AUTHOR=Serra Yolanda A. , Colón-López Vivian , Savas Lara S. , Vernon Sally W. , Fernández-Espada Natalie , Vélez Camille , Ayala Alelí , Fernández María E. 

TITLE=Using Intervention Mapping to Develop Health Education Components to Increase Colorectal Cancer Screening in Puerto Rico

JOURNAL=Frontiers in Public Health

VOLUME=Volume 5 - 2017

YEAR=2017

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2017.00324

DOI=10.3389/fpubh.2017.00324

ISSN=2296-2565

ABSTRACT=Introduction:	Colorectal cancer (CRC) is a leading cause of cancer-related mortality in Puerto Rico (PR). Although largely preventable through screening and treatment of precancerous polyps, CRC screening rates in PR remain low while CRC incidence and mortality continue to increase. 

Methods:	We used Intervention Mapping (IM), a systematic framework using theory and evidence to plan a health promotion intervention to increase Colorectal Cancer Screening (CRCS) among Puerto Rican adults 50 years and older who are patients Federally Qualified Health Centers (FQHCs) in Puerto Rico. 

Results:	To inform the development of a logic model of the problem during the needs assessment phase, we determined the CRC incidence and mortality rates in Puerto Rico using recent data from the PR Cancer Registry, conducted a literature review to better understand behavioral and environmental factors influencing CRC among Hispanics in general and in Puerto Ricans, and collected new data. We conducted 7 focus groups to identify community needs and resources, specific sub behaviors related to CRCS (performance objectives) and the determinants of CRCS. We then developed matrices of change objectives that would guide the content, behavioral change method selection and the practical applications that would be included in the program. We selected two overarching methods: entertainment education and behavioral journalism and developed practical applications, materials and messages containing several other methods including modeling, persuasion, information, and tailoring. We developed and pre-tested a tailored interactive multimedia intervention, newsletter, an action plan, and supplemental print materials for patients. We also developed a patient mediated provider prompt to increase provider recommendation and improve patient provider communication.

Conclusion:	The use of IM for systematic planning produced a detailed coherent plan for the CRCS educational intervention. Guided by IM processes, steps, and tasks, we used community level information, existing literature, theory, and new data to develop health education materials that were well received by the priority population and will likely increase CRCS among FQHC patients in PR.