Assigment .Apa seven . All instructions attached.

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Capstone Part I: PICOT Assignment: Bilingual Colorectal Cancer Screening Education for

Hispanic Adults

Mirlenys Diaz

Florida National University

MSN Capstone Project

Dr. Carmen Lazo

September 16, 2026

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Bilingual Colorectal Cancer Screening Education for Hispanic Adults

Introduction to your proposed problem

Colorectal cancer (CRC) is an important public health problem and a major cause of

cancer morbidity and mortality in the United States. Screening is important because it may detect

precancerous tissue and cancer before it can advance to a more serious or even deadly stage. The

U.S. Preventive Services Task Force (USPSTF) advises CRC screening in average-risk adults

ages 45 to 75 (Siddique et al., 2024). However, disparities in screening rates continue to be

significant for Hispanic adults, despite these recommendations.

The extent of the issue is reflected in the national data. In 2022, 61.4% of all adults aged

45-75 were up-to-date with CRC screening. However, only 52.4% of Hispanic adults were

current compared with 63.5% of non-Hispanic White adults, while 41.7% of Hispanic adults had

never been screened (King et al., 2025). Of the adults aged 45-49, 29.8% were up to date with

screening and 65.7% had never been screened (King et al., 2025). The results are significant

because adults as young as age 45 are now part of the regular screening guidelines.

The problem also affects Miami-Dade County. In 2023, there were approximately 1,320

new cases of CRC and an age-adjusted incidence of 36.5 cases per 100,000 population. The

number of CRC cases died in 2024 was about 456, and the age adjusted mortality rate was 12.2

deaths per 100,000 (Florida Department of Health, 2024). Screening also varies by

neighborhood. According to Ashad-Bishop et al., (2023) the average screening rates in Miami-

Dade County were approximately 59% but dropped to 53.3% in communities with higher social

vulnerability.

CRC costs are incurred due to diagnosis, treatment, hospitalisation, medications,

specialist services, loss of productivity, as well as early death. Cancer screening also utilizes a

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considerable amount of health care resources, but could decrease later disease burden through

early detection and prevention (Aguiar-Ibáñez, 2025). The total estimated cost for this project is

between $300 and $500 for bilingual printing, educational materials, and professional review.

The program that is being proposed would consist of creating a culturally responsive

bilingual English-Spanish teaching plan for Hispanic adults 45 to 75 at a community clinic

located in Hialeah, FL. The resource will cover the significance of screening, age, types of

screening, preparation, misconceptions, and early detection. The goal is to enhance the quality

and comprehensiveness of CRC screening education. Since patients will not be recruited or

directly treated, the project will quantify the development and expert review of the education

product instead of screening behavior.

PICOT

The PICOT question is: In Hispanic adults aged 45 to 75 receiving care at a community

clinic in Hialeah, Florida (P), how does development of a bilingual English-Spanish teaching

plan about colorectal cancer screening (I), compared with standard educational information (C),

improve the quality and completeness of colorectal cancer screening education (O) over 12

weeks (T)?

The population includes Hispanic adults aged 45 to 75 receiving care at the community

clinic that was selected and who are eligible for average-risk CRC screening. The intervention is

development of a bilingual teaching plan that provides screening information in English and

Spanish. Content will cover screening eligibility, screening methods available, benefits of early

detection, preparation prior to screening, common misconceptions, and follow-up after abnormal

screening.

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The comparison is standard educational information that is routinely used as part of the

standard clinical practice. The result is the quality and completeness of educational product.

Evaluation of accuracy, readability, cultural appropriateness, bilingual consistency, and current

screening recommendations will be done by experts. The time frame is 12 weeks for literature

review, development, translation, evaluation, revision and presentation.

The PICOT directly links the practice problem and the proposed change. Nationally,

Hispanic adults are less likely to participate in screening and communities in Miami-Dade show

differences based on social vulnerability. A bilingual educational resource is thus a viable answer

to remediable knowledge and communication barriers.

Describe the vulnerable population and setting

The target population is Hispanic adults (ages 45-75) attending their primary care in a

community clinic in Hialeah, FL. Social determinants of health in the population that can affect

preventive screening may include income, insurance status, health literacy, language,

transportation, employment demands and primary care access. Other barriers may be fear,

embarrassment, cultural beliefs, lack of knowledge, and uncertainty about screening procedures.

Materials provided only in English may limit understanding among patients with limited

English proficiency. An essential information bilingual resource that enhances access to

understandable screening education.

Social vulnerability also accounts for disparities in preventive care. Miami-Dade

Community Based Research noted that CRC screening rates differed by community social

vulnerability, the more vulnerable communities having lower CRC screening participation

(Ashad-Bishop et al., 2023). The national evidence also indicates that CRC screening rates are

lower among Hispanic adults (King et al., 2025).

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Change is important because the failure to do the screening can lead to late detection,

more complicated treatment, higher healthcare costs, poorer quality of life and early death.

Education cannot eliminate every structural barrier, but it can address knowledge and

communication barriers. Limited awareness, language differences, and healthcare-access issues

are identified as associated with delayed screening with Latino populations during research

(Montalvan-Sanchez et al., 2024).

Proposal

The proposed intervention involves a bilingual CRC screening education program that

will teach Hispanic adults ages 45 to 75 years old. The teaching will involve the reasons behind

screening, time to start screening, screening methods, how to prepare, misconceptions, and

follow up on abnormal findings. There is enough evidence regarding structured and culturally

tailored CRC screening education. According to research conducted among Hispanic and Latino

patients who speak Spanish, cultural tailoring of cancer screening educational material is

necessary (Jang et al., 2022). Meade et al. (2023) have also stressed the need for culturally-

tailored cancer prevention communication among Latinos. Structured outreach within

underserved primary care settings has further demonstrated the value of organized approaches to

screening support (Glascock et al., 2026). These findings support development of a bilingual

educational product.

The project will not recruit patients, administer surveys, collect identifiable health

information, or directly implement a screening intervention. The APRN will review literature,

identify educational needs, develop the English content, prepare the Spanish version, obtain

professional feedback, revise the materials, and complete final evaluation. The preceptor will

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review clinical accuracy, while bilingual personnel may assess language clarity and cultural

relevance.

Resources will include a computer, scholarly literature, current guidelines, bilingual

templates, printing supplies, visual resources, and staff review time. The project is feasible

because it does not require new equipment, medications, laboratory testing, or major

expenditure. During weeks 1 through 3, the literature and educational needs will be reviewed.

Weeks 4 through 6 will focus on development and translation. Weeks 7 through 9 will involve

clinical, language, and cultural review. Weeks 10 through 12 will include revisions, final

evaluation, formatting, and presentation.

The APRN will function as an evidence translator, educator, collaborator, and change

agent. The APRN will identify the practice problem, evaluate evidence, ensure that materials

reflect current recommendations, coordinate review, and evaluate the final product. Advanced

practice nurses contribute to translating evidence into clinical practice and supporting evidence-

based decisions.

The expected outcome is completion of a bilingual CRC screening teaching plan that

meets predetermined expert-review criteria for accuracy, completeness, readability, cultural

appropriateness, and consistency with current recommendations. The product may provide the

clinic with a sustainable educational resource for future preventive-care activities without

claiming that the project directly changes patient screening behavior.

Theoretical Framework/Nursing Theory

Pender’s Health Promotion Model will serve as the primary nursing framework. The

model emphasizes individual characteristics, previous experiences, perceived benefits, perceived

barriers, interpersonal influences, situational influences, and self-efficacy as factors affecting

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health-promoting behavior (Rojas-Torres et al., 2025). These concepts are relevant because CRC

screening decisions may be affected by knowledge, fear, perceived benefits, language, cultural

beliefs, financial concerns, and healthcare access.

The framework will guide development of educational content by addressing both

screening benefits and barriers. The teaching plan will explain how screening can identify cancer

or precancerous conditions early while addressing common concerns about screening

procedures. Bilingual communication will reduce language-related barriers, while culturally

appropriate explanations can improve relevance and understanding. Pender’s model therefore

supports the population, educational intervention, and expected outcome. Pender’s model

addresses beliefs, perceived barriers, benefits, and self-efficacy related to preventive behavior.

The framework supports an APRN-led project addressing CRC screening disparities among

Hispanic adults.

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References

Aguiar-Ibáñez, R., Mbous, Y., Sharma, S., Chakali, R., & Chawla, E. (2025). Barriers to cancer

screening uptake and approaches to overcome them: A systematic literature review.

Frontiers in Oncology, 15, 1575820. PubMed Central.

https://doi.org/10.3389/fonc.2025.1575820

Ashad-Bishop, K. C., Baeker Bispo, J. A., Nahodyl, L., Balise, R. R., Kobetz, E. K., & Bailey, Z.

D. (2023). Hyperlocal disparities in breast, cervical, and colorectal cancer screening: An

ecological study of social vulnerability in Miami-Dade county. Preventive Medicine

Reports, 35, 102371. https://doi.org/10.1016/j.pmedr.2023.102371

Florida Department of Health. (2024). Colorectal cancer incidence - Florida Health CHARTS -

Florida Department of Health. Www.Flhealthcharts.Gov.

https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=NonVitalInd.D

ataviewer&cid=0445

Glascock, M., Wangen, M., Ferrari, R. M., O’Leary, M. C., Schwartz, J., Ndugulile, M., Unger, J.

M., Li, L., Marciniak, M. W., Reuland, D. S., Watabayashi, K., Brenner, A. T., Wheeler,

S. B., & Shah, P. D. (2026). Expanding access to colorectal cancer screening through

community pharmacies: Study protocol for the PharmFITTM randomized controlled trial.

Contemporary Clinical Trials, 170, 108443. https://doi.org/10.1016/j.cct.2026.108443

Jang, S. H., Cole, A., Brown, E. V. R., & Ko, L. (2021). Adaptation of a Mailed-FIT kit and

patient navigation intervention to increase colorectal cancer (CRC) screening among

Spanish-speaking hispanic/latino patients. Hispanic Health Care International, 20(2),

80–88. https://doi.org/10.1177/15404153211024116

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King, S. C., King, J., Thomas, C. C., & Richardson, L. C. (2025). Baseline estimates of

colorectal cancer screening among adults aged 45 to 75 years, behavioral risk factor

surveillance system, 2022. Preventing Chronic Disease, 22.

https://doi.org/10.5888/pcd22.250175

Meade, C. D, Stanley, N. B., Arevalo, M., Tyson, D. M., Chavarria, E. A., Aguado, C. X., Rivera,

M., Gutierrez, L., Abdulla, R., Christy, S. M., & Gwede, C. K. (2023). Transcreation

matters: A learner centric participatory approach for adapting cancer prevention messages

for Latinos. Patient Education and Counseling, 115, 107888–107888.

https://doi.org/10.1016/j.pec.2023.107888

Montalvan-Sanchez, E. E., Beas, R., Karkash, A., Godoy, A., Norwood, D. A., & Dougherty, M.

(2024). Delays in colorectal cancer screening for latino patients: The role of immigrant

Healthcare in stemming the rising global incidence of colorectal cancer. Gastroenterology

Research, 17(1), 41–51. PubMed Central. https://doi.org/10.14740/gr1697

Rojas-Torres, I. L., Garizábalo Dávila, C. M., Ruidíaz Gómez, K. S., Fernández Aragón, S. P.,

Perea-Rojas, D. M., Rodelo Olmos, G. M., & Liñán Meléndez, N. I. (2025).

Effectiveness of Nola Pender’s health promotion model: A comprehensive approach for

enhancing healthy behaviors and quality of life in adults. International Journal of

Environmental Research and Public Health, 22(10), 1506.

https://doi.org/10.3390/ijerph22101506

Siddique, S., Wang, R., Yasin, F., Gaddy, J. J., Zhang, L., Gross, C. P., & Ma, X. (2024).

USPSTF colorectal cancer screening recommendation and uptake for individuals aged 45

to 49 years. JAMA Network Open, 7(10), e2436358–e2436358.

https://doi.org/10.1001/jamanetworkopen.2024.36358

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