Ongoing health disparity within the African American community has played a pivotal role in the need to address morbidities such as colorectal cancer and the promotion of earlier cancer screening recommendations for black males in Bell county. An estimated 52.1 percent of adults aged 50 to 75 years received a colorectal cancer screening (Healthy People 2020 2019) and, according to the American Cancer Society, colorectal cancer (CRC) incidence rates in the U.S. are highest among black men, with an incidence of 58.3 per 100,000 in non-Hispanic black men compared with an incidence of 46.9 per 100,000 among all men (Kwaan, M. 2018). Community health intervention has gained little momentum; however, a review of cancer screening interventions in non-clinical community settings derived lessons-learned about effective interventions including cost-sharing elimination for CRC screening, person-to person outreach, and mass media interventions (Berkowitz, Z 2018).
Cost Sharing Elimination
There are data to suggest that African Americans prefer colonoscopy as a screening choice. These findings were consistent with a prior study, specifically 70.1% of their African American patients who preferred colonoscopy over stool DNA or occult blood (Williams, R. 2016). Costs for high- deductible insurance plans (covering preventive care) are too expensive for 50- 74-year-old black males who represent 21 percent of black males in Bell county. Cost sharing refers to out-of-pocket costs paid for all claims billed on the same day; and the 14.3 percent poverty rate among 11 cities in Bell county patients have difficulty accurately estimating out-of-pocket healthcare payments. While the waiver of cost sharing for preventive services was introduced with a goal of increasing cancer screening rates, the implementation of the policy to eliminate cost sharing has not increased rates of colonoscopy to a significant degree (Mehta, S. J. 2015).
Health Outreach Programs
Outreach programs which can contribute significantly to reduce healthcare costs and community health promotion through screening and public education is integral to high-quality care (Tzrides, E.1988). Black males in Bell county have significant health disparity linked to social-economic and geographical disadvantage, and many residents believe there is a need for more affordable cancer screening services and clinics for people who cannot afford health care. Lack of access to health care in rural areas has been well documented and these areas may have higher rates of poverty along with fewer physicians (Berkowitz, Z 2018).
Mass Media Intervention
Computer-delivered tailored intervention is a program that guided all aspects of intervention development through web-based development focused on refining assessment questions, relevant graphics, charts illustrating changes in CRC risk and real-time assessment of the user’s age, gender, perceived risk for developing CRC, perceived barriers to testing, and family history (Rawl, S. 2012). Approximately 68 percent of Bell county residents have some college education, so disseminating health promotion via electronic survey or text notification of online healthcare events will serve as an alternative to geographic and access to healthcare concerns.
Black males 50-74 years old will benefit from the waiver of cost sharing for preventive services, in order to avoid expensive deductibles and increase colorectal cancer screening rates in Bell county. Outreach programs that will reduce healthcare costs and increase access to healthcare will overcome barriers to early cancer screening in areas of poverty and fewer physicians. Mass media intervention is pivotal in refining assessment strategies for cancer screening and promoting health interventions electronically, as well as alternative to service access concerns.
Kwaan, M., & Jones-Webb, R. (2018). Colorectal cancer screening in black men: Recommendations for best practices. American Journal of Preventive Medicine, 55(5), 102. doi: 10.1016/j.amepre.2018.05.008
Williams, R., White, P., Nieto, J., Vieira, D., Francois, F., & Hamilton, F. (2016). Colorectal Cancer in African Americans: An Update. Clinical and translational gastroenterology, 7(7), e185. doi:10.1038/ctg.2016.36
Healthy People 2020, Clinical Preventive Services Leading Health Indicator: Adults receiving colorectal cancer screening based on the most recent guidelines (C-16), 2019.
Berkowitz, Z., Zhang, X., Richards, T.B. et al. (2018) Multilevel small-area estimation of colorectal cancer screening in the United States. Cancer Epidemiolology, Biomarkers & Prevention, 27(3),245-253.
Mehta, S. J., Polsky, D., Zhu, J., Lewis, J. D., Kolstad, J. T., Loewenstein, G., & Volpp, K. G. (2015). ACA-mandated elimination of cost sharing for preventive screening has had limited early impact. The American journal of managed care, 21(7), 511–517.
Tzirides, E. (1988). Health Outreach Program. Nursing Management (Springhouse), 19(4), 55–57.
Rawl, S., Skinner, C., Perkins, S., Springston, J., Wang, H., Russell, K., . . . Champion, V. (2012). Computer-delivered tailored intervention improves colon cancer screening knowledge and health beliefs of African Americans. Health Education Research, 27(5), 868-85.