R01CA248981

Identifying Multi-Level Barriers and Facilitators to Digital Health Use in Federally Qualified Health Centers - Project Summary/Abstract

Colorectal cancer (CRC) is a leading cause of cancer death in the United States. National guidelines recommend that average risk people receive regular CRC screenings. Community health centers, such as Federally Qualified Health Centers (FQHCs), provide high-quality affordable healthcare to underserved populations across the nation. Among patients treated at FQHCs, only 44% have completed a CRC screening within the recommended timeframe (e.g., one colonoscopy per ten years).

Patient navigation has proven effective for improving CRC screening completion rates and screening quality. The effects of patient navigation are robust across socioeconomic status and racial/ethnic groups. Furthermore, extensive research has proven its efficacy in FQHC settings. Although efficacious, patient navigation requires staffing and economic resources, limiting its ability to be widely disseminated, particularly in low-resourced settings like FQHCs.

The proposed study aims to refine and test a digital health solution, called the eNav Toolkit, designed to improve CRC screening uptake among patients treated at FQHCs. The eNav Toolkit will be a web app that will assist with CRC screening decision making, appointment reminders, preparation instructions/reminders, education, motivational interviewing support, and linkage to follow-up care. In order to maximize reach, the eNav Toolkit will be accessible on any smartphone, tablet, or computer device.

For Aim 1, the eNav Toolkit 1.0 will be field-tested on 10 participants. Participants will be FQHC patients eligible for CRC screening. The field test results will be applied to refine the eNav content and improve the user experience. The second iteration of the intervention, eNav Toolkit 2.0, will then be field-tested on a new set of 10 participants. The results from the second field test will be applied to refine and finalize the eNav Toolkit.

Aim 2 will conduct a multi-site randomized clinical trial to evaluate the efficacy of the eNav Toolkit for improving CRC screening uptake among patients treated at FQHCs. Patients (N=400) will be randomly assigned to one of two conditions: eNav Toolkit group (N=200) or usual care group (N=200). Participants in the eNav Toolkit group will engage with the eNav Toolkit to assist in preparing for and completing the CRC screening. Participants in the usual care group will receive usual care. Primary outcomes (CRC screening completion) and secondary outcomes (CRC screening quality, follow-up adherence) will be evaluated at six months after study enrollment.

Aim 3 will evaluate theoretical mechanisms of change (e.g., perceived benefits, perceived barriers, perceived susceptibility, self-efficacy), guided by the Health Belief Model. If proven efficacious, the eNav Toolkit will be integrated into the electronic health record (EHR) and disseminated across FQHCs nationwide, with the ultimate goal of decreasing the burden of CRC among patients treated at FQHCs.

Icahn School Of Medicine At Mount Sinai

TO IDENTIFY CANCER RISKS AND RISK REDUCTION STRATEGIES, TO IDENTIFY FACTORS THAT CAUSE CANCER IN HUMANS, AND TO DISCOVER AND DEVELOP MECHANISMS FOR CANCER PREVENTION AND PREVENTIVE INTERVENTIONS IN HUMANS. RESEARCH PROGRAMS INCLUDE: (1) CHEMICAL, PHYSICAL AND MOLECULAR CARCINOGENESIS; (2) SCREENING, EARLY DETECTION AND RISK ASSESSMENT, INCLUDING BIOMARKER DISCOVERY, DEVELOPMENT AND VALIDATION; (3) EPIDEMIOLOGY; (4) NUTRITION AND BIOACTIVE FOOD COMPONENTS; (5) IMMUNOLOGY AND VACCINES; (6) FIELD STUDIES AND STATISTICS; (7) CANCER CHEMOPREVENTION AND INTERCEPTION; (8) PRE-CLINICAL AND CLINICAL AGENT DEVELOPMENT; (9) ORGAN SITE STUDIES AND CLINICAL TRIALS; (10) HEALTH-RELATED QUALITY OF LIFE AND PATIENT-CENTERED OUTCOMES; AND (11) SUPPORTIVE CARE AND MANAGEMENT OF SYMPTOMS AND TOXICITIES. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM; TO STIMULATE TECHNICAL INNOVATION; TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING; TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT; AND TO FOSTER AND ENCOURAGE PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY WOMEN AND SOCIALLY/ECONOMICALLY DISADVANTAGED PERSONS.SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS; TO FOSTER TECHNOLOGY TRANSFER THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS; TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING, AND FOSTER PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY WOMEN AND SOCIALLY/ECONOMICALLY DISADVANTAGED PERSONS.

93.393 - Cancer Cause and Prevention Research

National Cancer Institute (NCI) [HHS - NIH]

New York, New York 100296504 United States

Single Zip Code

Increasing Uptake of Evidence-Based Screening in Diverse Adult Populations (R01 Clinical Trial Optional) (PA-18-932)

Amendment Since initial award the End Date has been extended from 03/31/26 to 03/31/27 and the total obligations have increased 383% from $692,818 to $3,348,072.