The Annual Meeting and Expo for Public Health, sponsored by the American Public Health Association (APHA), occurred the week of November 2 through November 6, 2019, at the Philadelphia Convention Center in Philadelphia, PA. Over 13,000 people attended, which included university faculty, health organizations, nurse educators, and so forth, from around the world. The APHA 2019 theme was “creating the healthiest nation: For science. For action. For health.” This annual event is designed to demonstrate how we can improve “health outcomes locally, nationally, and worldwide.” The Centers for Disease Prevention and Control Director, Dr. Robert Redfield, opened the meeting by discussing the opioid epidemic crisis and reinforced the importance of childhood vaccinations in promoting healthy communities. The message at the APHA Annual Meeting and Expo was very clear to attendees, that we need to create a healthier nation, by uniting and eliminating health disparities in conjunction with public health research.
The INdigenous Samoan Partnership to Initiate Research Excellence (INSPIRE) in Colorectal Cancer (CRC) Health Literacy for American Samoans NIH grant (U24 MD011202-01) team was there presenting three posters and one oral presentation. American Samoa based community researchers partnered with academic researchers in Hawaii and Dr. Kathy Tong, who proudly represented Vanguard University, in conducting community-based participatory research.
The INSPIRE team looked at two aims. The first aim was to establish capacity and resources essential to conduct scientific research in American Samoa. The INSPIRE team was able to secure a facility and establish a repository, provide technical assistance and identify, recruit and provide technical support to the INSPIRE research cohort.
The second aim was to assess Colorectal Cancer (CRC) literacy in American Samoa. We piloted the Short form Test of Functional Health Literacy in Adults (STOFHLA) instrument in both English and Samoan. The Samoan version went through back-translation methods. Respondent-driven sampling (RDS) with community researchers exceeded recruitment sample size goals within a short duration with high response rates (sample size=713). The researchers also assessed knowledge, attitudes, and behaviors (KAB) on CRC screening. Informed by community-engaged principles and perspectives, INSPIRE’s research aims were accomplished with robust results.
The relationship between Colorectal Cancer (CRC) screening and health literacy has never been locally assessed in American Samoa (AS). CRC screening adherence among this sample in AS is low, consistent with reported AS nationwide figures. Less than 7% of age-eligible adults in AS participated in CRC screening; the Healthy People 2020 target is 70% screened.
In AS, community-relevant approaches guided local research training, instrument development, data collection, and data analysis to assess CRC knowledge, attitudes, behavior (KAB) and health literacy. Functional health literacy (FHL) among most demographic groups are low in AS. This first-ever study on FHL in AS uncovers directions for future research and interventions in increasing CRC screening and health promotion behaviors.
INSPIRE produced research is significant for AS because it lays a much-needed foundation for systematic public health research by building local research capacity and initial key health data. INSPIRE research will contribute to advancement in the science of health literacy and health promotion with resource-poor, yet tradition-rich INdigenous communities thereby, offering hope and reducing health disparities among Pacific Islanders in general, and American Samoans in particular.