Research

Our Research:

Community Based Participatory Research (CBPR) and community engaged approaches are foundational to our research. These perspectives inform our methodologies by working with our community partners to address their concerns. CBPR recognizes the strength of community members who work as equal partners with our research team. Key elements of our research are attention to culture, literacy, and language to activate patient behaviors.

To break down each of our studies, we will be answering the following questions: 1) What was the need? 2) How were community members involved? 3) What did we do? 4) What were the outcomes?

CARES

CARES (Colorectal Cancer Awareness, Research, Education and Screening) Study. This community clinic-based study that helps reduce the barriers to colorectal cancer screening among medically underserved, racially/ethnically diverse populations

  • What was the need?
    • To increase colorectal cancer screenings (CRC) among medically underserved, racially/ethnically diverse populations. The CARES study sought to enroll 420 men and women aged 50 to 75 years who were not up to date on CRC screening and sought  care at community clinics in Pasco and Pinellas counties.
  • How were community members involved?
    • Served on the community advisory board, assisted in the development of the educational materials, help operationalize research studies at clinics, assisted in training of staff, facilitated recruitment strategies for accrual of patients, participated in publications, presentations, and other dissemination research activities.
  • What did we do?
    • Participants were randomized into a standard intervention or a new culturally tailored intervention. The standard intervention consisted of standard educational materials, a Centers for Disease Control and Prevention (CDC) tri-fold brochure, about colorectal cancer screening. The culturally tailored intervention consisted of newly developed photo novella booklet and a DVD, about colorectal cancer screening. All participants regardless of intervention arm received a stool kit which is also referred to as Immunochemical Fecal Occult Blood Test (iFOBT) that they took home and mailed back to us at Moffitt Cancer Center.
  • What were the outcomes?
    • As part of this project, we developed English-language educational materials: Colorectal Cancer: Prevention Begins at Home. To view the materials click here.
    • High screening uptake (81%) exceeding the clinics baseline screening rates (18%-35%), surpassing the Healthy People 2020 target of 70% as well as the CDC’s goal of 80%. 21 abnormal FIT resolved,16 colonoscopies completed, 1 cancer found and the remainder resolved through clinic usual care practice.
    • Participating clinic partners adopted the use of a one-time FIT in their practice.
    • Clinic partners became invested in utilizing the CARES educational interventions which successfully promoted patients’ screening.
  • Publications
    • Davis, S. N., Christy, S. M., Chavarria, E., Abdulla, R., Sutton, S. K., Schmidt, A., Vadaparampil, S. T., Quinn, G. P., Simmons, V. N., Ufondu, C., Ravindra, C., Schultz, I., Roetzheim, R., Shibata, D., Meade, C. D., & Gwede, C. K. (2017). A randomized controlled trial of a multi-component targeted low-literacy educational intervention compared with a non-targeted intervention to boost colorectal cancer screening with fecal immunochemical test in community clinics. Cancer, 123, 1390-1400. PMID: 27906448; doi: 10.1002/cncr.30481
    • Christy, S. M., Schmidt, A., Wang, H. L., Sutton, S. K., Davis, S. N., Chavarria, E., Abdulla, R., Quinn, G. P., Vadaparampil, S. T., Schultz, I., Roetzheim, R., Shibata, D., Meade, C. D., & Gwede, C. K. (2018). Understanding cancer worry among patients in a community clinic-based colorectal cancer screening intervention study. Nursing Research. 2018 Jun 4. doi: 10.1097/NNR.0000000000000275. [Epub ahead of print]
    • Christy, S. M., Gwede, C. K., Sutton, S. K., Chavarria, E., Davis, S. N., Abdulla, R., Ravindra, C., Schultz, I., Roetzheim, R., & Meade, C. D. (2017). Health literacy among medically-underserved: The role of demographic factors, social influence, and religious beliefs. Journal of Health Communication, 22, 923-931. PMID: 29125435; doi: 10.1080/10810730.2017.1377322
    • Christy, S. M., Sutton, S. K., Gwede, C. K., Chavarria, E. A., Davis, S. N., Abdulla, R., Schultz, I., Roetzheim, R., Shibata, D., & Meade, C. D. (2017). Examining the durability of colorectal cancer screening awareness and health beliefs among medically underserved patients: Baseline to 12 months post-intervention. Journal of Cancer Education. 2017 Nov 25 [epub ahead of print]. PMID: 29177920; doi: 10.1007/s13187-017-1301-9

Latinos CARES

Latinos CARES study was a community-based study in 2 Tampa Bay area Federally Qualified Health Centers (FQHCs), the study was conducted to take a recently developed English language CRC educational toolkit and transcreated for Spanish language preferring patients in community health clinics.  

  • What was the need?
    • To provide colorectal cancer education  among Hispanic individuals who reported a preference for receiving colorectal cancer education  in Spanish.
      • To provide a iFOBT Kit and instructions in Spanish for individuals who reported a preference for Spanish language.
  • How were community members involved?
    • Served on the community advisory board, assisted in the development of the educational materials, facilitated recruitment strategies for accrual of patients, participated in publications, presentations and other dissemination research activities .
  • What did we do?
    • Produced a culturally relevant toolkit (consisting of a photo novella booklet and DVD) targeted for Latinos. The study assesses the efficacy of the Latinos toolkit on increased colorectal cancer screening uptake using the iFOBT (immunochemical fecal occult blood test). Introducing FIT screening test to clinics (n=76) and produced screening rates of 87%. The research study addresses disparities among Latino populations attending community-based clinics in the Tampa Bay area.
  • What were the outcomes? 
    • As part of this project, we developed Spanish-language materials (both booklet and DVD) that is easy to understand, salient, and culturally suitable for the Latinos population: Un examen sencillo para un colon saludable (A simple exam for a healthy colon). To view the materials, click here.
    • Educational materials were readily available for dissemination at all clinic locations as needed
    • Overall screening uptake is high (87%) which surpasses the Healthy People 2020 target of 70% as well as the Centers for Disease and Control and Prevention (CDC’s) goal of 80%. 1 abnormal FIT, colonoscopy preformed, no cancers found. Patients would receive follow up colonoscopy as needed.
  • Publications
    • Aguado Loi CX, Martinez Tyson D, Chavarria EA, Gutierrez L, Klasko L, Davis S, Lopez D, Johns T, Meade CD, Gwede CK. ‘Simple and easy:’ providers’ and latinos’ perceptions of the fecal immunochemical test (FIT) for colorectal cancer screening. Ethn Health. 2020 Feb;25(2):206-221. doi: 10.1080/13557858.2017.1418298. Epub 2018 Jan 10. PMID: 29319331; PMCID: PMC6513709.
    • Chavarria E, Abdulla R, Gutierrez L, Klasko L, Martinez Tyson D, Aguado Loi C, Sanchez J, Meade CD, Gwede CK. (abstract submitted 6/20/16) A culturally-linguistically salient intervention to increase fecal immunochemical test uptake among Spanish-preferring Latino adults receiving care in community-based clinics. Ninth American Association for Cancer Research (AACR) Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, September 25-28, 2016, Fort Lauderdale, FL.
    • Christy, S. M. (co-first author), Cousin, L. A. (co-first author), Sutton, S. K., Chavarria, E. A., Abdulla, R., Sanchez, J., Lopez, D., Gwede, C. K. (co-senior author), & Meade, C. D. (co-senior author) (2021). Characterizing health literacy among Spanish language-preferring Latinos ages 50-75. Nursing Research. doi: 0.1097/NNR.0000000000000519.

Community CARES

Community CARES: A Multilevel Intervention to Increase Colorectal Cancer Screening Adherence In Community Clinics. A community clinic-based intervention that helps reduce barriers to colorectal cancer screening among medically underserved individuals ages 50-75 years old English or Spanish as the preferred language. 

  • What was the need?
    • To increase Colorectal cancer (CRC) screening and adherence to screening over time using coaching for participants that haven’t returned a FIT Kit
    • How were community members involved?          
      • Community members are involved through the Community Advisory Board (CAB) and oversee research activities, establish priorities, and review the intervention components.
  • How were community members involved?
    • Served on the community advisory board and helped to oversee research activities, establish priorities, facilitated recruitment strategies for accrual of patients, participated in publications, presentations, and other dissemination research activities.
  • What did we do?
    • Test whether the improves long term FIT (Fecal Immunochemical Test) Kit adherence among people not up to date with CRC screening.
    • Coaching –participants that had not returned their FIT within 90 days received structured telephone interaction, with guided discussion about any obstacles and barriers to make sure different strategies are addressed in order to complete a FIT Kit and be up to date with colorectal cancer screening.
  • What were the outcomes?
    • Overall FIT uptake rate = 69%
  • Publications
    • A multilevel, low literacy dual language intervention to promote colorectal cancer screening in community clinics in Florida: A randomized controlled trial.
    • Christy SM, Sutton SK, Abdulla R, Boxtha C, Gonzalez P, Cousin L, Ewing A, Montoya S, Lopez D, Beehler T, Sanchez J, Carvajal R, Meade CD, Gwede CK. Prev Med. 2022 Mar 16:107021. doi: 10.1016/j.ypmed.2022.107021. Online ahead of print. PMID: 35305995

CARES-REACH

The CARES-REACH (Colorectal Cancer Awareness, Research, Education and Screening-Rural Expansion, Access and Capacity for Health) study where Moffitt is partnering with two Federally Qualified rural/urban clinic organizations, Central Florida Health Care and Manatee County Rural Health, to carry out a CRC screening study that includes organizational, provider, and patient-level processes to boost CRC screening using Fecal Immunochemical Test (FIT) kits among adults ages 50-75 who are at average risk for CRC

  • What was the need?
    • To speed up the adoption of effective CRC screening in clinics (rural and urban) in Central & SW Florida with attention on repeat screening.
  • How were community members involved?
    • Serve on the Cancer Control Implementation Advisory Board (CC-IAB) that provides the leadership and decision-making procedures concerning our implementation research. The CC-IAB is enriched by the key tenets of Community Based Participatory Research.
  • What did we do?
    • CARES-REACH is an important step in bringing new opportunities and significant promise for community impact by speeding up delivery of a life-saving intervention. This is guided by implementation science theory and emphasizes real world relevancy to build on what works to achieve sustainability.
    • This study involves delivering a core set of evidence-based interventions (EBIs) into practice. These EBIs include language specific/low literacy patient education, provider awareness, system wide Electronic Medical Records (EMR) tools and prompts, and FIT distribution plus an organization wide Cancer Control Champion who motivates providers and educates patients.
  • What were the outcomes? 
    • As a part of the CARES-REACH study to date we have completed a number of preparatory activities including: designing educational materials, conducting trainings needed for the success of the study, and appointing a Community Advisory Board (CAB) and kicked off our initial meeting to start working behind the scenes to develop the needed materials.
    • We have also just begun the implementation portion of the CARES-REACH study, thanks to the significant investment and full participation of our clinic and hospital partners. This includes training providers, preparing the champions for navigation of patients, collected year 1 data, and we are looking forward to continuing this study with our partners.
  • Publications
    • Coming Soon

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