Multilevel socioecological determinants of colorectal cancer screening among American Indian communities in New Mexico

Abstract

Purpose: Low rates of colorectal cancer (CRC) screening and persistent racial disparities in CRC incidence and mortality among American Indian communities present an urgent public health concern in the United States. Although several evidence-based interventions exist for CRC screening, a gap remains in understanding how these interventions could be effectively implemented in American Indian communities given local contextual factors and preferences.

Methods: Using a community-based participatory research approach, we worked with two American Indian communities and their tribally operated healthcare facilities in New Mexico. To better understand the implementation context within each community, we conducted focus group discussions with two groups of stakeholders: (1) community members and (2) staff, providers, and physicians (collectively referred to as "healthcare professionals") who worked in the tribally operated healthcare facilities. We conducted our analysis of transcripts and notes from these discussions using a grounded theory approach to examine factors according to the multilevel influences on cancer care delivery.

Results: We convened six focus groups and listening sessions with healthcare professionals (n = 15) and community members (n = 65) from the two tribal communities in New Mexico. Participants described key factors likely to influence the implementation and uptake of CRC screening interventions in their communities across three ecological levels. From an individual perspective, several participants mentioned understanding the importance of screening as a cancer prevention intervention, even when individuals perceived themselves to be healthy. Interpersonally, participants highlighted the crucial role of provider recommendations around screening and indicated that listening to individuals share their personal healthcare experiences motivated the community members to get screened. Finally, from a healthcare system perspective, many providers mentioned the need for improved technology and care coordination to support the healthcare delivery within clinical settings to improve CRC screening rates.

Conclusions: Engaging community members and providers through a community-based participatory research approach allowed us to identify key determinants for the successful implementation of CRC screening interventions in tribal communities. Future research will examine the effectiveness and implementation of the multicomponent, multilevel interventions and strategies for improving CRC screening rates in tribal communities in New Mexico.

Keywords: American Indian; Colorectal cancer; Community-based participatory research; Implementation science; Multilevel analysis; Qualitative research; Screening.

Fig. 1

Key findings from the study displayed on the multilevel model of cancer care delivery