Assigment .Apa seven . All instructions attached.

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Capstone Part II: Review of Literature

Bilingual Colorectal Cancer Screening Education for Hispanic Adults

Mirlenys Diaz

Florida National University

MSN Capstone Project

Dr. Carmen Lazo

October 1, 2026

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Review of Literature: Bilingual Colorectal Cancer Screening Education for Hispanic

Adults

The national targets for CRC screening are not met, and the disparities are greatest

among Hispanic adults. King et al. (2025) compared 2022 Behavioral Risk Factor Surveillance

System data to Healthy People 2030 targets in an analysis to find that 61.4% of adults ages 45–

75 years were current with screening, which is below the Healthy People 2030 goal of 72.8%.

Only 52.4% of Hispanic adults were current and an estimated 28 million adults aged 45 to 75

years were never screened. The suggested starting age was lowered to 45 in 2021 and there is a

lack of even gains. Siddique et al. (2024) conducted a study of over 10,000,000 privately insured

adults age 45 to 49 years and observed that screening uptake increased from 0.50% to 1.51%

following the recommendation, with uptake showing the most significant increases at the highest

socioeconomic status areas and in metropolitan areas. At the end of the post-recommendation

period, only 11.5% of average-risk adults in that age group had been screened. While both

studies found that eligibility does not narrow disparities, they vary in design, with one based on

population survey self-report and the other on commercial insurance claims with a considerable

number of safety-net patients excluded.

The gap is also apparent at the local level. The Florida Department of Health (2024)

reports that there were approximately 1,320 new cases of CRC in Miami-Dade County in 2023,

which equates to an age-adjusted incidence of 36.5 per 100,000 population, and approximately

456 deaths in 2024, which equals a mortality rate of 12.2 per 100,000 population. Ashad-Bishop

et al. (2023) divided the 492 census tracts in Miami-Dade into social vulnerability clusters and

found variation in screening participation between the clusters, but did not provide any

ecological design that can reveal the behaviors of individual patients. One mechanism seems to

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be language. Based on data from surveys from 2012 to 2020, Castañeda-Avila et al. (2024)

determined that Hispanic adults with LEP were less likely to be up to date than non-Hispanic

White adults with or without chronic conditions (adjusted prevalence ratio in the range of 0.67

with no chronic conditions to 0.66 with chronic conditions), and recommended developing

interventions for Hispanic people with LEP. The lowered screening age was not in effect on that

sample, which ranged from 50 to 75 years of age.

Understandings of why the problem continues to exist are consistent across sources.

Aguiar-Ibáñez et al. (2025) found that patient-level, social and economic factors, provider and

community factors, and access to care were among the barriers to cancer screening, and that

higher deprivation, lower socioeconomic status, and living in rural areas were among those. The

most common solution suggested to overcome these barriers was to implement targeted

educational programs. This discovery provides support for education as a response, yet it also

has a caveat: the results of the review included several cancer types and recommendations for

suggested approaches, but not tested effects in Hispanic adults. Jang et al. (2022) provide detail

at the population level. The participants of focus groups of Spanish-speaking Hispanic and

Latino patients, which were convened to optimize a mailed fecal immunochemical test (FIT) and

patient navigation program, noted that the instructions on the original FIT were confusing and

that a patient navigator would be appreciated. The findings suggest that besides being reluctant

to be screened, there is also some lack of clarity in information that may play a role in the delay

in screening among Spanish speakers.

There is more evidence that multicomponent outreach is effective than that

multicomponent education is effective. Okasako-Schmucker et al (2023) found that interventions

involving CHWs led to a median increase in CRC screening of 10.5 percentage points

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(interquartile interval: 4.5 to 17.5), which was observed across all racial/ethnic groups, income

groups, and insurance groups. The interventions assessed screening completion and were

generally multi-component interventions, while a teaching plan is one. Message development

with a cultural focus is common throughout the Hispanic sources. Meade et al. (2023) described

a participatory approach that uses a learner-centered lens and engages the target audience in the

creation of cancer prevention messages for Latinos. In a scoping review of mobile health

interventions for Hispanic persons, Watanabe-Galloway and Ratnapradipa (2022) identified the

following: most provided education via videos, slides, and multimedia; effective interventions

were primarily for easier to screen cancers including skin and cervical cancer; and in some cases

they did not describe how cultural adaptation was conducted. In sum, the sources agree that

cultural and linguistic tailoring is warranted, but vary in their conclusions regarding the

educational potential alone, and none of the reviewed studies evaluated a stand-alone bilingual

teaching plan for CRC screening in a community clinic setting similar to the Hialeah setting.

This gap is the difference the proposed project will make and restricts any claims regarding

patient outcomes for Hispanic adults served by the project.

There are some methodological limitations in the quality of this type of evidence, which

limit the extent to which it can be extended. Most problem descriptions found are cross-sectional,

ecological, or claims based and are able to report disparities but unable to prove that disparities

are caused by language or knowledge. The best designs, those from the systematic reviews by

Okasako-Schmucker et al. (2023) and Aguiar-Ibáñez et al. (2025), involve general populations

and a range of strategies, whereas those sources specific to Hispanics tend to be mostly

qualitative or descriptive. Jang et al. (2022) and Meade et al. (2023) provide great cultural detail

in small groups, enhancing relevance but doing less to increase generalizability. For nurse

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leaders, this pattern says that a project based on documented barriers is warranted, but a project

that relies on the claims of behavior change needs evaluation.

The framework to guide the project has supportive but indirect evidence. By applying a

quasi-experimental design, Rojas-Torres et al. (2025) conducted their nursing educational

intervention using Pender's Health Promotion Model with adults in a community in Colombia

and reported statistically significant healthy behavior outcomes with the greatest changes in

health responsibility and spiritual growth. The study did not focus on CRC screening, and the

community is not the same as Hispanic adults in Florida; therefore, the findings suggest that the

model was beneficial—but do not verify its effects on CRC screening. As for leadership, Fosah

and Llahana (2025) reported that they synthesized 14 studies with 5,243 participants and found

18 enablers and 24 barriers to leadership for APs. Mentorship, leadership programs, and

organizational support were enablers, whereas unclear roles, limited leadership training and

limited resources were barriers. Preceptor review and bilingual staff input are essential

components of the project, as are the specific 12-week project timeframe which could limit role

ambiguity for the advanced practice registered nurse (APRN) who coordinates translation of the

evidence and as change agent.

Weighing the evidence, advantages and limitations are both evident. It is a low cost

project, costing $300-$500 to print, materials and professional review, does not require new

equipment, addresses a documented language barrier and fits into the proposal of the systematic

review for targeted education and cultural adaptation. The limitations are that the referenced

literature lacks cost-effectiveness information for education-only products, that outcomes can

only be measured as expert-rated product quality, not screening behavior, and that education

cannot eliminate structural barriers (insurance, transportation, access, etc.). The reviewed sources

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do not delineate the clinical or economic consequences of this particular product, and the best

that can be argued is that it is a reusable resource for education that the clinic can use in the

future for prevention activities. The goal of the objectives is to create an English / Spanish

teaching plan that addresses eligibility, screening methods, preparation, misconceptions, and

follow-up, as well as to have an expert review for accuracy and readability, cultural

appropriateness, bilingual consistency, and agreement with current recommendations with

revisions to be made in 12 weeks. The need for change: screening gaps remain among Hispanic

adult populations across the country, language barriers are known, and the age 45 cutoff

increases the number of individuals requiring a clear message. Overall, the findings suggest that

bilingual/culturally adapted education is a reasonable and feasible part of the APRN-led response

and that the impact of the bilingual/culturally adapted education on screening behaviors need to

be assessed in subsequent phases.

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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, Article 1575820. 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, Article 102371. https://doi.org/10.1016/j.pmedr.2023.102371

Castañeda-Avila, M. A., Tisminetzky, M., Oyinbo, A. G., & Lapane, K. (2024). Racial and

ethnic disparities in use of colorectal cancer screening among adults with chronic medical

conditions: BRFSS 2012–2020. Preventing Chronic Disease, 21, Article 230257.

https://doi.org/10.5888/pcd21.230257

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

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

ataviewer&cid=0445

Fosah, R., & Llahana, S. (2025). Barriers and enablers to leadership in advanced practice

nursing: A systematic review. International Nursing Review, 72(2), Article e70034.

https://doi.org/10.1111/inr.70034

Jang, S. H., Cole, A., Brown, E. V. R., & Ko, L. (2022). 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, Article E49.

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, Article

107888. https://doi.org/10.1016/j.pec.2023.107888

Okasako-Schmucker, D. L., Peng, Y., Cobb, J., Buchanan, L. R., Xiong, K. Z., Mercer, S. L.,

Sabatino, S. A., Melillo, S., Remington, P. L., Kumanyika, S. K., Glenn, B., Breslau, E.

S., Escoffery, C., Fernandez, M. E., Coronado, G. D., Glanz, K., Mullen, P. D., &

Vernon, S. W. (2023). Community health workers to increase cancer screening: 3

Community Guide systematic reviews. American Journal of Preventive Medicine, 64(4),

579–594. https://doi.org/10.1016/j.amepre.2022.10.016

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), Article 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

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

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

Watanabe-Galloway, S., & Ratnapradipa, K. L. (2022). Mobile health (mHealth) interventions to

increase cancer screening rates in Hispanic/Latinx populations: A scoping review. Health

Promotion Practice. Advance online publication.

https://doi.org/10.1177/15248399221103851