Emie Lou Cruz

Department of Health Science

Assessment Prompt Student Learning Objective 3A
Prompt
In the position of Outreach Coordinator for Martin Luther King, Jr. Community Hospital, located
in South Los Angeles and serving primarily a low income, African American community, you
are in charge of developing programs that link communities with hospital services. Your
supervisor has asked you to develop a colorectal cancer outreach program due to the high rates of
colorectal cancer incidence and death rates among African Americans.
With limited knowledge about colorectal cancer, you call your colleague, Pat, who works at
Cedars-Sinai Medical Center in Beverly Hills, which serves an older, primarily white and
relatively wealthy patient population. Pat tells you about their colorectal cancer screening
program, based on the U.S. Preventive Services Task Force Guidelines. The Cedars-Sinai
program includes health education outreach via distribution of brochures/pamphlets at farmers
markets, shopping centers, parks, museums, and other community gathering points.
They use the Theory of Planned Behavior as the basis of their outreach to present basic
information about what colorectal cancer is, prevention strategies, screening interventions
(especially colonoscopies), and how to ask for colonoscopies from their physicians. They have
found the community to be very receptive to their outreach, and have observed increased rates of
men and women ages 50 years and older requesting colonoscopies for colorectal cancer
screening.
As you consider developing a colorectal cancer awareness and education program to increase
screening rates in a new colorectal cancer screening program offered by Martin Luther King, Jr.
Community Hospital, answer the two major questions below, each of which is divided into
several parts. Question 1 should be answered in approximately 200-300 words (in total,
including all subparts), and question 2 should be answered in approximately 250-350 words (in
total, including all subparts); do so with one or more complete sentences; use correct spelling,
grammar, and punctuation; and include reference citations in text and a References page in APA
format.

1. Based on your review of the empirical research literature and published best practices from
valid sources, what sociocultural, economic, and historical factors would you have to take into
consideration if you were adapting the Cedars-Sinai program to African Americans in South Los
Angeles?
Sociocultural (include references): Among African Americans, cultural characteristics such as
collectivism, racial pride, religiosity and time orientation are important factors that contribute to

Emie Lou Cruz

their health behaviors (Lukwago, Kreuter, Bucholtz, Holt & Clark, 2001). Family support and
informed decisions are also significant predictors of their adherence to any treatment (Lukwago
et al., 2001).
Economic (include references): The average family income for Blacks was $33,762 in
comparison to Whites with $56,565 (Office of Minority Health, OMH, 2014). In Blacks, the
poverty and unemployment rates are 28.1% and 10.3% respectively (OMH, 2014). Some of the
risk factors are environmental toxins, crime, illicit drug, poor quality housing, and health care
resources (OMH, 2014). Lower socioeconomic affects access to healthcare system, health
information, technological advances, quality clinics and hospitals, physician attitudes and
adherence to treatment (Institute of Medicine of National Academies, 2003).
Historical (include references): Besides the history of slavery and segregation, the most cited
medical event among African Americans was the Tuskegee study, which was conducted for 40
years by the U.S. Public Health Service (Brandon, Isaac & Thomas, 2005). They were deceived
into believing that they were being treated for syphilis (Brandon et al., 2005). According to
Brandon et al. (2005), negative experiences such as limited access to health care, historical
segregation in hospitals and disrespectful treatment and maltreatment by medical personnel and
other healthcare professionals contributed to the mistrust among African Americans.
2. Discuss how you would develop an intervention to increase colorectal cancer screening via
colonoscopies for African Americans in South Los Angeles using the Theory of Planned
Behavior. Discuss the activities that you would develop and implement to address each of the six
constructs of the Theory of Planned Behavior below. Use what you found in the empirical
research literature to answer Question 1 (above) and information in clinical best practices
guidelines (e.g., U.S. Preventive Services Task Force, Community Preventive Services Task
Force).
Behavioral beliefs: Due to issues of mistrust towards physicians, we need to form relationships
with the patients through constant one-on-one meetings. Through facilitated workshops, we can
present facts and statistics on the prevalence of colorectal cancer (CRC) among African
Americans. Physicians may also be invited to talk about detailed procedures about CRC
screening.
Evaluation of behavioral outcomes: Through informed consent and gained knowledge about
CRC, they will value their health even more. We can also conduct workshops on how to
understand insurance if they have any. If not, we can discuss discount and/or payment plans.
Normative beliefs: Since family support is important among African Americans, we must
include their family members and loved ones in the intervention and in workshops. By
participant approval, we can conduct closed-group discussions with one or two health personnel
to monitor and record conversations to increase awareness on how important CRC screening is.
Motivation to comply: In order to gain more motivation, we can also address African
Americans through their pastors. Religion is one of the most important factors that Blacks value.

Emie Lou Cruz

If we include their pastors and nuns, there will be better adherence to CRC screening.
Control beliefs: By forming strong and trusted relationships with physicians, African American
patients will more likely to attend their CRC screening. Once they are informed and supported by
family and loved ones, patients will gain the courage they need to get screened. We can enact
different scenarios that will promote various ways on how to deal with anxiety, new physicians
and etc.
Perceived power: When African Americans have full understanding of both preventative
measures and consequences, they will realize that they are competent enough to make rational
decisions. At the end of the intervention, we can evaluate their perceived powers through surveys
that will measure their likelihood of attending CRC screenings.

Emie Lou Cruz

References
Brandon, D., Isaac, L. & LaVeist, T. (2005). The legacy of tuskegee and trust in medical care:
Is tuskegee responsible for race differences in mistrust of medical care?. Journal of the
National Medical Association, 97(7), 951-956.
Institute of Medicine of National Academies. (2003). Unequal treatment: Confronting racial and
ethnic disparities in health care. Retrieved from
http://www.nap.edu/read/12875/chapter/1
Lukwago, S. N., Kreuter, M. W., Bucholtz, D. C., Holt, C.L. & Clark, E. M. (2001).
Development and validation of brief scales to measures collectivism, religiosity, racial
pride, and time orientation in urban african american women. Family and Community
Health, 24(3), 6371.
Office of Minority Health. (2014). Profile: Black/african americans. Retrieved from
http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61