Prostate cancer is the most diagnosed cancer in African American men and the
second-leading cause of cancer-related death. The prostate-specific antigen (PSA) test is
an early detection screening tool for prostate cancer, however, knowledge about prostate
cancer and screening benefits and risks and uptake of PSA screening remains low among
African American men. To address this inequity, this project proposes the use of the
Connect2Care App to improve knowledge of prostate cancer, screening benefits, risks and
increase readiness to complete a PSA test (e.g., intentions, motivation, confidence, and
self-efficacy). The primary goal of this study is to evaluate the efficacy of the
Connect2Care App in a 30-day randomized control trial compared to an existing app
developed by the U.S. Department of Health & Human Services (Prevention Taskforce App).
African American men between the ages of 45 and 69 from Oklahoma (N = 266), who are not
up to date with PSA screening according to recommended guidelines, will be randomly
assigned 1:1 to receive either app. The app feasibility will be assessed: (1) efficacy,
evaluated via post-intervention differences in knowledge of prostate cancer, screening
benefits and risks, (2) app engagement and accessibility, measured via self-report
validated questionnaires, and (3) app acceptability, explored via semi-structured
qualitative interviews. We will explore readiness to complete a PSA test and identify
predictors of readiness across both study arms. The successful demonstration of the
feasibility of the Connect2Care App among African American men living in Oklahoma will
support expanding this intervention to African American men nationwide.
A. Specific Aims
The overall objectives of this proposal are to: (1) address two key SDOH (i.e.,
neighborhood and built environment and access to high-quality preventive care); (2)
leverage community and individual levels of influence; and (3) implement a social risk
screener and social needs referral process, at both community and individual levels, that
mitigates significant barriers to PSA screening and timely follow-up care. Our central
hypothesis is that combining a traditional community-engaged research intervention with
an innovative smartphone app navigation intervention, while providing access to free PSA
screening tests and follow-up care at Stephenson Cancer Center (see Letter of Support),
will have a meaningful impact on prostate cancer outcomes among AA men in Oklahoma. This
hypothesis has been formulated based on our promising pilot data (see Preliminary
Studies). To attain our overall objectives, we will recruit a total of 466 AA men, aged
55-69 and not up to date with PSA screening. As such, the following specific aims are
proposed:
Aim 1. Conduct a multimodal community outreach intervention to improve awareness of and
access to PSA screening. Approach. The intervention will include (1) a culturally
tailored Social Media Campaign, geofenced to counties with the greatest AA prostate
cancer incidence. Participants who click on the campaign can order a free at-home PSA
test. (2) In-person Community Health Events will provide educational information and
access to on-site PSA screening via our mobile screening vans. A total of 200 AA men will
be accrued across both outreach methods. Outcomes. Awareness will be measured by the
reach and penetration of the interventions and access by the number of completed PSA
screening tests.
Aim 2. Determine the efficacy of smartphone intervention on at-home PSA screening rates.
Approach. A total of 266 AA men will be randomized to a two-arm RCT for 4 weeks.
Intervention arms include US Preventive Services Task Force App (control) vs. Prostate
Cancer Genius App (Genius App; intervention). In both arms, participants will receive
information about prostate cancer and screening, have access to a free at-home PSA test
and free follow-up care, and social needs referrals. Participants in the Genius App will
also have access to several culturally tailored, novel features to support at-home PSA
screening. Outcomes. Efficacy (primary outcome) is determined by PSA screening rates 30
days post-randomization.
Aim 3. Explore the feasibility and acceptability of a social risk screening tool to
connect participants to social needs referral services. Approach. After completing a
baseline social risk screener, all participants will receive some form of navigation for
social needs referral. Navigation will differ by type and intensity. Participants accrued
by community outreach will receive One-Time Navigation via a list of referral resources,
tailored to their social needs assessment and geography. Participants enrolled in the
smartphone intervention will receive Weekly Navigation, which provides more intensive
support via a study navigator and geofenced social needs notifications on their study
app. Outcomes. Feasibility will be measured by the percentage of participants who
complete a social risk screener, and the percentage connected to a referral service.
Acceptability will be assessed via qualitative exit interviews (N=80), stratified by
social need (high vs. low).