1) A 15-minute video on colorectal cancer screening was developed in Spanish for the El Paso area based on behavioral theory. It will be adapted for a rural West Texas population using focus group feedback and intervention mapping. 2) Focus groups with rural residents identified barriers like long travel distances, work schedules, and lack of insurance. Facilitators included a promotora presentation with a flip chart. 3) The video and flip chart will be modified to reflect the people, places, and barriers of rural West Texas based on the focus group research. Intervention mapping will guide the adaptation process.

1. 1) Video Developed in El Paso Behavioral theory based 15 minute video developed
and filmed in Spanish with an English version voiced over. Actors all staff
at TTUHSC-El Paso. Well received.
2) Promotora Identical information presented with the aid of a flip chart.
Adapting Colorectal Cancer Screening Education for the Rural West Texas Population
• Colorectal cancer (CRC) is the second leading cause of
cancer related deaths in the US, and screening is widely
recommended with three main tests:
− Guaiac or immunochemical based fecal occult blood
test (FIT)
− Flexible Sigmopidoscopy
− Colonoscopy
• However, CRC screening rates remain low, especially
among Hispanics, rural residents, and low
socioeconomic groups
• Strategies to increase screening in these groups are
needed
Purpose Adapt the ACCION program which has been
successful in El Paso for the rural population
in Lubbock and the surrounding counties
Method Used focus group interviews with rural
residents to understand barriers to and
facilitators for CRC screening, and will use
Intervention Mapping methods to adapt the
ACCION program
Setting Community and clinic sites in 9 rural counties
(Crosby, Floyd, Garza, Hale, Hockley, Lamb,
Lubbock, Lynn, Terry)
Inclusion Criteria
• 50 – 75 years old
• Living in a rural community
Introduction What will be modified?
Theresa L. Byrd, Dr PH; Navkiran Shokar, MD MPH; Liesl Wyett, MPA; Chip Shaw, EdD
Texas Tech University Health Sciences Center- Graduate School of Biomedical Sciences, Department of Public Health
What we heard
Focus group results
Methods
 We have completed 4 focus groups (Lubbock,
Hale, Hockley, Lamb). Four more groups will be
completed in November. We had:
 15 participants; 9 female and 6 male
 7 uninsured
 Average age 61 (50-85)
 Participants were given a $10 gift card for their
participation
Most of the barriers were the same in both El
Paso and West Texas, especially among the
Hispanic population: cost, lack of insurance, fear,
not wanting to know something might be wrong,
embarrassment. Some that were unique or much
stronger in West Texas were:
 Long distance transportation issues
 Work schedule issues
 Farmers’ independent spirit
 Oil field workers not insured
 More common that people had not heard of
CRC or screening
 Indigent care plans have lower percent of
poverty scores in the rural counties (21% of
poverty)
 Some counties with no health care services
How will modifications be done?
What kinds of changes ?
1) Video We will change the look of the video to reflect the people and places of
rural West Texas. We will use data from the focus groups to determine
how the script should be changed to reflect the barriers and
facilitators in this community.
2) Promotora The flip chart will also be adapted based on the changes in the video
We will use Intervention Mapping* to adapt the
video and flipchart:
◦ Form a planning group including people
from the community we will serve.
◦ Assess matrices of determinants
◦ Select theoretical methods and strategies
◦ Re-write script
◦ Pilot with story board
◦ Re-shoot video
*Bartholomew LK, Parcel GS, Kok G, Gottlieb NH,
Fernandez ME. (2011)Planning Health Promotion
Programs: An intervention mapping approach. Josey-
Bass, San Francisco