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  1. Development of a Tailored Interactive Multimedia Intervention to increase Colorectal Cancer Screening among Hispanics along Texas-Mexico BorderMaría E. Fernández, Ph.D.The University of Texas, School of Public Health

  2. RESEARCH TEAM This project is supported by Cooperative Agreement Number U48 DP000057 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention

  3. OVERVIEW • Formative Research • Intervention Planning using • Intervention Mapping • Brief Description of Program • Evaluation

  4. STUDY SETTING The study sites are colonias along the Texas-Mexico border: the formative work was conducted in El Paso County, (El Paso), Cameron County (Brownsville), and Webb County (Laredo); the intervention trial will be carried out in the LRGV. Colonias are unincorporated, un-zoned, semi-rural communities often without access to public drinking water or wastewater systems. Individuals living in colonias have high rates of poverty, unemployment, and low education levels.

  5. FORMATIVE RESEARCH • Qualitative Study • 12 Focus Groups: 5 with men, 6 with women, 1 with promotoras • Colonias of the El Paso, Laredo, & Brownsville regions • Interview guide question categories- Knowledge, Experience, CRCS behavior • Eligibility: Hispanic/Latino, 50+, No prior/current cancer diagnosis • Recruitment: Flyers, Word of mouth, Local colonia churches, Promotoras • Audio-taped sessions were transcribed, translated, and back-translated • Qualitative analysis using Atlas.ti

  6. FORMATIVE RESEARCH • Survey • Face to face interviews with 544 men and women • Colonias of the El Paso, Laredo, & Brownsville • Eligibility: Hispanic/Latino, 50+, no prior/current cancer diagnosis • Recruitment: Flyers, Word of mouth, Local colonia churches, Promotoras • The survey was conducted in Spanishincluded items assessing: demographics, colorectal cancer screening behaviors, Knowledge, Perceived Susceptibility/Risk, Intentions, Self Efficacy, Decisional Balance, Subject Norms, Social Norms, Fatalism, Acculturation

  7. FORMATIVE RESEARCH “If the doctor would tell me to do it, the yes… (I would get tested)” “ “It is because of ignorance….one does not ask to be screened because she does not know that she should do it, because one does not know the importance of being screened.”

  8. FORMATIVE RESEARCH “If it is outside the skin, I think it can be cured.” “..there are two types of cancer, but the one that you cannot feel or detect, “the silent one,” is the one that kills you quickly “ “No, what I tell you is that cancer is a bad disease, very ugly for the people who have it, almost always there is no cure. It is very rare to hear that one has been saved from cancer… it is a terrible disease.”



  11. FORMATIVE RESEARCHFindings- CRCS Behavior (Survey findings)

  12. FORMATIVE RESEARCHSurvey Findings- Determinants of CRCS Behavior


  14. INTERVENTION MAPPINGMatrix of Change Objectives

  15. INTERVENTION MAPPINGMethods and Strategies


  17. Tailored Interactive Multimedia InterventionWhyTIMI ? • Engages user in active learning • Individualized, user his/her own pace • Audio and Video facilitate learning in low literacy populations • Little training required • Reduces promotora burden • Easy to Disseminate

  18. Tailored Interactive Multimedia InterventionFlowchart

  19. Tailored Interactive Multimedia InterventionFlowchart

  20. Tailored Interactive Multimedia InterventionFlowchart

  21. Tailored Interactive Multimedia Intervention Intervention with moving video (novela type story and testimonials), audio, graphics, animation, stills, and interactive educational segments. Targeted for: Hispanics Low literacy level Low education Tailored to: Gender Language preference Awareness of CRCS Individual Stage of Change Attitudes about screening Knowledge Specific barriers Interactive: Allows participants to choose topics of interest Allows participant to follow own learning pace Gives individualized feedback Provides decision support

  22. Tailored Interactive Multimedia InterventionVale La Pena…..Prevenir

  23. Vale La Pena…..Prevenir‘Telenovela’ Style

  24. Vale La Pena…..PrevenirInteractive Segment REASONS TO GET TESTED FOR COLORECTAL CANCER Colorectal cancer can be cured! To live a long life For my family To do things I’ve planned To prevent treatments and feeling ill To prevent cancer

  25. Vale La Pena…..Prevenir

  26. Study Design

  27. Tailored Interactive Multimedia InterventionIntervention Delivery • Lay Health Worker • Laptop Computer with Stylus • Home Visit

  28. Planned Activities