Connecting Appalachians to Lung Cancer Screening

Abstract Annual lung cancer screening (LCS) counseling and shared-decision making visits and annual low-dose computed tomography screening are now recommended for eligible adults by The U.S. Preventive Services Task Force, and covered for those insured by the Centers for Medicaid & Medicare Services. Yet we have little information about LCS knowledge, attitudes, and behavior in the population of Appalachian counties that suffer the highest burden of lung cancer, a knowledge gap that stymies the uptake of this potentially lifesaving medical innovation. Primary care providers and significant others are the most important and trusted sources of health information, and knowledge, attitudes, behavior, and resources of those in our social network significantly impact health behavior, yet Appalachians are not a health-seeking population. Despite limited access to formal resources, Appalachian populations are characterized as having strong social and kin networks and social cohesion. People turn to others that they trust to understand health information and to reduce risk when faced with health services or behaviors – like LCS –that are complex, high-risk, or ambiguous. This word-of-mouth communication may be critical in connecting socioeconomically disadvantaged populations – for whom health literacy is low and who access information online less than higher income populations –with LCS. In addition, public health outreach strategies are unlikely to transmit information in communities as quickly as this naturally occurring word-of-mouth. Dissemination and implementation scientists have championed the use of social network analysis in understanding influences of network members on communication and behavior, identifying early adopters of innovations, and recruiting them as models for behavior change. Because these social ties and communication networks determine the diffusion of new ideas and information, we need to examine their influence on diffusion of LCS in an Appalachian population at high risk for lung cancer. Using network data collection software developed by Dr. Eddens for use in populations with low-literacy (OpenEddi), we will: 1) Assess knowledge, attitudes, and beliefs about LCS and sources of LCS information among Appalachians at elevated risk of lung cancer; 2) Describe communication and support networks of LCS eligible individuals; and, 3) Build a predictive model of LCS intention for high risk Appalachians. Understanding the most powerful influences on screening will lead to effective translational interventions to promote shared decision making regarding LCS among those at greatest risk of lung cancer, reducing the tremendous burden of lung cancer mortality in Appalachian Kentucky. This is a resubmission of a LOI from Cycle 14 that is responsive to reviewers’ comments. The initial submission included the recruitment of health care providers. Because there are other ongoing investigations with providers, this application can now focus directly on the target population of Appalachians eligible for LCS