ASPO Abstracts
Implementation determinants for improving colorectal cancer screening among New Mexico's American Indian communities
Category: Cancer Health Disparities
Conference Year: 2021
Abstract Body:
American Indians (AIs) have lower colorectal cancer screening rates than other racial/ethnic populations in
the nation. In New Mexico (NM), many AIs receive healthcare at the Indian Health Services (I), Tribal (T),
and Urban Indian (U) healthcare facilities where implementation of colorectal cancer screening services
(CRCS) is challenging.
To understand how best to improve CRCS in these settings and among tribal communities, we conducted
two focus groups with providers (n=15) and four focus groups or listening sessions with community
members (n=65) in two NM communities. The discussions helped elicit input on appropriate patient-,
provider-, and system-level strategies for promoting the uptake and delivery of CRCS in AI communities.
While considering specific strategies for implementation, community members and providers highlighted
implementation determinants that were unique to the AI communities in NM. Using a grounded theory
approach, we identified three themes important for implementing CRCS in I/T/U healthcare facilities.
First, several discussants mentioned the need for incorporating the context of NM's AI communities when
implementing CRCS. For example, communicating with patients was preferable though text messages, mail,
or home visits rather than phone calls. They also highlighted widespread fear of cancer and the very private
AI culture, making it challenging to reach men and share experiences to motivate others in the community
for CRCS. The need to incorporate intergenerational approaches, native languages, and tribal members as
navigators was also underscored as a means to promote cultural congruency in sorely needed CRCS health
education delivery. Second, several community members discussed the historical distrust in medical
providers and healthcare settings as important reasons for not seeking healthcare. Third, several providers
discussed operating healthcare settings under limited resources, resulting in fragmented referral networks
and information systems and limited support for patient/provider reminder/recall systems.
Using a community-based research approach allows for identifying determinants prior to implementation,
thereby providing the opportunity to understand and address these for sustainable implementation of CRCS.
Keywords: Implementation science, colorectal cancer screening, American Indian communities, health disparities