The Texas Mexico Border Region population is rapidly increasing and colorectal cancer incidence is rising among Hispanics. Regionally, 59% have never had screening endoscopy and 90% have not had FOBT in the prior 2 yrs. Education, awareness, access, socioeconomic and cultural barriers adversely affect regional screening practices.

In Del Rio Texas, the target project community, only 16% and 20% of people report ever having FOBT or endoscopy respectively. Hispanic CRC incidence and mortality in Del Rio surpasses those of Hispanics state wide (38.2 vs. 37.4 and 14.1 vs. 13.6; age adjusted, per 100,000). Guideline concordant screening could prevent 60% of these deaths. 

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The Texas Mexico Border Region population is rapidly increasing and colorectal cancer incidence is rising among Hispanics. Regionally, 59% have never had screening endoscopy and 90% have not had FOBT in the prior 2 yrs. Education, awareness, access, socioeconomic and cultural barriers adversely affect regional screening practices.

In Del Rio Texas, the target project community, only 16% and 20% of people report ever having FOBT or endoscopy respectively. Hispanic CRC incidence and mortality in Del Rio surpasses those of Hispanics state wide (38.2 vs. 37.4 and 14.1 vs. 13.6; age adjusted, per 100,000). Guideline concordant screening could prevent 60% of these deaths.

The FluFIT on the Frontera project will establish a comprehensive, sustainable, community based CRC screening program by leveraging and expanding the chronic care model of primary care health delivery at Val Verde Regional Medical Center in Del Rio Texas through partnerships with Quad Counties Council Colonia Promotoras Program (QCC-CPP), community advocates, academic health centers and loco-regional government. The team’s collective knowledge and experience, combined with practice and community based screening management tools will streamline access to culturally tailored CRC screening education and services in the community and clinic settings.

Certified promotoras and providers/health educators will deliver CRC screening education in colonias (via Loterias) and clinics respectively and provide social support to promote CRC screening in Del Rio and the colonias. Integrating community and hospital based navigation services will facilitate transparent, bidirectional participant flow between the community and clinic environs.The FluFIT program is an evidence based, multicultural CRC screening intervention, that will target un- and underinsured, average risk Hispanic adults, aged 50-75 years who live in Del Rio and the geographically isolated Val Verde County colonias and have never, or infrequently, been screened. The project directly addresses screening barriers through education, timely access to care, diagnosis and treatment, rapid screening throughput and utilization of promotoras and navigators in the community and clinic settings for preventive services.

CRC screening educational activities will be delivered by clinic based providers and project staff and certified community promotoras in the colonias. The FluFIT on the Frontera project, will provide CRC screening information, free fecal immune-chemical test (FIT) kits, navigation to appropriate free and/or discounted follow-up colonoscopies for those with positive tests and insurance enrollment to cover healthcare costs. Primary care physicians and surgical endoscopists, together with integrated support from program staff and navigators, will deliver screening results and coordinate the follow-up care for patients with a positive FOBT, i.e. colonoscopy, and subsequent CRC treatment referral. The program will be conducted in conjunction with flu vaccination clinics during flu season and community events linked with health promotion initiatives (diabetes, cardiovascular disease, colorectal, breast and cervical cancer awareness, obesity, women’s health) and Loterias throughout the remaining year.

The overarching project goal is to decrease CRC mortality in Val Verde County. The proximate and intermediate goals are to: 1) increase rural and frontier community capacity to implement and sustain comprehensive, colorectal cancer screening and education programs 2) increase guideline concordant colorectal cancer screening among underserved Border populations and 3) assess the longitudinal impact of FluFIT on CRC screening practices. Over the funding period, 15-20 professionals (promotoras, clinic and project staff) will receive FluFIT curriculum training. The project will reach 23,355 people/professionals through program awareness and services delivered to 14,200.

Integrated community and hospital based navigation to streamline screening, utilizing promotoras to implement and disseminate the FluFIT program, integrating the FluFIT program into community programs (Loterias) and targeting frontier populations are innovative features of this inaugural project. The impact of this CRC screening initiative on Val Verde County will be realized through: 1) Increased community CRC awareness and screening, 2) Augmented community and hospital workforce capacity through CRC education and screening training, 3) Empowered Del Rio and colonias residents who adopt guideline concordant CRC screening behaviors, 4) Leveraged public-private health sector partnerships to address community wide, low CRC screening prevalence across the screening continuum and 5) Facilitated project sustainability, dissemination and scalability through community partner led program design and implementation.

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