1. State your health outcome of interest. (It could be the one you used for week #2 or another one.) Pick two key behaviors that are important factors leading to your health outcome. Explain the importance of these behaviors either for etiology, prevention, or intervention. (If none of the behaviors in the readings are important for your health outcome, suggest another behavior that is.)
Health Outcome of Interest: Increasing CRC Screening Completion
Key Behaviors:
-Health Literacy = How People Understand FIT/bowel preparation instructions
Safety-net health systems often experience difficulty comprehending and completing FIT/bowel preparation instructions using word-based and English instructions. Despite effectiveness for population-level screening for CRC, screening relies on patients properly completing FIT tests for laboratory processing and adequate bowel preparation for colonoscopy follow-up. Timely and proper FIT and colonoscopy completion is required for accurate up-to-date CRC screening.
-Diet Quality = Risk of GI diseases (e.g. CRC)
Some studies have shown an association between Western diet to increased risk of CRC due to a higher fat and low fiber dietary content. Although unclear of the exact pathogenesis, a potential mechanism is how diet affects the microbiome of the colon which may cause underlying inflammation that may contribute to cancer risk.
2. Describe how you would study the role of one of the behaviors described for question #1 and your health outcome of interest. Incorporate a social factor (e.g. race/ethnicity, social exclusion, stress) in the study approach.
Behavior: Health Literacy - How People Understand FIT/bowel preparation instructions
To better understand the key behaviors and my health outcome of interest, I would conduct qualitative interviews. I would create a focus group or CAB to discuss the various hurdles that community members face when completing CRC screening tests. A multidisciplinary community engaged research (CER) approach could be employed to implement the interview process, taking advantage of the diverse patients residing in target population setting – San Francisco’s Health Network (SFHN) which is comprised of 11 community primary care clinics and 1 GI referral unit within a health safety-net system. The SFHN is a diverse, low-income, non-English speaking and recent immigrant population. In total, for the focus group/CAB, I would plan to recruit 11 participants (one from each of the community clinic each representative of a different race/ethnic group). The focus group/CAB could potentially meet in total of four times.
In the first meeting, we could query the participants of what they know about CRC, and what their experiences and the general attitudes of CRC screening are. After, we would present information to help educate participants and encourage feedback of what could be improved. If needed, an external facilitator will ask community members to help facilitate the process. In the second meeting, we can present FIT and colonoscopy bowel preparation instruction and ask for participants to demonstrate and interpret the instructions. After, we would form a discussion reflection group to discuss how the instructions could be better improved for each race/ethnicity. In the third meeting, we would present the culturally appropriate instructions to members for further feedback. In the fourth meeting, we would ask participants of their experience with the interview, present final revisions for feedback and query community members how we could begin to better increase CRC screening through these interventional avenues. The aim is to build meaningful relationships through interfacing with diverse underserved community members, and allowing these members to help shape the research team’s research plans to ensure sustainable impact.
3. If key health behaviors (e.g. smoking, exercise, nutritious diet) are strongly influenced by neighborhood, income, and/or education, do we need to continue to study how these behaviors influence health outcomes? Why or why not?
Yes, we should still continue to study how these types of behaviors may influence health literacy and even if they are strongly influenced by neighborhood, income, and/or education because interventions could be better tailored/targeted to certain patient demographics groups. Without these other variable inclusions, the impact of interventions could be diminished and/or unsustainable.