Examining Factors Influencing Colorectal Cancer Screening of Rural Nebraskans Using Data from Clinics Participating in an Accountable Care Organization: A Study Protocol.

BACKGROUND: Although mortality rates of colorectal cancer (CRC) can be significantly reduced through increased screening, rural communities are still experiencing lower rates of screening compared to urban counterparts. Understanding and eliminating barriers to cancer screening will decrease cancer burden and lead to substantial gains in quality and quantity of life for rural populations. However, existing studies have shown inconsistent findings and fail to address how contextual and provider-level factors impact CRC screening in addition to individual-level factors. PURPOSE: The purpose of the study is to examine multi-level factors related to CRC screening, and providers\u27 perception of barriers and facilitators of CRC screening in rural patients cared for by accountable care organization (ACO) clinics. METHODS/DESIGN: This is a convergent mixed method design. For the quantitative component, multiple data sources, such as electronic health records (EHRs), Area Resource File (ARF), and provider survey data, will be used to examine patient-, provider-, clinic-, and county-level factors. About 21,729 rural patients aged between 50 and 75 years who visited the participating ACO clinics in the past 12 months are included in the quantitative analysis. The qualitative methods include semi-structured in-depth interviews with healthcare professionals in selected rural clinics. Both quantitative and qualitative data will be merged for result interpretation. Quantitative data identifies what factors influence CRC screening, while qualitative data explores how these factors interact with CRC screening. The study setting is 10 ACO clinics located in nine rural Nebraska counties. DISCUSSION: This will be the first study examining multi-level factors related to CRC screening in the new healthcare delivery system (i.e., ACO clinics) in rural communities. The study findings will enhance our understanding of how the ACO model, particularly in rural areas, interacts with provider- and patient-level factors influencing the CRC screening rate of rural patients

Disparities in Awareness of and Willingness to Participate in Cancer Clinical Trials Between African American and White Cancer Survivors

BACKGROUND: Cancer clinical trials (CCTs) are essential for cancer care, yet the evidence is scarce when it comes to racial disparities in CCT participation among cancer survivors in the Midwest. This study aimed to 1) assess disparities in the awareness of and willingness to participate in CCTs between African American and White cancer survivors; and 2) compare perceptions about CCTs between the two racial groups. METHODS: The study was based on cross-sectional data from the survey Minority Patient Participation in Cancer Clinical Trials that collected information from 147 Black and White cancer survivors from Nebraska between 2015 and 2016. Chi-square tests and logistic regressions were used to assess differences between Black and White cancer survivors regarding their awareness, willingness, and perceptions associated with CCT participation. RESULTS: After adjusting for the effects of socio-demographic, health status, and psychosocial variables, Black cancer survivors were much less likely than White cancer survivors to be aware of CCTs (AOR 0.26; CI 0.08-0.81), to express willingness to participate in CCTs (AOR 0.03; CI 0.01, 0.32) and to actually participate in CCTs (AOR 0.13; CI 0.04-0.38). Black cancer survivors reported a lower level of trust in physicians and were less likely than White cancer survivors to believe that CCTs make a significant contribution to science. CONCLUSIONS: Relative to White cancer survivors, Black cancer survivors had much lower awareness of and willingness to participate in CCTs. Part of these differences might be related to the differential perception of CCTs, psychosocial factors, and trust in physicians between the two groups

Longitudinal associations between body mass index, physical activity, and healthy dietary behaviors in adults: A parallel latent growth curve modeling approach

Background Physical activity (PA) and healthy dietary behaviors (HDB) are two well-documented lifestyle factors influencing body mass index (BMI). This study examined 7-year longitudinal associations between changes in PA, HDB, and BMI among adults using a parallel latent growth curve modeling (LGCM). Methods We used prospective cohort data collected by a private company (SimplyWell LLC, Omaha, NE, USA) implementing a workplace health screening program. Data from a total of 2,579 adults who provided valid BMI, PA, and HDB information for at least 5 out of 7 follow-up years from the time they entered the program were analyzed. PA and HDB were subjectively measured during an annual online health survey. Height and weight measured during an annual onsite health screening were used to calculate BMI (kgm2). The parallel LGCMs stratified by gender and baseline weight status (normal: BMI30) were fitted to examine the longitudinal associations of changes in PA and HDB with change in BMI over years. Results On average, BMI gradually increased over years, at rates ranging from 0.06 to 0.20 kgm 2year, with larger increases observed among those of normal baseline weight status across genders. The increases in PA and HDB were independently associated with a smaller increase in BMI for obese males (b = -1.70 and -1.98, respectively), and overweight females (b = -1.85 and -2.46, respectively) and obese females (b = -2.78 and -3.08,respectively). However, no significant associations of baseline PA and HDB with changes in BMI were observed. Conclusions Our study suggests that gradual increases in PA and HDB are independently associated with smaller increases in BMI in overweight and obese adults, but not in normal weight individuals. Further study is warranted to address factors that check increases in BMI in normal weight adults

Barriers of Colorectal Cancer Screening in Rural USA: A Systematic Review

INTRODUCTION: Colorectal cancer (CRC) screening rates are lower in rural areas in the USA. To guide the design of interventions to improve CRC screening, a systematic review was conducted to identify CRC screening barriers for rural populations. METHODS: A search was conducted in four literature databases - Medline, CINAHL, Embase, and Scopus - for articles from 1998 to 2017 that examine CRC screening barriers in rural areas. This review included a total of 27 articles reporting perceived CRC screening barriers by rural residents or providers or examining factors associated with CRC screening of rural populations in the USA. RESULTS: The most frequently reported barriers were high screening cost and lack of insurance coverage, embarrassment or discomfort undergoing screening, lack of knowledge or perceived need on CRC screening, and lack of physician recommendation. These barriers were confirmed in quantitative studies examining their association with CRC screening status. Age, marital status, and race/ethnicity were the most frequently reported factors associated with CRC screening in rural areas. Lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities were reported as rural-specific barriers for CRC screening. CONCLUSIONS: Main barriers for CRC screening at both the individual and healthcare system level are identified in rural areas and they are in line with those found in urban areas in general. In particular, lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities disproportionately hamper CRC screening for rural Americans

Matters of Trust: A Comparison of Patient-Provider Trust in Colorectal Cancer Survivors Using the Trust in Oncologist Scale

Objective: Trust is a vital component of the patient-provider relationship. Higher trust is associated with increased adherence to treatment and improved outcomes. The purpose of this study was to compare colorectal cancer (CRC) survivors\u27 reported trust toward their primary care physician (PCP) and oncologist (ONC). Methods: CRC survivors (n=62) were surveyed using the Trust in Oncologist (TiOS) instrument that assessed five domains (honesty, fidelity, caring, competence, and global/overall) using a 5-point Likert scale. Social and demographic variables were analyzed using nonparametric tests. Results: Mean trust was higher toward the ONC compared to the PCP across all TiOS domains (P=0.001-0.023). Trust was lowest in the competence and caring domains for both ONC and PCP. Younger age was associated with lower trust compared to older age (P=.0002, P=0.018). Higher cancer stage was associated with significantly lower trust toward PCP (P=0.074). Conclusion: Results confirm the importance of trust between cancer patients and physicians. Although CRC survivors report high overall trust toward their oncologist, they do not always believe their oncologist is competent to treat their disease. We propose the novel concept of Forced Attachment Theory to explain the phenomenon of an obligated sense of attachment from CRC patients toward their treating physicians

How Accurate Are Wearable Activity Trackers For Measuring Steps?

Wearable activity trackers have become popular for tracking individual’s daily physical activity, but little or no information is available to substantiate the validity of these devices in step counts. PURPOSE: The purpose of this study was to systemically examine the validity of newly developed wearable activity trackers for measuring steps compared to the criterion measure (hand tally) in two different conditions. METHODS: Twenty (28.2±4.8 years) healthy males (n=19) and females (n=17) participated in the study. The participants were fitted with eight wearable activity trackers while walking and running on a treadmill (speeds of 2, 2.5, 3, 3.5, 4, and 5 mph) for 3-minutes at each speed. For overground protocol, participants walked at three-self-determined speeds; gradually becoming faster (slow, normal, and fast) for one lap on an indoor track (200 meter track). The number of actual steps taken was manually tallied by researchers using a hand-tally counter. The monitors included the Basis B1 band (BB), Misfit Shine (MS), Polar Loop (PL), and Jawbone UP (UP) worn on the right wrist; the Nike+Fuelband (NF), Garmin VivoFit (GV), and Fitbit Flex (FF) worn on the left wrist; and Withings Pulse (WP) and Fitbit Zip (FZ) worn with a clip on the waist. Step counts from each monitor were compared with criterion values from manually counted steps. RESULTS: Total step counts (means ±SD) were 329.5±71.0, 267.8±89.9, 290.6±105.1, 326.2 ±73.2, 282.2±85.1, 294.3±85.8, 329.2±70.0, 322.1±75.7, 310.8±82.8, and 318.±76.7, for manual counts, NF, MS, WP, PL, FF, FZ, UP, GV, and BB, respectively. Corresponding absolute error rates (computed as the average absolute value of the individuals’ errors) were 19.8±16.4%, 18.9±12.2%, 17.4±15.8%, 11.3±13.1%, 0.7±1.4%, 4.5±7.8%, 6.6±12.6%, and 3.5±6.0%, respectively. ANOVA and Post hoc analyses with Bonferroni revealed the MS, WP, FZ, UP, GV, and BB were the devices to give non-significant differences (p\u3e .05) compared to the manual step counts, but significant differences were found with NF, PL, and FF. CONCLUSION: The results demonstrate that the waist-oriented trackers, FZ and WP, show the most accuracy in measuring steps. However, promising preliminary findings were observed with the wrist-oriented trackers, BB, UP, and GV

Clinic Exploration of Care Processes to Promote Colorectal Cancer Screening in Rural Accountable Care Organization Clinics: A Qualitative Case Study

It is essential to have an effective care process to promote colorectal cancer (CRC) screening particularly in rural areas. Primary care health care providers may have a significant impact on improving CRC screening rates among rural residents through systematic screening processes in their clinics. In this qualitative study, we aimed to explore the whole clinic processes of recommending and referring CRC screening in the rural accountable care organization (ACO) primary care clinics. We collected qualitative data through 21 semi-structured in-depth interviews with healthcare providers in rural primary care ACO clinics in Nebraska. We audio recorded and transcribed the interviews and analyzed the data using an inductive content analysis approach. The qualitative analyses revealed that ACO clinics are promoting CRC screening through teamwork with enhanced utilization of electronic health records and various other reminder strategies for both providers and patients. Areas for improvement in ACO clinic processes were also identified

Joint Influence of Individual Choices, Parenting Practices, and Physician Advice on Adolescent Obesity, Nebraska, 2008

Introduction Reducing childhood obesity remains a public health priority given its high prevalence and its association with increased risk of adult obesity and chronic diseases. The objective of this study was to examine the joint influence of multiple risk factors on adolescent overweight status. Methods We conducted a random-digit-dialed telephone survey of adolescents aged 12 to 19 years in fall 2008 in a Midwestern city in Nebraska. On the basis of survey data for 791 youths aged 12 to 18 years, we conducted latent class analysis to group youths by the joint occurrence of dietary behavior, physical activity, parenting practices, and physician advice. We then examined the association between the groups and overweight status by using logistic regression, controlling for age, sex, race/ethnicity, and parent and family information. Results Youths were clustered into 3 groups. Group I (52%) were youths with healthy dietary behavior and physical activity, less permissive parenting practices, and physician advice; Group II (30%) were youths with moderately healthy dietary behavior and physical activity, less permissive parenting practices, and no physician advice; and Group III (18%) were youths with unhealthy dietary behavior and physical activity, permissive parenting practices, and physician advice. Youths in Groups I and II were less likely to be overweight than youths in Group III. Conclusions Youths with healthier behavior and less permissive parenting practices were less likely to be overweight. Study findings highlight the need to address obesity risk factors among youths with unhealthy dietary behavior, inadequate exercise, permissive parenting practices, and some physician advice. Tailored interventions should be used to target youths with different obesity risk factors

Exploring Barriers and Promoters of CRC Screening Use Among Agricultural Operators: A Pilot Study of an Application of Concept Mapping

INTRODUCTION: The purpose of the study was to identify barriers and facilitators of colorectal cancer (CRC) screening use among agricultural operators in Nebraska, US. METHODS: The concept mapping approach was used to engage participants and enhance the generation of ideas and opinions regarding CRC screening. Two focus groups (seven women and seven men) were conducted. RESULTS: Among women, the cost domain was most agreed upon as important, followed by experiencing symptoms, awareness, and family. Among men, the important concepts related to CRC screening were family and friend support, feeling too young to get CRC, family or personal history of CRC, and lack of awareness of the need to be screened. Some gender differences regarding barriers were observed, such as women were more concerned about the cost of screening while men were far more concerned about the embarrassment associated with CRC screening. CONCLUSION: These findings will be crucial to developing educational materials to increase knowledge of risk factors for CRC and of CRC screening in the agricultural population