# The Effectiveness of ¡Salud!, por la Vida, an Educational Intervention to Increase Colorectal Cancer Screening in Puerto Rico

## TL;DR

A culturally tailored educational program in Puerto Rico increased colorectal cancer screening rates by 48% among adults aged 50–75.

## Contribution

Demonstrates that community health worker-led interventions can effectively boost cancer screening in underserved populations.

## Key findings

- Screening rates were 48% higher in the intervention group compared to standard care.
- Participants were over three times more likely to undergo colonoscopy after the intervention.
- The program significantly increased fecal occult blood test completion rates.

## Abstract

Colorectal cancer is the leading cause of cancer-related death in Puerto Rico, yet screening rates remain low. To address this gap, researchers developed and tested a culturally tailored educational intervention, ¡Salud! Por la Vida, aimed at increasing colorectal cancer screening among adults aged 50–75 who were not up to date with current guidelines. A randomized controlled trial was conducted in Federally Qualified Health Centers. Participants in the intervention group received one-on-one education from Community Health Workers (CHWs) along with follow-up reminders, while the control group received standard care. After four months, screening rates—including fecal occult blood tests and colonoscopies—were 48% higher among those in the intervention group. These findings suggest that CHW-delivered, culturally responsive strategies can effectively improve screening uptake in underserved populations. This study may inform future community-based cancer prevention initiatives and reduce late-stage diagnoses and mortality, contributing meaningfully to public health and health equity efforts.

Background/Objectives: Colorectal cancer (CRC) is the leading cancer-related death in Puerto Rico (PR). Yet CRC screening (CRCS) rates remain low. We developed ¡Salud!, por la Vida, an educational intervention aiming to increase CRCS among age-eligible adults living in PR. Methods: We conducted a cluster randomized controlled trial among adults 50–75 years old at Federally Qualified Health Clinics in PR. Participants could not have a history of CRC nor be currently adherent to CRCS guidelines for a fecal occult blood test (FOBT) or fecal immunochemical test (FIT) (within last year) or colonoscopy (within last 5–10 years). Out of 445 randomized participants, 355 completed the study procedures (Control: 277; Intervention: 78) and were included in the main analysis. Participants in the intervention arm completed baseline and follow-up questionnaires alongside the educational intervention (at baseline) and two reminder calls (before follow-up) within a four-month period. Control arm participants only completed baseline and follow-up questionnaires within the same period. All participants were followed up to assess CRCS completion. Results: Post-trial screening rates were significantly higher in the intervention group: FOBT/FIT (55% vs. 39%, p = 0.02), colonoscopy (10% vs. 3%, p = 0.02), and any CRCS (60% vs. 41%, p < 0.01). Compared to controls, those in the intervention group showed a 48% higher probability of undergoing any CRCS (RR = 1.48, 95%CI: 1.17, 1.86), were 1.4 times more likely to complete a FOBT/FIT (RR = 1.40, 95%CI: 1.09, 1.80), and were over 3 times more likely to undergo a colonoscopy (RR = 3.16, 95%CI: 1.26, 7.91). Conclusions: The findings underscore the efficacy of the intervention in increasing CRCS uptake, potentially preventing late-stage detection and reducing CRC mortality in PR.