Dissertation
Increasing Colorectal Cancer Screening Rates Among Marshallese Patients
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
Abstract
Background: Colorectal cancer (CRC) is the third most common cancer globally and second most deadly. The incidence rate was 36.5 and the death rate 12.9 per 100,000 people in the United States from 2017-2021. Screening rates remain below national targets, particularly among minority populations. Among these are Marshallese immigrants, who face significant disparities due to limited healthcare access, cultural barriers, language differences, and low health literacy. Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to increase CRC screening adherence among Marshallese patients aged 45–75 at a federally qualified health center in the Upper Midwest. Methods: A quality improvement project guided by the Plan-Do-Study-Act framework was implemented from September to December 2025. Interventions included culturally tailored educational brochures and posters in the Marshallese language, QR code-linked educational videos, and workflow integration involving clinic staff. Data collected monthly included screening rate percentages, number of tests ordered, test return rates, and video engagement. Findings: A total of 191 patients were eligible. The first outcome of a three percent increase in CRC screening rates was not achieved; however, rates improved compared to prior baseline data. The second goal of 80 percent willingness to screen following education was not met, with a peak of 55 percent. The third objective was achieved, with an average test return rate of 21 percent, exceeding the 10 percent target. Trends suggested increased engagement over time as staff adapted to the intervention. Discussion: Although not all objectives were met, the project demonstrated clinical and practical significance. Culturally tailored educational materials showed promise in improving screening engagement and test return rates. Barriers included small sample size, staff workflow challenges, and cultural factors influencing health behaviors. Findings support continued use of culturally appropriate interventions, with future efforts focusing on community partnerships and addressing structural barriers.
Details
- Title: Subtitle
- Increasing Colorectal Cancer Screening Rates Among Marshallese Patients
- Creators
- Parker Faber - University of Iowa
- Contributors
- Ann Weltin (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Family Nurse Practitioner
- Date degree season
- Spring 2026
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright © 2026 Parker Faber
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9985217822602771
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