sutton SK, Chavarria EA, Gutierrez L, Abdulla R, Christy SM, Lopez D, Sanchez J, Meade CD. A culturally and linguistically salient pilot intervention to promote colorectal cancer screening among Latinos receiving care in a Federally Qualified Health Center. Health Educ Res. 2019 Jun 1;34(3):310-320. 
  3. Dalton AF, Golin CE, Morris C, et al. Effect of a Patient Decision Aid on Preferences for Colorectal Cancer Screening Among Older Adults: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2022;5(12):e2244982. doi:10.1001/jamanetworkopen.2022.44982. 
  4. Reuland DS, Brenner AT, Hoffman R, McWilliams A, Rhyne RL, Getrich C, et al. Effect of Combined Patient Decision Aid and Patient Navigation vs Usual Care for Colorectal Cancer Screening in a Vulnerable Patient Population. JAMA Internal Medicine. 2017 Jul 1;177(7):967. 
  5. Coronado GD, Golovaty I, Longton G, Levy L, Jimenez R. Effectiveness of a clinic-based colorectal cancer screening promotion program for underserved Hispanics. Cancer. 2010 Nov 8;117(8):1745–54.‌ 
  6. Tong EK, Nguyen TT, Lo P, Stewart SL, Gildengorin GL, Tsoh JY, et al. Lay health educators increase colorectal cancer screening among Hmong Americans: A cluster randomized controlled trial. Cancer. 2016 Aug 26;123(1):98–106. 
  7. Nguyen TT, Tsoh JY, Woo K, Stewart SL, Le GM, Burke A, et al. Colorectal Cancer Screening and Chinese Americans: Efficacy of Lay Health Worker Outreach and Print Materials. American Journal of Preventive Medicine. 2017 Mar;52(3):e67–76.