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Title: WINCART Pacific Islander Colorectal Cancer Education Toolkit


Abstract: Created by the Weaving an Islander Network for Cancer Awareness, Research and Training (WINCART) Center, the Pacific Islander Colorectal Cancer Education Toolkit is a community tailored education campaign developed by and implemented with community leaders and academic researchers to educate Pacific Islanders (PIs) in Southern California about the importance of early colorectal cancer (CRC) screening. It is intended for use by PI community-based educators to promote colorectal cancer awareness, prevention, and screening among PI adults 50 years of age and older. The community-developed materials and messages can be used in one-on-one and group education settings. When the flipchart is used with the accompanying video and bookmark, three key health messages are highlighted - 1) there are ways that PIs can prevent CRC, 2) PIs need to ask their doctor about the recommended screening tests for CRC, and 3) to get screened for yourself and your family.

Included in the Pacific Islander Colorectal Cancer Education Toolkit CD:
• Colorectal Cancer Education Process Form
• Colorectal Cancer Education Sign-in Sheet
• Pre- and Post-Education Surveys (in English, Chamorro, Marshallese, Samoan and Tongan)
• Video - 60 seconds and 5 minutes (in English)
• Flipchart (in English, Chamorro, Marshallese, Samoan and Tongan)
• Bookmark (in English, Chamorro, Marshallese, Samoan and Tongan)
• Resource List
• Colorectal Cancer Informational Handout (in English, Chamorro, Marshallese, Samoan and Tongan)


Type of Product: http://wincart.fullerton.edu/cancer_edu/ToolkitColorectalCancer.htm


Year Created: 2012


Date Published: 3/5/2016

Author Information

Corresponding Author
Mandy LaBreche
California State University, Fullerton
Department of Health Science
800 N. State College Blvd.
Fullerton, CA 92831
United States
p: 657-278-3499
alabreche@fullerton.edu

Authors (listed in order of authorship):
Ku'ulei Fahilga
Pacific Islander Health Partnership

Lola Sablan Santos
Guam Communications Network

Mary Anne Foo
Orange County Asian & Pacific Islander Community A

Jane Ka'ala Pang
Pacific Islander Health Partnership

Dorothy Vaivao
Samoan National Nurses Association

Brian Hui

Jonathan Tana Lepule
Empowering Pacific Islander Communities

Zul Surani
University of Southern California

Alek Sripipatana
Health Resources & Services Administration

Sora Park Tanjasiri
California State University, Fullerton

Paula Healani Palmer
Claremont Graduate University

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Medicine, Nursing, Public Health, Social & Behavioral Sciences


What specific topics does your product address?

Cancer, Community engagement, Community health , Cultural competency , Health care quality, Health disparities, Health education , Minority health, Community-based participatory research


Does your product focus on a specific population(s)?

Hawaiian/Pacific Islander, Immigrant, Native Hawaiian or other Pacific Islander, Uninsured


What methodological approaches were used in the development of your product, or are discussed in your product?

Community-academic partnership, Community-based participatory research , Focus group


What resource type(s) best describe(s) your product?

Toolkit


Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

Created by the Weaving an Islander Network for Cancer Awareness, Research and Training (WINCART) Center, the Pacific Islander Colorectal Cancer Education Toolkit is a community tailored education campaign developed by and implemented with community leaders and academic researchers to educate Pacific Islanders (PIs) in Southern California about the importance of early colorectal cancer (CRC) screening. It is intended for use by PI community-based educators to promote colorectal cancer awareness, prevention, and screening among PI adults 50 years of age and older. The community-developed materials and messages can be used in one-on-one and group education settings. When the flipchart is used with the accompanying video and bookmark, three key health messages are highlighted - 1) there are ways that PIs can prevent CRC, 2) PIs need to ask their doctor about the recommended screening tests for CRC, and 3) to get screened for yourself and your family.

Included in the Pacific Islander Colorectal Cancer Education Toolkit CD:
• Colorectal Cancer Education Process Form
• Colorectal Cancer Education Sign-in Sheet
• Pre- and Post-Education Surveys (in English, Chamorro, Marshallese, Samoan and Tongan)
• Video - 60 seconds and 5 minutes (in English)
• Flipchart (in English, Chamorro, Marshallese, Samoan and Tongan)
• Bookmark (in English, Chamorro, Marshallese, Samoan and Tongan)
• Resource List
• Colorectal Cancer Informational Handout (in English, Chamorro, Marshallese, Samoan and Tongan)


2. What are the goals of the product?

This toolkit was developed to educate PIs in Southern California about the importance of early CRC screening, including increasing the awareness of the impact of CRC on the PI community, the various risk factors associated with CRC, CRC prevention information, and CRC screening tests available. The goal is to increase CRC knowledge and awareness in order to 1) promote health dialogue among PI community members, 2) dispel myths and address taboos about cancer, 3) increase patient-initiated conversations with health providers regarding CRC screenings, and 4) ultimately encourage early participation in CRC screenings.


3. Who are the intended audiences or expected users of the product?

The Pacific Islander Colorectal Cancer Education Toolkit is intended for use by PI community health educators, outreach workers, health professionals and community organizations to promote CRC awareness, prevention and screening among PI adult men and women who are 50 years of age and older. This toolkit can also be used for other populations. However, we recommend adaptation of the materials for cultural appropriateness and relevancy.


4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

Included in the flipchart is a flipchart facilitation guide that provides learning objectives and talking points for each flipchart page. Included in the toolkit materials are three documents that help guide PI community health educators in implementing the education sessions. The protocol includes: 1) a process form that lists the seven steps to complete the education workshop, 2) sign-in sheet, and 3) pre- and post-education surveys in English, Chamorro, Marshallese, Samoan, and Tongan.

Tanjasiri, S.P. (2010, November). Tools for Addressing Cancer Health Disparities: Colorectal Cancer Education for Pacific Islanders. Oral session presented at the American Public Health Association's 138th Annual Meeting and Exposition, Denver, CO.


5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

CRC and PIs: CRC cancer rates are in the top five most commonly diagnosed cancers among Native Hawaiian and Samoan American men and women (1). Further, most Samoans and other PIs in California are diagnosed with CRC at later stages. Among Asian Americans and PIs , CRC is the third most common type of cancer for men and second for women (2). In addition, CRC mortality rates among Asian Americans and PIs is high and screening rates are low when compared to non-Hispanic Whites and African Americans (3). To date, the bulk of research on CRC aggregates Asian Americans and PIs as one group, thus masking the ethnicity-specific CRC burden that exists across Asian American and PI groups.

CRC Prevention and Early Detection: Almost all CRCs begin with abnormal growths (precancerous polyps) in the colon and rectum, which can be present in the colon for years before cancer develops. In many cases, people are without symptoms. CRC screening can discover these abnormal growths and remove them before they become cancerous. Screening can also detect CRC early, providing a greater chance that treatment will be both effective and curable. The most effective way to reduce your risk of developing CRC is by having regular CRC screening tests starting at the age of 50 (4). The U.S. Preventive Services Task Force recommends screening for CRC using one or a combination of the following three tests beginning at age 50 and continuing until 75 years of age: high-sensitivity fecal occult blood testing, sigmoidoscopy, or colonoscopy (5).

Community Based Participatory Research & Community Informed Materials: The principles of Community Based Participatory Research (CBPR) were used in the development and implementation of the WINCART PI Colorectal Cancer Education Toolkit, including partnerships between community members and academic researchers in all phases of the research (6). Disparity populations, such as PIs, are better reached and programs are more effective when they are tailored to the target population (7, 8). Community partners implemented the CRC education, worked closely with academic partners to evaluate the data, and disseminated the Toolkit throughout their communities.


6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

(1) Liu L, Noone AM, Gomez, SL, Scoppa S, Gibson JT, Lichtensztajn D, Fish K, Wilkens LR, Goodman MT, Morris C, Kwong S, Deapen D, Miller BA. Cancer incidence trends among Native Hawaiians and Other Pacific Islanders in the United States, 1990-2008. J Natl Cancer Inst 2013;105(15):1085-1095.
(2) California Colorectal Cancer Coalition. Colorectal Cancer in the Asian Pacific Islander Community, 2014. Available from http://cacoloncancer.org/documents/FactSheets/API_2014.pdf
(3) Lee HY, Lundquist M, Ju E, Luo X, Townsend A. Colorectal cancer screening disparities in Asian Americans and Pacific Islanders: Which groups are most vulnerable. Eth Health 2011; 16(6):501-518.
(4) Centers for Disease Control and Prevention. Colorectal (Colon) Cancer: What can I do to reduce my risk of Colorectal Cancer? CDC, 2014. Available from http://www.cdc.gov/cancer/colorectal/basic_info/prevention.htm
(5) U.S. Preventive Services Task Force. Colorectal Cancer: Screening. U.S. Preventive Services Task Force, 2008. Available from http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening
(6) Tanjasiri SP, Tran JH, Palmer PH, Foo MA, Hanneman M, Lee C. Developing a community-based collaboration to reduce cancer health disparities among Pacific Islanders in California. Pac Health Dialog 2007;14(1):119-27.
(7) Kreuter MW, Lukwago SN, Bucholtz DC, Clark CM, Sanders-Thompson V. Achieving cultural appropriateness in health promotion programs: Targeted and tailored approaches. Health Educ Behav 2002;30(2):133-146.
(8) Betancourt JR, Green AR, Carrillo JE, Ananneh-Firempong O 2nd. Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep 2003;118(4):293-302.


7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

  • For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
  • For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
  • For other types of work, discuss how the project was developed and reasons for the methodological choices made.

The Weaving an Islander Network for Cancer Awareness, Research, and Training (WINCART) Center is a unique CBPR effort to reduce cancer health disparities among PIs in Southern California. The WINCART Center is comprised of two academic institutions (California State University, Fullerton and Claremont Graduate University) and six PI-serving community-based organizations (Guam Communications Network, Orange County Asian and Pacific Islander Community Alliance, Pacific Islander Health Partnership, Samoan National Nurses Association, Tongan Community Service Center/Special Service for Groups, Inc., and Union of Pan Asian Communities).

WINCART’s mission is to promote healthy PI communities through increasing cancer awareness, collaborative research programs, and providing valuable leadership and training opportunities. The WINCART Pacific Islander Colorectal Cancer Education Toolkit fits into the following aims of the WINCART Center:
• Identify multilevel cancer health needs and resources of the communities
• Develop and implement programs to increase cancer awareness among PI from primarily five populations in Southern California: Chamorros, Marshallese, Native Hawaiians, Samoans and Tongans
• Disseminate best practices

The WINCART Center uses a CBPR approach in all Center projects, including the Pacific Islander Colorectal Cancer Education Campaign. All WINCART academic and community partners are treated as equal partners in the development, implementation, evaluation, and dissemination of cancer research and educational activities. The WINCART Center is guided by a Steering Committee that is made up of representatives from PI community-based organizations, cancer researchers, and cancer clinical providers. Specifically, the WINCART Center Steering Committee is responsible for key decisions and actions related to the overall direction and implementation of network activities, including setting policies, providing core and project guidance, and supporting project-centered activities.

The WINCART Center is divided into four Cores – 1) Administrative Core, 2) Community Outreach Core, 3) Research Core, and 4) Training Core. The Pacific Islander Colorectal Cancer Toolkit and all accompanying materials are products of the Community Outreach Core, The overarching goal of the Community Outreach Core is to facilitate an increase in knowledge of, access to, and use of beneficial biomedical and behavioral procedures in cancer disparities.

Since its inception in 2005, WINCART has achieved the following:
• Conducted needs assessments on substance abuse behaviors, health communications, and acculturation among young adult PIs
• Led a pilot study that explored knowledge, attitudes, and behaviors towards biospecimen donation among adult PIs
• Provided cancer-related patient navigation services to PI community members to help bridge the gap between cancer education and improved patient care
• Conducted outreach at various PI venues to promote cancer screening, healthy and active living, and biospecimen research and clinical trials
• Informed policymakers on the need for PI-specific data and resources for reducing cancer disparities and improving health status
• Mentored and training trainees at the masters, pre-doctoral, and post-doctoral career level to conduct cancer disparities research in PI population
• Developed, implemented and evaluated a community-tailored PI Colorectal Cancer Education Campaign
• Developed and implemented a culturally-attuned, online tobacco cessation program for young adult PI smokers to address the high disparity in tobacco use
• Developed, implemented, and evaluated the Let’s Move Program, a physical activity program designed to encourage Pacific Islander groups and organizations to engage in regular physical activity
• Developed, implemented, and evaluated a biospecimen education and collection project for PI adults

Together, we are working to promote community education, research, and training Southern California’s PI communities.


8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

The WINCART Center utilized a CBPR approach for choosing a topic for their educational campaign. This iterative process involved three perspectives – scientific perspective, community perspective, and WINCART Workgroup perspective. The WINCART Advisory Board recommended three different programs: 1) Every Woman Counts! Program, 2) Breast Cancer Treatment Fund, and 3) Existing evidence-based programs that could be adapted for PIs. The community had two requests: 1) address a cancer affecting both men and woman and equally, and 2) address a cancer where there was no existing access or services. The WINCART Workgroup, comprised of community leaders from PI communities (Chamorro, Marshallese, Native Hawaiian, Samoan, and Tongan),were directly involved in the development, planning and implementation of the educational campaign. They were charged to: 1) recommend appropriate mechanisms to outreach and educate community members on CRC, 2) advise in the design and pre-testing of campaign materials, 3) advise in the testing of the appeal, cultural appropriateness and impact of the campaign, and 4) update WINCART members on the progress of efforts and request feedback. American Community Survey data for PI males and females in California and Los Angeles found that colorectal cancer was the 3rd most common cancer for PI males in California and Los Angeles and 4th most common cancer for PI females in California and Los Angeles. Based off American Community Survey data and anecdotal experiences from the community, the WINCART Workgroup recommended CRC to be the main focus of the educational campaign.

A CRC flipchart, bookmark and public service announcement were developed and served as the main educational tools for the campaign, each of which illustrated two key messages - 1) ask your doctor about colorectal cancer screening and 2) do it for your family and yourself. The workgroup also led the campaign through Kreuter’s evidence-based cultural-tailoring techniques, including:
• Constituent involvement – utilizing a CBPR approach to encourage equitable participation and equal value among academic and community participant contributions,
• Peripheral images – using PI pictures, colors and patterns,
• Evidential statements – including PI-specific statistics,
• Linguistics – providing materials that are translated into the various PI languages, and
• Sociocultural cues – incorporating references to family and the community.

Through the efforts of the workgroup, Community Advisory Board and scientific advisory board, the Pacific Islander Colorectal Cancer Education Toolkit was created, containing all educational and evaluation materials.

The WINCART Pacific Islander Colorectal Cancer Education Toolkit is a 14-page booklet that consists of: a) an overview of the campaign, including the approach for identifying the need, methodology and strategies; b) background and statistics of CRC among PIs; c) process and results from pre-testing the messages and pilot testing the toolkit; d) strategies for reporting back to the PI community; and e) copies of materials for dissemination and replication to organizations and providers. The toolkit is a how-to-guide of evidence based strategies in reducing health disparities. The toolkit development process was led by the WINCART workgroup and in close collaboration with all the WINCART Scientific Advisory Board and with final review and approval of the WINCART Center Steering Committee.

In November 2010, the toolkit was made available both electronically and printed, and distributed to PI organizations and groups via WINCART’s community dissemination efforts.


9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

The WINCART Workgroup evaluated education materials via lay-leader led education sessions with small groups of adult PIs age 50 years and older. The evaluation was done as a quasi-experimental design to evaluate the tailored materials compared to a non-tailored handout of information (based on the National Cancer Institute’s "What You Need To Know About handouts). A pre-, post-, and follow-up survey was developed to test the efficacy of the CRC educational campaign. Self-administered pre- and post- workshop surveys were utilized to assess changes in knowledge, beliefs and intentions. The overall change in knowledge was greater for participants who received the community-tailored materials (n=27) compared to those who received non-tailored materials (n=53).

The Pacific Islander Colorectal Cancer Education Toolkit was disseminated to health educators, community organizations, and health professionals who work with PI communities. Through a partnership between WINCART and St. Joseph's Hospital in Orange (California), St. Joseph's was able to expand their CRC education and follow-up via PI patient navigators. In addition, the toolkit was disseminated to other Native Hawaiian and PI-serving CBPR centers, including Imi Hale at the University of Hawaii. Imi Hale has recently revised the layout of the Flipchart and reprinted for use by clinicians and health educators to use in Hawaii.


10. Please describe why you chose the presentation format you did.

The WINCART Center decided to compile all of the PI CRC education materials together into a toolkit because of its versatility for dissemination to PIs outside of Southern California. We have both print and electronic versions of the toolkit available. Given the variety of educational and evaluation materials that comprised the PI CRC education campaign, it was decided that the best way to package them all up into one product was to include them in a toolkit. The three educational tools - bookmark, flipchart and public service announcements - allowed WINCART to community and linguistically tailor the education to make it relevant and appealing to the PI communities. The flipchart is easy to use in a community or clinic setting, making it both versatile and practical.


11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

The WINCART Center is proud to say that their Pacific Islander Colorectal Cancer Education Toolkit utilized a CBPR approach to ensure that all final products are community tailored and community-informed. Through the guidance of the Workgroup and feedback from the WINCART Community Advisory Board and WINCART Scientific Advisory Board, creating the toolkit was truly a collaborative effort.

Additionally, in-language focus group discussions with adult PIs age 50+ years were conducted to gather feedback on the readability of the written materials and surveys; acceptability of colors, fonts and images; clarity of educational messages; appropriateness of sensitive information; and suggestions for improvement.

Strengths of Pacific Islander Colorectal Cancer Education Toolkit include:
• Community tailored, community informed and data driven
• Addresses one of the top 5 cancers affecting PI men and women
• Fills gap of lack of tailored CRC educational materials and resources

Limitations of the toolkit include inability to address larger access to primary care barriers (hence the focus on promoting communication with current providers), focus on PIs in Southern California (hence terminology and context not applicable to community members in Hawaii or other states), and applicability for non-PIs (given the tailoring of images, language, etc).


12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

The principles of CBPR were used in the development, testing, implementation and dissemination of the PI CRC Campaign. These principles included close partnerships between community members and academic researchers in all phases of study design, intervention development, collection and interpretation of data, and the dissemination of results. Development of the Pacific Islander Colorectal Cancer Toolkit involved a series of meetings with the WINCART workgroup, WINCART Community Advisory Board, WINCART Center Steering Committee and Scientific Advisory Board members, to maximize cultural sensitivity and appropriateness of all materials.

The final product, the Pacific Islander Colorectal Cancer Toolkit, was presented by the WINCART workgroup and reviewed and approved by WINCART Center Steering Committee, which consists of academic, community, and clinical partners. Additionally, all community and academic partners of the WINCART Center reviewed the application and provided feedback in the phases leading up to the final submission.

The WINCART Pacific Islander Colorectal Cancer Education Campaign was IRB approved by California State University, Fullerton (Application Number HSR-HSR-09-0129) on March 26, 2009.