Colorectal cancer community engagement: a qualitative exploration of American Indian voices from North Dakota

Abstract

Background American Indians (AI) in North Dakota present with higher rates of advanced-stage disease for screening detectable colorectal cancers and have lower overall baseline colorectal cancer screening rates than non-AIs. We sought to identify the perceived barriers and facilitators for the engagement with colorectal cancer prevention within North Dakota tribal communities. Methods Twelve semi-structured interviews were carried out across four tribal reservation communities in the state of North Dakota with American Indian adults between the ages of 30 and 75 years. We utilized purposive sampling to ensure maximum variation in age, sex, and tribal community until data saturation was achieved. The interviews were transcribed, and thematic analysis was carried out to identify consistent themes rooted within the data. Ethical approval was gained for this project from all relevant institutional review boards. Results Four main themes were identified as barriers for the engagement with colorectal cancer prevention, including: colorectal cancer screening barriers, focused on other health problems, lack of colorectal cancer tailored health promotion, and socio-cultural factors affecting colorectal cancer prevention. Three main themes were identified as facilitators for the engagement with colorectal cancer prevention, including: reasons for getting colorectal cancer screening, role of culture, and getting out into the community. Conclusion There is need for more community-rooted, strengths-based approaches to colorectal cancer prevention activities in AI communities in North Dakota. Socio-cultural factors, such as the use of storytelling, and the use of traditional knowledge have been demonstrated to be an important element of consideration for colorectal cancer tribal community engagement and prevention planning in the state.

Cancer Screening Services: What Do Indigenous Communities Want? A Systematic Review

“…A general lack of awareness among Indigenous peoples pertaining to cancer symptoms, risks, prevention, and screening recommendations were common themes discussed among a plurality of the examined studies. 36 , 38 , 40 , 48 To address this, a wide variety of information dissemination strategies, such as pamphlets, videos, television advertisements, magazines, posters, and social media, were suggested in a variety of public settings such as laundromats, health fairs, drug stores, public bathrooms, and other public areas to maximize reach. 35 , 38 , 40 , 41 A culturally competent and respectful approach to any information dissemination strategy was recommended, with an integration of the Indigenous language or the Indigenous visual designs where possible.…”

“… 36 , 38 Community outreach promotion events were recommended by many studies, as it would present an excellent chance for education and opportunistic screening. 35 , 37 , 42 , 46 , 48 …”

“…Explanation and support from community members with experience around screening examinations were seen as important facilitators in encouraging participation. 36 , 40 , 44 , 46 , 48 A formal patient navigator with experience in navigating the health system was suggested to help guide patients through the processes involved in cancer screening. 36 , 37 Those who were seen as leaders and role models, who were of the same ethnicity and sex from the same community, were considered to be ideal in serving these roles.…”

“…The involvement of health care providers with whom the individual has a positive relationship was seen as a major facilitator of screening access. 35 , 43 , 44 , 47 , 48 Many reported negative past experiences with the Western health care system related to a lack of cultural understanding and respect, which had led to distrust, disappointment, and dissatisfaction, and an acknowledgment and understanding of this was viewed as important in forming a positive relationship. 38 , 40 , 42 , 47 However, past positive experiences, as well as encouragement and education from such health care providers, were reported to be a significant facilitator in an persons' willingness to participate in cancer screening programs.…”

“…There is a tendency for Indigenous peoples to have a strong emphasis on the family and the community. 35 , 39 , 48 As such, some even conveyed a sense of obligation to take care of their own physical health in the interest of the family. 35 , 45 , 46 Therefore, a significant involvement of the family and the community in efforts to promote and encourage cancer screening and prevention is likely to be key in alleviating certain social taboos and building positive attitudes toward these services.…”