Elimination of colorectal cancer disparities is a national priority. Despite the effectiveness of colorectal cancer (CRC) screening tests for average risk adults, these tests are underutilized by American Indians/Alaska Natives. Subsequently, these populations have experienced either no change or an increase in CRC incidence. Prior to conducting a trial to determine the efficacy of interventions of graded intensity on screening behavior among six tribal communities in the Southwest United States, we set out to develop a culturally appropriate and theoretically grounded brochure to increase community demand for CRC screening. In order to ensure the brochure's health literacy to diverse tribal participants, we utilized the Suitability Assessment of Materials and Comprehensibility of Materials (SAM+CAM) instrument as a basis for structuring this process. Using an iterative process, we conducted two focus groups and made modifications to the brochure. We then implemented the SAM+CAM assessment. We report here on the findings from both the focus groups and the SAM+CAM testing. We organized focus group findings by the SAM+CAM categories, including content, literacy demand, numeracy, graphic material, layout/typography, and learning stimulation/motivation. We will provide quotes and summaries of the relevance for each of these SAM+CAM categories. By structuring focus groups with American Indian participants using these categories, we then made revisions to the brochure. The resulting SAM+CAM scores confirmed that the brochure was suitable and comprehensible to participants. Overall, the SAM+CAM scores were generally high as the overall rating was 90%, which indicates a superior product. Using this participatory and iterative process, we found that structuring the development and revision of the brochure through the SAM+CAM categories provided a useful process to balance the presentation of evidence-based data for CRC screening with community preferences and norms.

Citation Format: Andrew L. Sussman, Kevin English, Matthew Frank, Dolores Guest, Deborah Helitzer, Shiraz Mishra. Development of a culturally grounded brochure to enhance colorectal cancer screening in Southwestern American Indian communities [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A014.