Adsul Prajakta, Kanabar Nidhi, Rodman Joseph, English Kevin, Jim Cheyenne, Pankratz Vernon Shane, Edwardson Nicholas, Charlie Jimmie, Pagett John, Trujillo Jonathan, Grisel-Cambridge Jillian, Mora Steven, Yepa Kaitlyn L, Mishra Shiraz I
Cancer Control and Populations Sciences Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
Department of Internal Medicine, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Cancer Causes Control. 2025 Apr 25. doi: 10.1007/s10552-025-01993-6.
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.
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.
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.
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.
美国印第安社区中结直肠癌（CRC）筛查率较低，且CRC发病率和死亡率方面存在持续的种族差异，这在美国是一个紧迫的公共卫生问题。尽管存在几种基于证据的CRC筛查干预措施，但鉴于当地的背景因素和偏好，在理解如何在美国印第安社区有效实施这些干预措施方面仍存在差距。
我们采用基于社区的参与性研究方法，与新墨西哥州的两个美国印第安社区及其部落运营的医疗保健机构合作。为了更好地了解每个社区内的实施背景，我们与两组利益相关者进行了焦点小组讨论：（1）社区成员，以及（2）在部落运营的医疗保健机构工作的工作人员、提供者和医生（统称为“医疗保健专业人员”）。我们使用扎根理论方法对这些讨论的记录和笔记进行分析，以根据对癌症护理提供的多层次影响来检查因素。
我们与新墨西哥州两个部落社区的医疗保健专业人员（n = 15）和社区成员（n = 65）召开了六次焦点小组会议和听证会。参与者描述了可能在三个生态层面影响其社区中CRC筛查干预措施实施和采用的关键因素。从个人角度来看，几位参与者提到理解筛查作为癌症预防干预措施的重要性，即使个人认为自己健康。在人际层面，参与者强调了提供者关于筛查的建议的关键作用，并表示倾听个人分享他们的个人医疗保健经历促使社区成员接受筛查。最后，从医疗保健系统的角度来看，许多提供者提到需要改进技术和护理协调，以支持临床环境中的医疗保健提供，以提高CRC筛查率。
通过基于社区的参与性研究方法让社区成员和提供者参与进来，使我们能够确定在部落社区成功实施CRC筛查干预措施的关键决定因素。未来的研究将检查多成分、多层次干预措施和策略在提高新墨西哥州部落社区CRC筛查率方面的有效性和实施情况。
