Community-based Educational Intervention for Lung Cancer Screening for Non-Hispanic Black Adults.

Background
Lung cancer is the leading cause of cancer mortality in the United States, with an estimated 125,070 deaths in 2024 (1). Mortality has declined, partly because of early detection by lung cancer screening (LCS) and reduced smoking rates, but Black men experience higher lung cancer mortality than White men (58.3 vs. 38.9 per 100,000) (1). LCS with low-dose computed tomography reduces lung cancer mortality by 20% (2), but overall participation is low at 5.8% (3) and even lower among non-Hispanic Black (NHB) individuals at 1.7% (4). Factors contributing to this disparity include lack of awareness, perceived low cancer risk, fear, distrust of the healthcare system, avoidance of cancer screening, and concerns about cost and insurance coverage (5–7). Direct outreach to community members interested in cancer screening may effectively increase LCS use by providing LCS education, identifying decision factors, and distributing LCS information outside traditional healthcare settings. The aim of this study was to test the feasibility, acceptability, and usability of a community-based LCS intervention in NHB individuals eligible for LCS. The secondary aim was to assess existing LCS knowledge and shared decision making with primary care providers (PCPs) and understand factors influencing decisions about LCS, healthcare use, participation in other cancer screenings, and effective methods for disseminating LCS information.

Methods

Study Setting and Population
This study was conducted during the Culture of Health Indiana Black and Minority Health Fair, organized by the Indiana Department of Health, which provided a platform for community engagement, including a panel featuring an LCS expert (F.C.D.), a thoracic oncologist, and a breast cancer screening expert. Each panelist presented for 20 minutes, followed by a 15-minute question-and-answer session. Our population included individuals meeting the U.S. Preventive Services Task Force LCS eligibility criteria without prior LCS. Before enrollment, participants were screened to determine if they were present for the educational content shared in the panel discussion. Those who acknowledged not being present had the educational content presented during enrollment to ensure consistent exposure.

Intervention Components and Enrollment
The LCS education intervention, developed by LCS physician experts (F.C.D., E.J.J.), was culturally tailored and accessible to individuals with less than a sixth grade education. It included a 20-minute oral presentation and fact sheet titled “Let’s Talk about Lung Cancer Screening,” which covered lung cancer incidence and mortality, racial disparities in lung cancer outcomes, the mortality benefit of LCS, eligibility criteria (pack-year calculations), insurance coverage and costs, and strategies to reduce lung cancer risk. LCS-eligible participants were determined after the panel and enrolled. For those who missed the panel, content was reviewed by the LCS expert. The fact sheet was reviewed with all participants by F.C.D. After the intervention, participants completed a 33-item survey exploring primary and secondary outcomes and received a $50 Visa gift card.

Outcomes
Primary outcomes were the feasibility, acceptability, and usability of the education intervention. Feasibility was defined as the ability to recruit eligible participants, deliver the intervention logistically at a community health fair, and achieve complete participation in the educational and survey components. Acceptability was evaluated through participants’ feedback on their willingness to engage with the materials, interest in pursuing LCS, and willingness to share information. Usability focused on participants’ perceived improvement in LCS knowledge, information quality for decision making, and ability to determine LCS eligibility. Secondary outcomes included reasons for interest or disinterest in LCS and preferred methods to increase LCS uptake among NHB individuals.

Results

Participant Characteristics
Among 17 participants, 93.8% were Black and 76.5% were women. Most (81%) had some college or higher education, with 25% reporting annual incomes of $50,000–$74,999. All participants had PCPs and reported regular checkups. Most participants had undergone other cancer screenings, including mammography (75%) and colon cancer screening (94%). However, 76% reported that their provider had never discussed LCS.

Feasibility
The intervention was successfully executed within a community health fair. All individuals meeting the U.S. Preventive Services Task Force criteria (n = 17) consented to participate and completed the educational intervention and postintervention survey.

Acceptability
The intervention was well received, with 94.1% of participants finding the session helpful and 88.2% expressing their willingness to share the information. Preferred methods to increase LCS included community health fairs (25%), educational sessions (15%), discussions with PCP about all cancer screenings simultaneously (15%), distribution of brochures in frequented locations (13%), and personal stories from those who had undergone LCS (13%) (Figure 1). Fewer than 6% reported disinterest in LCS, while 53% expressed interest in screening. Reasons for interest included the link between cigarette use and lung cancer (24%), desire for a healthier life (21%), and trust in the physician presenter (21%) (Figure 2). Reasons for disinterest included fear of results, cost and insurance concerns, unwillingness to pursue treatment if cancer diagnosed, desire to consult with their PCP, and misinformation about lung cancer risk in former smokers.

Usability
The majority (94.1%) of participants reported increased LCS knowledge after the intervention, and 88.2% believed that they had sufficient information to decide about LCS. Although 47% believed that they met eligibility criteria, 41.2% were unsure.

Conclusions
This study demonstrates the feasibility, acceptability, and usability of a community-based LCS education intervention for NHB individuals, identifying factors influencing LCS decisions and preferred outreach methods. Despite strong engagement and a highly educated cohort, 41.2% remained unsure of their screening eligibility, suggesting a need for enhanced educational strategies.
Despite regular PCP visits and participation in other cancer screenings, 76% had never discussed LCS with a provider, similar to a study by Simmons and colleagues (8), emphasizing the need for tailored shared decision making. Preferred outreach methods included community health fairs and educational sessions, though this may reflect participant bias. Although 53% expressed interest in LCS, some remained hesitant, possibly because of challenges in calculating pack-years, as noted in prior studies (9). Simplified eligibility criteria focusing on smoking duration may help address these gaps (9).
This pilot highlights the potential of targeted LCS educational interventions to engage NHB communities. Future efforts should focus on refining educational content, improving provider–patient communication, and addressing persistent hesitancy to increase LCS participation. Furthermore, integrating trainees into the intervention allowed them to learn from the communities they serve and foster trust between community members and healthcare systems. Strengthening this trust may increase LCS and address barriers to care.