Impact of Spanish Language Outreach on Multi-Target Stool DNA Test Adherence in a Federally Qualified Health Center in the United States

Abstract

IntroductionThe objective of the current study was to examine the impact of Spanish-language patient outreach and navigation services on adherence to initial colorectal cancer (CRC) screening with multitarget stool DNA (mt-sDNA) testing in a predominantly Spanish-speaking patient population receiving care at Federally Qualified Health Centers (FQHCs).MethodThis study included patients aged 45 years or older who identified as Hispanic from FQHCs in a California Health System who were new to mt-sDNA testing and shipped a Cologuard® collection kit between 10-1-2022, and 1-1-2024. Patient outreach was provided only in English prior to 1-22-2023 (pre-intervention period). From 1-23-2023, onward, patient outreach was offered in either English or Spanish based on the patients' preferred language selection (post-intervention period). Patients were classified into two subgroups: Spanish language preference (SLP) or non-Spanish language preference (NSLP). It was hypothesized that adherence would be greater in SLP patients when patient outreach was provided in Spanish compared to the NSLP.ResultsThe final sample comprised 20 341 Hispanic patients who met the study criteria, comprising 15 702 patients with SLP and 4639 with NSLP, stratified across pre- and post-intervention periods. Overall, adherence to initial mt-sDNA testing within 180 days following the index date was 51.4% for SLP patients and 41.3% for NSLP patients, with a significant post-intervention improvement observed after the intervention for SLP patients (47.1% to 52.7%, P < .001), compared to a non-significant improvement (40.7% to 41.4%, P = .713) among NSLP patients.DiscussionFollowing the introduction of Spanish-language patient outreach, adherence to mt-sDNA testing improved significantly among SLP patients. The preference of Hispanic individuals for stool-based tests, combined with the non-invasive nature of mt-sDNA testing, supports its suitability as a CRC screening option for this population.

Keywords: Hispanic; adherence; colorectal cancer; health disparities; mt-sDNA.

Figure 1.

Predicted Adherence Rates Pre- and Post-Implementation of Spanish Outreach.