Clinical Prevention for a Whole Panel: A Mailed Stool Test Outreach Plan to Raise Colorectal Cancer Screening at a Rural Health Clinic
[Student Name]
University of Phoenix
NSG/482: Promoting Healthy Communities
Week 3 Assignment
[Instructor Name]
[Date]
The clinic, population and figures are a composite written for a model paper.
Clinical prevention is often pictured as one provider reminding one patient at one visit. That approach misses the people who do not come in. A composite rural health clinic serving 5,600 patients in a farming county found that only 44% of its 1,900 patients aged 45 to 75 had current colorectal cancer screening, well below both the 2023 national baseline of 63.5% and the Healthy People 2030 target of 72.8% for adults aged 45 to 75 (Office of Disease Prevention and Health Promotion [ODPHP], n.d.). The clinic did not have a screening problem at its visits; it had a screening problem among the more than 1,000 patients who were not coming to visits at all. This paper plans a population-level clinical prevention program, mailed stool test outreach, to close that gap.
The Population and the Gap
The clinic's panel of 1,900 adults aged 45 to 75 is older and more rural than the state average. About 60% live more than 20 miles from the regional hospital where colonoscopies are performed, and about a quarter are uninsured or underinsured. Chart review showed three groups among the roughly 1,060 patients who were not up to date. About a third had visited in the past year, but screening was not discussed or was declined. About half had not visited in over a year. The rest had an abnormal stool test in the past with no documented colonoscopy, a group at especially high risk.
Current federal guidance recommends screening for colorectal cancer in all adults aged 50 to 75 and, since its 2021 update, in adults aged 45 to 49, using any of several tests, including annual fecal immunochemical tests (FIT) and colonoscopy every ten years (US Preventive Services Task Force, 2021). The choice of test matters less than whether a person is screened. For a rural population far from colonoscopy, an annual home stool test is often the most practical option.
Understanding the Barriers
The Health Belief Model explains preventive behavior through a person's perceived susceptibility to a condition, its perceived severity, the perceived benefits of action, perceived barriers and cues that prompt action (Rosenstock, 1974). Conversations with a sample of patients who were not screened showed each element. Many felt healthy and did not think cancer was likely without symptoms, a low perceived susceptibility. Most understood that colon cancer is serious but believed that screening meant colonoscopy, with its preparation, time off work and a long drive, a high perceived barrier. Few had received a clear, recent cue to act.
The model points to specific changes. A home test lowers the barriers of time, travel and preparation. A letter from the patient's own clinic, saying that screening is recommended for people their age even without symptoms, addresses susceptibility and serves as a cue. A follow-up call adds a second cue and a chance to answer questions.
Evidence for Mailed Outreach
Pooling U.S. trials of strategies to raise screening, Dougherty et al. (2018) found that mailed FIT outreach was among the most effective single interventions, and that patient navigation and combinations of interventions also increased screening. The review supports sending kits directly to patients rather than waiting for visits, and adding reminders and navigation for those who need them.
The Outreach Plan
The plan has four steps, led by the clinic's registered nurse care coordinator with support from medical assistants.
1. Identify. Using the electronic health record, the coordinator builds a list of all patients aged 45 to 75 who are not up to date and have no exclusion, such as a history of colorectal cancer or a recent colonoscopy.
2. Notify. Each patient receives a letter signed by his or her own provider explaining that screening is recommended at this age, that a simple test can be done at home and that a kit will arrive within two weeks.
3. Mail and remind. The kit arrives with picture-based instructions and a prepaid return envelope. Medical assistants make reminder calls at two and four weeks to patients who have not returned the kit, and a text reminder is sent to patients who have agreed to receive texts.
4. Follow up. Normal results are mailed with a reminder that the test is repeated yearly. Positive results trigger a call from the nurse within three business days to explain the result, schedule a colonoscopy and address transportation, cost and preparation.
The patients with a past abnormal test and no colonoscopy are not sent a new kit. They receive a direct call from the nurse, because another stool test would not resolve an abnormal result that is still open.
Closing the Loop on Abnormal Results
Many outreach programs lose patients between a positive stool result and the colonoscopy it requires. For this clinic, distance and cost are the main risks. The nurse care coordinator will keep a list of every patient with a positive result until the colonoscopy is completed, arrange rides through the county's senior transportation program or a volunteer driver network, help uninsured patients apply for the regional hospital's charity care program and review bowel preparation instructions by phone the week before the procedure. A program that mails kits but does not follow abnormal results through to colonoscopy would find cancers without treating them.
Reaching Patients the Letter Will Miss
A mailed program assumes a working address, reading ability in English and trust in the clinic. About 15% of the clinic's patients prefer Spanish, many of them farmworkers whose addresses change with the season. For these patients the letter and instructions will be translated and reviewed by a bilingual medical assistant for plain language, and kits will also be offered in person at the clinic's two evening hours during harvest season and at the county's migrant health outreach events. Patients with limited literacy will receive picture-based instructions and a call from a staff member who can walk through the steps. Patients without a stable address will be offered a kit at any visit, including sick visits and medication refills, so that every contact becomes a screening opportunity. Without these adjustments, an outreach program built for the whole panel would quietly raise the screening rate among the easiest patients to reach and widen the gap for the rest, which is the opposite of population health.
Measures and Targets
The program sets a one-year target of raising the up-to-date screening rate from 44% to 60%, on the way to the Healthy People 2030 target. Process measures include the kit return rate, with 30% as the initial goal, and the percentage of positive results with a completed colonoscopy within six months, with 80% as the goal. The coordinator will report these monthly to the clinic's quality committee. A balancing measure will track staff time per kit returned, so the clinic can judge whether the program is sustainable.
Conclusion
A clinic that waits for patients to come in will not screen the people most at risk of being missed. By treating its whole panel as the population, this composite rural clinic can use the Health Belief Model to understand why patients were not screened, the outreach evidence to choose mailed stool tests with reminders and navigation, and a clear set of measures to track progress toward the national target. Clinical prevention at the population level is still delivered one kit and one phone call at a time, but it is planned for everyone.
References
Dougherty, M. K., Brenner, A. T., Crockett, S. D., Gupta, S., Wheeler, S. B., Coker-Schwimmer, M., Cubillos, L., Malo, T., & Reuland, D. S. (2018). Evaluation of interventions intended to increase colorectal cancer screening rates in the United States: A systematic review and meta-analysis. JAMA Internal Medicine, 178(12), 1645-1658. https://doi.org/10.1001/jamainternmed.2018.4637
Office of Disease Prevention and Health Promotion. (n.d.). Increase the proportion of adults who get screened for colorectal cancer: C-07. Healthy People 2030. U.S. Department of Health and Human Services. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/increase-proportion-adults-who-get-screened-colorectal-cancer-c-07
Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328-335. https://doi.org/10.1177/109019817400200403
US Preventive Services Task Force. (2021). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(19), 1965-1977. https://doi.org/10.1001/jama.2021.6238
How this NSG 482 Week 3 example is structured
The NSG/482 library guide has no separate Week 3 tab, and the University of Phoenix course page lists clinical prevention and population health among the skills the course builds, so this model treats Week 3 as a clinical prevention planning week. The paper defines the population and the gap in numbers, grounds the intervention in the screening recommendation and the outreach evidence, explains the barriers through one health behavior theory and then gives the plan, the follow-up for abnormal results and the measures in that order. Students search this week as NSG 482 Week 3, NSG482 Wk 3 or NSG/482 Wk 3; all three are the same assignment.
NSG/482 Week 3 questions, answered
What does NSG/482 Week 3 usually ask for?
The NSG/482 library guide has no separate Week 3 tab, so read your own week's instructions closely. The course page lists clinical prevention and population health as a core skill, and many sections ask for a health promotion or prevention plan for a defined population, often tied to a Healthy People 2030 objective.
Why does the plan include follow-up colonoscopy?
A stool test is only the first step. When it is positive, the patient needs a colonoscopy, and many outreach programs lose patients at that point. A plan that ends with mailing kits prevents nothing if abnormal results are not followed up, so the sample treats navigation to colonoscopy as part of the intervention.
Which health behavior theory fits a screening paper?
The Health Belief Model is common for screening because it explains decisions through perceived susceptibility, severity, benefits and barriers, plus cues to action. Other models, such as the transtheoretical model, can also work if they are applied to the population's actual barriers.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official University of Phoenix document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.