Need: Bexar County has a population of 1.9 million Hispanics, who comprise 59% of the population and are the largest medically underserved minority. Maverick County has a population of 58K with 95% of Hispanic origin. In a population as such, cancer prevention efforts are imperative and need to continue to evolve and expand. Our priority population in Bexar includes those enrolled in CareLink, our financial assistance program for underserved/uninsured county residents. These CareLink members experience adverse health outcomes and barriers to care. Of those patients, only 32.3% of the eligible men and women in medically underserved areas (MUAs) have received a FIT screening or colonoscopy in ...

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Need: Bexar County has a population of 1.9 million Hispanics, who comprise 59% of the population and are the largest medically underserved minority. Maverick County has a population of 58K with 95% of Hispanic origin. In a population as such, cancer prevention efforts are imperative and need to continue to evolve and expand. Our priority population in Bexar includes those enrolled in CareLink, our financial assistance program for underserved/uninsured county residents. These CareLink members experience adverse health outcomes and barriers to care. Of those patients, only 32.3% of the eligible men and women in medically underserved areas (MUAs) have received a FIT screening or colonoscopy in the last year. Overall, the numbers for the colonoscopies are low, compared to national standards. Maverick County is a MUA and the need for comprehensive cancer prevention efforts for this county remains unmet as less than half of the eligible population has received colorectal screening. Critical obstacles to preventive cancer screening services for this population include language barriers, financial limitations, comorbidities, and low awareness of current screening guidelines. Prevention and screening efforts are shown to reduce mortality from colorectocal cancer. However, access to treatment and screening services is a significant barrier experienced by these counties' uninsured and medically underserved communities. This proposal will target men and women residing in MUAs within Bexar and Maverick Counties, specifically low-income Hispanic individuals who make up the majority of these communities, to educate and navigate to colorectal screening. Overall Project Strategy: This proposal focuses on establishing Get FIT as a comprehensive evidenced-based outreach, education, navigation, and colorectal screening program. The program aims to increase cancer prevention by providing colorectal cancer screenings and early detection for men and women primarily in the form of FIT tests. This comprehensive program will consist of: 1) Culturally tailored outreach strategies incorporating components from our A Su Salud model reaching uninsured patients; 2) Navigation to screening services using bicultural navigators to help mitigate barriers to care, providing follow-up care, and increased patient satisfaction; and 3) Provide patient education on current guidelines and options for CRC screenings. Specific Goals: The goal of Get FIT is to decrease colorectal cancer rates by increasing knowledge about and access to these cancer screenings. We aim to increase the number of men and women who receive early detection and cancer screening services by providing 1720 FIT screenings and 258 colonoscopies, to eligible uninsured men and women in MUAs or to those who have never received these screenings before. In addition, we will also increase the screening completion rates by providing navigation services to eligible individuals who agree to participate in a screening. We plan to focus on eligible people who are Bexar County CareLink members or residents of Maverick County, that have either never had a screen before or who missed or cancelled their screening appointment. We plan to reach 60,000 community members with culturally tailored educational materials and outreach events in the targeted MUAs over the length of the project. Innovation: Get FIT is a comprehensive cancer prevention program focused on CRC screenings for eligible uninsured men and women, specifically targeting those residing in MUAs. We will incorporate patient navigation to help mitigate barriers these individuals encounter when scheduling or attending these screenings. Moreover, we will provide education to men and women in the MUAs aimed at understanding the benefits and the various options for screening for colorectal cancer. This program will enhance successful existing program models surrounding prevention and early disease detection as well as provide information on the FIT test as an option for those reluctant to undergo colonoscopy screening. Significance and Impact: As a safety-net health system with a wide community reach and collaborative partners, we are uniquely positioned to decrease the incidence and mortality of colorectal cancer. This program will reduce the prevalence of cancer among underserved Hispanics by addressing barriers to prevention and screening. By implementing the proposed outreach, education, navigation, screening and prevention program for uninsured men and women in MUAs, as well as navigating patients back to screening appointments that were missed, we will prevent the development of late to care and late stage cancers. Thus, down the road we will avoid costs and prevent high-utilization of health care services. Most importantly, we will prevent the development of cancer incidence and mortality.

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