Assignment Prompt & Instructions
**files (2)**
– ## capstoneintrucction.docx
– ## CapstonePartIPICOTAssignment1.pdf
**## capstoneintrucction.docx**
Did you find research to back up your statements on APRNS?
Missing Conclusion paragraph
For Part II and III discuss your findings and proposal in more details.
You are on the right track.
Capstone Part II: Review of Literature
**CAPSTONE: PART II due 10/4/2025 by 11:59pm**
1. Review of Literature:
– Review and discuss literature: Synthesize at least 10 primary research studies and/or systematic reviews; do not include summary articles. This section is all about the scientific evidence rather than someone else's opinion of the evidence. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. This is a synthesis rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.
2. Analyze and apply knowledge directly to your PICOT- The studies that you cite in this section must relate directly to your PICOT question.
3. Provide precise body of evidence for your Practice Change- Include Nurses as leaders in this project, statistics, cost, impact on healthcare.
4. Discuss objectives for your practice change, Why is change necessary?
5. Discuss where the problem exists, why it exists, what is the preposition for change. Include information from your PICOT.
6. Apply all that is relevant to the problem. For example: Pros vs Cons, current state of problem
NOTE: It should not reflect your opinion, but rather Evidence Based Practice should be applied
-After completing a literature search on interventions addressing your chosen health problem, write a review that evaluates the strengths and weaknesses of all the sources you have found, compare anc constrast.
-Use appropriate APA 7th Ed. Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be minimum 4-6 pages long (not including the title and reference page).
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written APA in the 3rd person.
**Rubric Capstone II.docx**
1. Integration of Knowledge — 25 points
Thoroughly select and present an appropriate evidence-based practice intervention for the identified health problem and proposed change. Clearly explain how the evidence supports the intervention.
2. Topic Focus — 25 points
Choose a health problem narrow enough for the assignment’s scope. Include a clear topic statement that provides direction for the paper. Maintain a consistent focus, develop thoughtful insights, and support the discussion with cited evidence.
3. Depth of Discussion and Cohesiveness — 25 points
Provide an in-depth discussion throughout the paper. Integrate information from all sources and demonstrate an understanding of the relationships among their findings. Ensure that ideas flow logically from one issue to the next. The rubric specifically requires the paper’s body to flow without headings.
4. Spelling and Grammar — Category Listed as 10 Points
Meet the required word count and include fewer than five grammatical, spelling, capitalization, or punctuation errors. Carefully proofread the paper before submission.
5. Sources — 10 points
Use at least six current sources, including at least three peer-reviewed journal articles or scholarly books. Include both general background information and specialized evidence. All websites must be authoritative. Identify special-interest sources or popular literature appropriately if used.
6. Citations — 5 points
Follow APA formatting consistently, with fewer than five errors involving citations, quotations, or formatting. Ensure that in-text citations and reference entries are complete and accurate.
Scoring clarification: The spelling and grammar category is labeled as worth 10 points, but the Outstanding column awards 8 points. This discrepancy should be clarified with the instructor.
**## CapstonePartIPICOTAssignment1.pdf**
1
Capstone Part I: PICOT Assignment: Bilingual Colorectal Cancer Screening Education for
Hispanic Adults
Mirlenys Diaz
Florida National University
MSN Capstone Project
Dr. Carmen Lazo
September 16, 2026
2
Bilingual Colorectal Cancer Screening Education for Hispanic Adults
Introduction to your proposed problem
Colorectal cancer (CRC) is an important public health problem and a major cause of
cancer morbidity and mortality in the United States. Screening is important because it may detect
precancerous tissue and cancer before it can advance to a more serious or even deadly stage. The
U.S. Preventive Services Task Force (USPSTF) advises CRC screening in average-risk adults
ages 45 to 75 (Siddique et al., 2024). However, disparities in screening rates continue to be
significant for Hispanic adults, despite these recommendations.
The extent of the issue is reflected in the national data. In 2022, 61.4% of all adults aged
45-75 were up-to-date with CRC screening. However, only 52.4% of Hispanic adults were
current compared with 63.5% of non-Hispanic White adults, while 41.7% of Hispanic adults had
never been screened (King et al., 2025). Of the adults aged 45-49, 29.8% were up to date with
screening and 65.7% had never been screened (King et al., 2025). The results are significant
because adults as young as age 45 are now part of the regular screening guidelines.
The problem also affects Miami-Dade County. In 2023, there were approximately 1,320
new cases of CRC and an age-adjusted incidence of 36.5 cases per 100,000 population. The
number of CRC cases died in 2024 was about 456, and the age adjusted mortality rate was 12.2
deaths per 100,000 (Florida Department of Health, 2024). Screening also varies by
neighborhood. According to Ashad-Bishop et al., (2023) the average screening rates in Miami-
Dade County were approximately 59% but dropped to 53.3% in communities with higher social
vulnerability.
CRC costs are incurred due to diagnosis, treatment, hospitalisation, medications,
specialist services, loss of productivity, as well as early death. Cancer screening also utilizes a
3
considerable amount of health care resources, but could decrease later disease burden through
early detection and prevention (Aguiar-Ibáñez, 2025). The total estimated cost for this project is
between $300 and $500 for bilingual printing, educational materials, and professional review.
The program that is being proposed would consist of creating a culturally responsive
bilingual English-Spanish teaching plan for Hispanic adults 45 to 75 at a community clinic
located in Hialeah, FL. The resource will cover the significance of screening, age, types of
screening, preparation, misconceptions, and early detection. The goal is to enhance the quality
and comprehensiveness of CRC screening education. Since patients will not be recruited or
directly treated, the project will quantify the development and expert review of the education
product instead of screening behavior.
PICOT
The PICOT question is: In Hispanic adults aged 45 to 75 receiving care at a community
clinic in Hialeah, Florida (P), how does development of a bilingual English-Spanish teaching
plan about colorectal cancer screening (I), compared with standard educational information (C),
improve the quality and completeness of colorectal cancer screening education (O) over 12
weeks (T)?
The population includes Hispanic adults aged 45 to 75 receiving care at the community
clinic that was selected and who are eligible for average-risk CRC screening. The intervention is
development of a bilingual teaching plan that provides screening information in English and
Spanish. Content will cover screening eligibility, screening methods available, benefits of early
detection, preparation prior to screening, common misconceptions, and follow-up after abnormal
screening.
4
The comparison is standard educational information that is routinely used as part of the
standard clinical practice. The result is the quality and completeness of educational product.
Evaluation of accuracy, readability, cultural appropriateness, bilingual consistency, and current
screening recommendations will be done by experts. The time frame is 12 weeks for literature
review, development, translation, evaluation, revision and presentation.
The PICOT directly links the practice problem and the proposed change. Nationally,
Hispanic adults are less likely to participate in screening and communities in Miami-Dade show
differences based on social vulnerability. A bilingual educational resource is thus a viable answer
to remediable knowledge and communication barriers.
Describe the vulnerable population and setting
The target population is Hispanic adults (ages 45-75) attending their primary care in a
community clinic in Hialeah, FL. Social determinants of health in the population that can affect
preventive screening may include income, insurance status, health literacy, language,
transportation, employment demands and primary care access. Other barriers may be fear,
embarrassment, cultural beliefs, lack of knowledge, and uncertainty about screening procedures.
Materials provided only in English may limit understanding among patients with limited
English proficiency. An essential information bilingual resource that enhances access to
understandable screening education.
Social vulnerability also accounts for disparities in preventive care. Miami-Dade
Community Based Research noted that CRC screening rates differed by community social
vulnerability, the more vulnerable communities having lower CRC screening participation
(Ashad-Bishop et al., 2023). The national evidence also indicates that CRC screening rates are
lower among Hispanic adults (King et al., 2025).
5
Change is important because the failure to do the screening can lead to late detection,
more complicated treatment, higher healthcare costs, poorer quality of life and early death.
Education cannot eliminate every structural barrier, but it can address knowledge and
communication barriers. Limited awareness, language differences, and healthcare-access issues
are identified as associated with delayed screening with Latino populations during research
(Montalvan-Sanchez et al., 2024).
Proposal
The proposed intervention involves a bilingual CRC screening education program that
will teach Hispanic adults ages 45 to 75 years old. The teaching will involve the reasons behind
screening, time to start screening, screening methods, how to prepare, misconceptions, and
follow up on abnormal findings. There is enough evidence regarding structured and culturally
tailored CRC screening education. According to research conducted among Hispanic and Latino
patients who speak Spanish, cultural tailoring of cancer screening educational material is
necessary (Jang et al., 2022). Meade et al. (2023) have also stressed the need for culturally-
tailored cancer prevention communication among Latinos. Structured outreach within
underserved primary care settings has further demonstrated the value of organized approaches to
screening support (Glascock et al., 2026). These findings support development of a bilingual
educational product.
The project will not recruit patients, administer surveys, collect identifiable health
information, or directly implement a screening intervention. The APRN will review literature,
identify educational needs, develop the English content, prepare the Spanish version, obtain
professional feedback, revise the materials, and complete final evaluation. The preceptor will
6
review clinical accuracy, while bilingual personnel may assess language clarity and cultural
relevance.
Resources will include a computer, scholarly literature, current guidelines, bilingual
templates, printing supplies, visual resources, and staff review time. The project is feasible
because it does not require new equipment, medications, laboratory testing, or major
expenditure. During weeks 1 through 3, the literature and educational needs will be reviewed.
Weeks 4 through 6 will focus on development and translation. Weeks 7 through 9 will involve
clinical, language, and cultural review. Weeks 10 through 12 will include revisions, final
evaluation, formatting, and presentation.
The APRN will function as an evidence translator, educator, collaborator, and change
agent. The APRN will identify the practice problem, evaluate evidence, ensure that materials
reflect current recommendations, coordinate review, and evaluate the final product. Advanced
practice nurses contribute to translating evidence into clinical practice and supporting evidence-
based decisions.
The expected outcome is completion of a bilingual CRC screening teaching plan that
meets predetermined expert-review criteria for accuracy, completeness, readability, cultural
appropriateness, and consistency with current recommendations. The product may provide the
clinic with a sustainable educational resource for future preventive-care activities without
claiming that the project directly changes patient screening behavior.
Theoretical Framework/Nursing Theory
Pender’s Health Promotion Model will serve as the primary nursing framework. The
model emphasizes individual characteristics, previous experiences, perceived benefits, perceived
barriers, interpersonal influences, situational influences, and self-efficacy as factors affecting
7
health-promoting behavior (Rojas-Torres et al., 2025). These concepts are relevant because CRC
screening decisions may be affected by knowledge, fear, perceived benefits, language, cultural
beliefs, financial concerns, and healthcare access.
The framework will guide development of educational content by addressing both
screening benefits and barriers. The teaching plan will explain how screening can identify cancer
or precancerous conditions early while addressing common concerns about screening
procedures. Bilingual communication will reduce language-related barriers, while culturally
appropriate explanations can improve relevance and understanding. Pender’s model therefore
supports the population, educational intervention, and expected outcome. Pender’s model
addresses beliefs, perceived barriers, benefits, and self-efficacy related to preventive behavior.
The framework supports an APRN-led project addressing CRC screening disparities among
Hispanic adults.
8
References
Aguiar-Ibáñez, R., Mbous, Y., Sharma, S., Chakali, R., & Chawla, E. (2025). Barriers to cancer
screening uptake and approaches to overcome them: A systematic literature review.
Frontiers in Oncology, 15, 1575820. PubMed Central.
https://doi.org/10.3389/fonc.2025.1575820
Ashad-Bishop, K. C., Baeker Bispo, J. A., Nahodyl, L., Balise, R. R., Kobetz, E. K., & Bailey, Z.
D. (2023). Hyperlocal disparities in breast, cervical, and colorectal cancer screening: An
ecological study of social vulnerability in Miami-Dade county. Preventive Medicine
Reports, 35, 102371. https://doi.org/10.1016/j.pmedr.2023.102371
Florida Department of Health. (2024). Colorectal cancer incidence – Florida Health CHARTS –
Florida Department of Health. Www.Flhealthcharts.Gov.
https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=NonVitalInd.D
ataviewer&cid=0445
Glascock, M., Wangen, M., Ferrari, R. M., O’Leary, M. C., Schwartz, J., Ndugulile, M., Unger, J.
M., Li, L., Marciniak, M. W., Reuland, D. S., Watabayashi, K., Brenner, A. T., Wheeler,
S. B., & Shah, P. D. (2026). Expanding access to colorectal cancer screening through
community pharmacies: Study protocol for the PharmFITTM randomized controlled trial.
Contemporary Clinical Trials, 170, 108443. https://doi.org/10.1016/j.cct.2026.108443
Jang, S. H., Cole, A., Brown, E. V. R., & Ko, L. (2021). Adaptation of a Mailed-FIT kit and
patient navigation intervention to increase colorectal cancer (CRC) screening among
Spanish-speaking hispanic/latino patients. Hispanic Health Care International, 20(2),
80–88. https://doi.org/10.1177/15404153211024116
9
King, S. C., King, J., Thomas, C. C., & Richardson, L. C. (2025). Baseline estimates of
colorectal cancer screening among adults aged 45 to 75 years, behavioral risk factor
surveillance system, 2022. Preventing Chronic Disease, 22.
https://doi.org/10.5888/pcd22.250175
Meade, C. D, Stanley, N. B., Arevalo, M., Tyson, D. M., Chavarria, E. A., Aguado, C. X., Rivera,
M., Gutierrez, L., Abdulla, R., Christy, S. M., & Gwede, C. K. (2023). Transcreation
matters: A learner centric participatory approach for adapting cancer prevention messages
for Latinos. Patient Education and Counseling, 115, 107888–107888.
https://doi.org/10.1016/j.pec.2023.107888
Montalvan-Sanchez, E. E., Beas, R., Karkash, A., Godoy, A., Norwood, D. A., & Dougherty, M.
(2024). Delays in colorectal cancer screening for latino patients: The role of immigrant
Healthcare in stemming the rising global incidence of colorectal cancer. Gastroenterology
Research, 17(1), 41–51. PubMed Central. https://doi.org/10.14740/gr1697
Rojas-Torres, I. L., Garizábalo Dávila, C. M., Ruidíaz Gómez, K. S., Fernández Aragón, S. P.,
Perea-Rojas, D. M., Rodelo Olmos, G. M., & Liñán Meléndez, N. I. (2025).
Effectiveness of Nola Pender’s health promotion model: A comprehensive approach for
enhancing healthy behaviors and quality of life in adults. International Journal of
Environmental Research and Public Health, 22(10), 1506.
https://doi.org/10.3390/ijerph22101506
Siddique, S., Wang, R., Yasin, F., Gaddy, J. J., Zhang, L., Gross, C. P., & Ma, X. (2024).
USPSTF colorectal cancer screening recommendation and uptake for individuals aged 45
to 49 years. JAMA Network Open, 7(10), e2436358–e2436358.
https://doi.org/10.1001/jamanetworkopen.2024.36358
10
**## CapstonePartIPICOTAssignment1.pdf**
1
Capstone Part I: PICOT Assignment: Bilingual Colorectal Cancer Screening Education for
Hispanic Adults
Mirlenys Diaz
Florida National University
MSN Capstone Project
Dr. Carmen Lazo
September 16, 2026
2
Bilingual Colorectal Cancer Screening Education for Hispanic Adults
Introduction to your proposed problem
Colorectal cancer (CRC) is an important public health problem and a major cause of
cancer morbidity and mortality in the United States. Screening is important because it may detect
precancerous tissue and cancer before it can advance to a more serious or even deadly stage. The
U.S. Preventive Services Task Force (USPSTF) advises CRC screening in average-risk adults
ages 45 to 75 (Siddique et al., 2024). However, disparities in screening rates continue to be
significant for Hispanic adults, despite these recommendations.
The extent of the issue is reflected in the national data. In 2022, 61.4% of all adults aged
45-75 were up-to-date with CRC screening. However, only 52.4% of Hispanic adults were
current compared with 63.5% of non-Hispanic White adults, while 41.7% of Hispanic adults had
never been screened (King et al., 2025). Of the adults aged 45-49, 29.8% were up to date with
screening and 65.7% had never been screened (King et al., 2025). The results are significant
because adults as young as age 45 are now part of the regular screening guidelines.
The problem also affects Miami-Dade County. In 2023, there were approximately 1,320
new cases of CRC and an age-adjusted incidence of 36.5 cases per 100,000 population. The
number of CRC cases died in 2024 was about 456, and the age adjusted mortality rate was 12.2
deaths per 100,000 (Florida Department of Health, 2024). Screening also varies by
neighborhood. According to Ashad-Bishop et al., (2023) the average screening rates in Miami-
Dade County were approximately 59% but dropped to 53.3% in communities with higher social
vulnerability.
CRC costs are incurred due to diagnosis, treatment, hospitalisation, medications,
specialist services, loss of productivity, as well as early death. Cancer screening also utilizes a
3
considerable amount of health care resources, but could decrease later disease burden through
early detection and prevention (Aguiar-Ibáñez, 2025). The total estimated cost for this project is
between $300 and $500 for bilingual printing, educational materials, and professional review.
The program that is being proposed would consist of creating a culturally responsive
bilingual English-Spanish teaching plan for Hispanic adults 45 to 75 at a community clinic
located in Hialeah, FL. The resource will cover the significance of screening, age, types of
screening, preparation, misconceptions, and early detection. The goal is to enhance the quality
and comprehensiveness of CRC screening education. Since patients will not be recruited or
directly treated, the project will quantify the development and expert review of the education
product instead of screening behavior.
PICOT
The PICOT question is: In Hispanic adults aged 45 to 75 receiving care at a community
clinic in Hialeah, Florida (P), how does development of a bilingual English-Spanish teaching
plan about colorectal cancer screening (I), compared with standard educational information (C),
improve the quality and completeness of colorectal cancer screening education (O) over 12
weeks (T)?
The population includes Hispanic adults aged 45 to 75 receiving care at the community
clinic that was selected and who are eligible for average-risk CRC screening. The intervention is
development of a bilingual teaching plan that provides screening information in English and
Spanish. Content will cover screening eligibility, screening methods available, benefits of early
detection, preparation prior to screening, common misconceptions, and follow-up after abnormal
screening.
4
The comparison is standard educational information that is routinely used as part of the
standard clinical practice. The result is the quality and completeness of educational product.
Evaluation of accuracy, readability, cultural appropriateness, bilingual consistency, and current
screening recommendations will be done by experts. The time frame is 12 weeks for literature
review, development, translation, evaluation, revision and presentation.
The PICOT directly links the practice problem and the proposed change. Nationally,
Hispanic adults are less likely to participate in screening and communities in Miami-Dade show
differences based on social vulnerability. A bilingual educational resource is thus a viable answer
to remediable knowledge and communication barriers.
Describe the vulnerable population and setting
The target population is Hispanic adults (ages 45-75) attending their primary care in a
community clinic in Hialeah, FL. Social determinants of health in the population that can affect
preventive screening may include income, insurance status, health literacy, language,
transportation, employment demands and primary care access. Other barriers may be fear,
embarrassment, cultural beliefs, lack of knowledge, and uncertainty about screening procedures.
Materials provided only in English may limit understanding among patients with limited
English proficiency. An essential information bilingual resource that enhances access to
understandable screening education.
Social vulnerability also accounts for disparities in preventive care. Miami-Dade
Community Based Research noted that CRC screening rates differed by community social
vulnerability, the more vulnerable communities having lower CRC screening participation
(Ashad-Bishop et al., 2023). The national evidence also indicates that CRC screening rates are
lower among Hispanic adults (King et al., 2025).
5
Change is important because the failure to do the screening can lead to late detection,
more complicated treatment, higher healthcare costs, poorer quality of life and early death.
Education cannot eliminate every structural barrier, but it can address knowledge and
communication barriers. Limited awareness, language differences, and healthcare-access issues
are identified as associated with delayed screening with Latino populations during research
(Montalvan-Sanchez et al., 2024).
Proposal
The proposed intervention involves a bilingual CRC screening education program that
will teach Hispanic adults ages 45 to 75 years old. The teaching will involve the reasons behind
screening, time to start screening, screening methods, how to prepare, misconceptions, and
follow up on abnormal findings. There is enough evidence regarding structured and culturally
tailored CRC screening education. According to research conducted among Hispanic and Latino
patients who speak Spanish, cultural tailoring of cancer screening educational material is
necessary (Jang et al., 2022). Meade et al. (2023) have also stressed the need for culturally-
tailored cancer prevention communication among Latinos. Structured outreach within
underserved primary care settings has further demonstrated the value of organized approaches to
screening support (Glascock et al., 2026). These findings support development of a bilingual
educational product.
The project will not recruit patients, administer surveys, collect identifiable health
information, or directly implement a screening intervention. The APRN will review literature,
identify educational needs, develop the English content, prepare the Spanish version, obtain
professional feedback, revise the materials, and complete final evaluation. The preceptor will
6
review clinical accuracy, while bilingual personnel may assess language clarity and cultural
relevance.
Resources will include a computer, scholarly literature, current guidelines, bilingual
templates, printing supplies, visual resources, and staff review time. The project is feasible
because it does not require new equipment, medications, laboratory testing, or major
expenditure. During weeks 1 through 3, the literature and educational needs will be reviewed.
Weeks 4 through 6 will focus on development and translation. Weeks 7 through 9 will involve
clinical, language, and cultural review. Weeks 10 through 12 will include revisions, final
evaluation, formatting, and presentation.
The APRN will function as an evidence translator, educator, collaborator, and change
agent. The APRN will identify the practice problem, evaluate evidence, ensure that materials
reflect current recommendations, coordinate review, and evaluate the final product. Advanced
practice nurses contribute to translating evidence into clinical practice and supporting evidence-
based decisions.
The expected outcome is completion of a bilingual CRC screening teaching plan that
meets predetermined expert-review criteria for accuracy, completeness, readability, cultural
appropriateness, and consistency with current recommendations. The product may provide the
clinic with a sustainable educational resource for future preventive-care activities without
claiming that the project directly changes patient screening behavior.
Theoretical Framework/Nursing Theory
Pender’s Health Promotion Model will serve as the primary nursing framework. The
model emphasizes individual characteristics, previous experiences, perceived benefits, perceived
barriers, interpersonal influences, situational influences, and self-efficacy as factors affecting
7
health-promoting behavior (Rojas-Torres et al., 2025). These concepts are relevant because CRC
screening decisions may be affected by knowledge, fear, perceived benefits, language, cultural
beliefs, financial concerns, and healthcare access.
The framework will guide development of educational content by addressing both
screening benefits and barriers. The teaching plan will explain how screening can identify cancer
or precancerous conditions early while addressing common concerns about screening
procedures. Bilingual communication will reduce language-related barriers, while culturally
appropriate explanations can improve relevance and understanding. Pender’s model therefore
supports the population, educational intervention, and expected outcome. Pender’s model
addresses beliefs, perceived barriers, benefits, and self-efficacy related to preventive behavior.
The framework supports an APRN-led project addressing CRC screening disparities among
Hispanic adults.
8
References
Aguiar-Ibáñez, R., Mbous, Y., Sharma, S., Chakali, R., & Chawla, E. (2025). Barriers to cancer
screening uptake and approaches to overcome them: A systematic literature review.
Frontiers in Oncology, 15, 1575820. PubMed Central.
https://doi.org/10.3389/fonc.2025.1575820
Ashad-Bishop, K. C., Baeker Bispo, J. A., Nahodyl, L., Balise, R. R., Kobetz, E. K., & Bailey, Z.
D. (2023). Hyperlocal disparities in breast, cervical, and colorectal cancer screening: An
ecological study of social vulnerability in Miami-Dade county. Preventive Medicine
Reports, 35, 102371. https://doi.org/10.1016/j.pmedr.2023.102371
Florida Department of Health. (2024). Colorectal cancer incidence – Florida Health CHARTS –
Florida Department of Health. Www.Flhealthcharts.Gov.
https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=NonVitalInd.D
ataviewer&cid=0445
Glascock, M., Wangen, M., Ferrari, R. M., O’Leary, M. C., Schwartz, J., Ndugulile, M., Unger, J.
M., Li, L., Marciniak, M. W., Reuland, D. S., Watabayashi, K., Brenner, A. T., Wheeler,
S. B., & Shah, P. D. (2026). Expanding access to colorectal cancer screening through
community pharmacies: Study protocol for the PharmFITTM randomized controlled trial.
Contemporary Clinical Trials, 170, 108443. https://doi.org/10.1016/j.cct.2026.108443
Jang, S. H., Cole, A., Brown, E. V. R., & Ko, L. (2021). Adaptation of a Mailed-FIT kit and
patient navigation intervention to increase colorectal cancer (CRC) screening among
Spanish-speaking hispanic/latino patients. Hispanic Health Care International, 20(2),
80–88. https://doi.org/10.1177/15404153211024116
9
King, S. C., King, J., Thomas, C. C., & Richardson, L. C. (2025). Baseline estimates of
colorectal cancer screening among adults aged 45 to 75 years, behavioral risk factor
surveillance system, 2022. Preventing Chronic Disease, 22.
https://doi.org/10.5888/pcd22.250175
Meade, C. D, Stanley, N. B., Arevalo, M., Tyson, D. M., Chavarria, E. A., Aguado, C. X., Rivera,
M., Gutierrez, L., Abdulla, R., Christy, S. M., & Gwede, C. K. (2023). Transcreation
matters: A learner centric participatory approach for adapting cancer prevention messages
for Latinos. Patient Education and Counseling, 115, 107888–107888.
https://doi.org/10.1016/j.pec.2023.107888
Montalvan-Sanchez, E. E., Beas, R., Karkash, A., Godoy, A., Norwood, D. A., & Dougherty, M.
(2024). Delays in colorectal cancer screening for latino patients: The role of immigrant
Healthcare in stemming the rising global incidence of colorectal cancer. Gastroenterology
Research, 17(1), 41–51. PubMed Central. https://doi.org/10.14740/gr1697
Rojas-Torres, I. L., Garizábalo Dávila, C. M., Ruidíaz Gómez, K. S., Fernández Aragón, S. P.,
Perea-Rojas, D. M., Rodelo Olmos, G. M., & Liñán Meléndez, N. I. (2025).
Effectiveness of Nola Pender’s health promotion model: A comprehensive approach for
enhancing healthy behaviors and quality of life in adults. International Journal of
Environmental Research and Public Health, 22(10), 1506.
https://doi.org/10.3390/ijerph22101506
Siddique, S., Wang, R., Yasin, F., Gaddy, J. J., Zhang, L., Gross, C. P., & Ma, X. (2024).
USPSTF colorectal cancer screening recommendation and uptake for individuals aged 45
to 49 years. JAMA Network Open, 7(10), e2436358–e2436358.
https://doi.org/10.1001/jamanetworkopen.2024.36358
10
**## capstoneintrucction.docx**
Did you find research to back up your statements on APRNS?
Missing Conclusion paragraph
For Part II and III discuss your findings and proposal in more details.
You are on the right track.
Capstone Part II: Review of Literature
**CAPSTONE: PART II due 10/4/2025 by 11:59pm**
1. Review of Literature:
– Review and discuss literature: Synthesize at least 10 primary research studies and/or systematic reviews; do not include summary articles. This section is all about the scientific evidence rather than someone else's opinion of the evidence. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. This is a synthesis rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.
2. Analyze and apply knowledge directly to your PICOT- The studies that you cite in this section must relate directly to your PICOT question.
3. Provide precise body of evidence for your Practice Change- Include Nurses as leaders in this project, statistics, cost, impact on healthcare.
4. Discuss objectives for your practice change, Why is change necessary?
5. Discuss where the problem exists, why it exists, what is the preposition for change. Include information from your PICOT.
6. Apply all that is relevant to the problem. For example: Pros vs Cons, current state of problem
NOTE: It should not reflect your opinion, but rather Evidence Based Practice should be applied
-After completing a literature search on interventions addressing your chosen health problem, write a review that evaluates the strengths and weaknesses of all the sources you have found, compare anc constrast.
-Use appropriate APA 7th Ed. Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be minimum 4-6 pages long (not including the title and reference page).
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written APA in the 3rd person.
**Rubric Capstone II.docx**
1. Integration of Knowledge — 25 points
Thoroughly select and present an appropriate evidence-based practice intervention for the identified health problem and proposed change. Clearly explain how the evidence supports the intervention.
2. Topic Focus — 25 points
Choose a health problem narrow enough for the assignment’s scope. Include a clear topic statement that provides direction for the paper. Maintain a consistent focus, develop thoughtful insights, and support the discussion with cited evidence.
3. Depth of Discussion and Cohesiveness — 25 points
Provide an in-depth discussion throughout the paper. Integrate information from all sources and demonstrate an understanding of the relationships among their findings. Ensure that ideas flow logically from one issue to the next. The rubric specifically requires the paper’s body to flow without headings.
4. Spelling and Grammar — Category Listed as 10 Points
Meet the required word count and include fewer than five grammatical, spelling, capitalization, or punctuation errors. Carefully proofread the paper before submission.
5. Sources — 10 points
Use at least six current sources, including at least three peer-reviewed journal articles or scholarly books. Include both general background information and specialized evidence. All websites must be authoritative. Identify special-interest sources or popular literature appropriately if used.
6. Citations — 5 points
Follow APA formatting consistently, with fewer than five errors involving citations, quotations, or formatting. Ensure that in-text citations and reference entries are complete and accurate.
Scoring clarification: The spelling and grammar category is labeled as worth 10 points, but the Outstanding column awards 8 points. This discrepancy should be clarified with the instructor.
**## CapstonePartIPICOTAssignment1.pdf**
1
Capstone Part I: PICOT Assignment: Bilingual Colorectal Cancer Screening Education for
Hispanic Adults
Mirlenys Diaz
Florida National University
MSN Capstone Project
Dr. Carmen Lazo
September 16, 2026
2
Bilingual Colorectal Cancer Screening Education for Hispanic Adults
Introduction to your proposed problem
Colorectal cancer (CRC) is an important public health problem and a major cause of
cancer morbidity and mortality in the United States. Screening is important because it may detect
precancerous tissue and cancer before it can advance to a more serious or even deadly stage. The
U.S. Preventive Services Task Force (USPSTF) advises CRC screening in average-risk adults
ages 45 to 75 (Siddique et al., 2024). However, disparities in screening rates continue to be
significant for Hispanic adults, despite these recommendations.
The extent of the issue is reflected in the national data. In 2022, 61.4% of all adults aged
45-75 were up-to-date with CRC screening. However, only 52.4% of Hispanic adults were
current compared with 63.5% of non-Hispanic White adults, while 41.7% of Hispanic adults had
never been screened (King et al., 2025). Of the adults aged 45-49, 29.8% were up to date with
screening and 65.7% had never been screened (King et al., 2025). The results are significant
because adults as young as age 45 are now part of the regular screening guidelines.
The problem also affects Miami-Dade County. In 2023, there were approximately 1,320
new cases of CRC and an age-adjusted incidence of 36.5 cases per 100,000 population. The
number of CRC cases died in 2024 was about 456, and the age adjusted mortality rate was 12.2
deaths per 100,000 (Florida Department of Health, 2024). Screening also varies by
neighborhood. According to Ashad-Bishop et al., (2023) the average screening rates in Miami-
Dade County were approximately 59% but dropped to 53.3% in communities with higher social
vulnerability.
CRC costs are incurred due to diagnosis, treatment, hospitalisation, medications,
specialist services, loss of productivity, as well as early death. Cancer screening also utilizes a
3
considerable amount of health care resources, but could decrease later disease burden through
early detection and prevention (Aguiar-Ibáñez, 2025). The total estimated cost for this project is
between $300 and $500 for bilingual printing, educational materials, and professional review.
The program that is being proposed would consist of creating a culturally responsive
bilingual English-Spanish teaching plan for Hispanic adults 45 to 75 at a community clinic
located in Hialeah, FL. The resource will cover the significance of screening, age, types of
screening, preparation, misconceptions, and early detection. The goal is to enhance the quality
and comprehensiveness of CRC screening education. Since patients will not be recruited or
directly treated, the project will quantify the development and expert review of the education
product instead of screening behavior.
PICOT
The PICOT question is: In Hispanic adults aged 45 to 75 receiving care at a community
clinic in Hialeah, Florida (P), how does development of a bilingual English-Spanish teaching
plan about colorectal cancer screening (I), compared with standard educational information (C),
improve the quality and completeness of colorectal cancer screening education (O) over 12
weeks (T)?
The population includes Hispanic adults aged 45 to 75 receiving care at the community
clinic that was selected and who are eligible for average-risk CRC screening. The intervention is
development of a bilingual teaching plan that provides screening information in English and
Spanish. Content will cover screening eligibility, screening methods available, benefits of early
detection, preparation prior to screening, common misconceptions, and follow-up after abnormal
screening.
4
The comparison is standard educational information that is routinely used as part of the
standard clinical practice. The result is the quality and completeness of educational product.
Evaluation of accuracy, readability, cultural appropriateness, bilingual consistency, and current
screening recommendations will be done by experts. The time frame is 12 weeks for literature
review, development, translation, evaluation, revision and presentation.
The PICOT directly links the practice problem and the proposed change. Nationally,
Hispanic adults are less likely to participate in screening and communities in Miami-Dade show
differences based on social vulnerability. A bilingual educational resource is thus a viable answer
to remediable knowledge and communication barriers.
Describe the vulnerable population and setting
The target population is Hispanic adults (ages 45-75) attending their primary care in a
community clinic in Hialeah, FL. Social determinants of health in the population that can affect
preventive screening may include income, insurance status, health literacy, language,
transportation, employment demands and primary care access. Other barriers may be fear,
embarrassment, cultural beliefs, lack of knowledge, and uncertainty about screening procedures.
Materials provided only in English may limit understanding among patients with limited
English proficiency. An essential information bilingual resource that enhances access to
understandable screening education.
Social vulnerability also accounts for disparities in preventive care. Miami-Dade
Community Based Research noted that CRC screening rates differed by community social
vulnerability, the more vulnerable communities having lower CRC screening participation
(Ashad-Bishop et al., 2023). The national evidence also indicates that CRC screening rates are
lower among Hispanic adults (King et al., 2025).
5
Change is important because the failure to do the screening can lead to late detection,
more complicated treatment, higher healthcare costs, poorer quality of life and early death.
Education cannot eliminate every structural barrier, but it can address knowledge and
communication barriers. Limited awareness, language differences, and healthcare-access issues
are identified as associated with delayed screening with Latino populations during research
(Montalvan-Sanchez et al., 2024).
Proposal
The proposed intervention involves a bilingual CRC screening education program that
will teach Hispanic adults ages 45 to 75 years old. The teaching will involve the reasons behind
screening, time to start screening, screening methods, how to prepare, misconceptions, and
follow up on abnormal findings. There is enough evidence regarding structured and culturally
tailored CRC screening education. According to research conducted among Hispanic and Latino
patients who speak Spanish, cultural tailoring of cancer screening educational material is
necessary (Jang et al., 2022). Meade et al. (2023) have also stressed the need for culturally-
tailored cancer prevention communication among Latinos. Structured outreach within
underserved primary care settings has further demonstrated the value of organized approaches to
screening support (Glascock et al., 2026). These findings support development of a bilingual
educational product.
The project will not recruit patients, administer surveys, collect identifiable health
information, or directly implement a screening intervention. The APRN will review literature,
identify educational needs, develop the English content, prepare the Spanish version, obtain
professional feedback, revise the materials, and complete final evaluation. The preceptor will
6
review clinical accuracy, while bilingual personnel may assess language clarity and cultural
relevance.
Resources will include a computer, scholarly literature, current guidelines, bilingual
templates, printing supplies, visual resources, and staff review time. The project is feasible
because it does not require new equipment, medications, laboratory testing, or major
expenditure. During weeks 1 through 3, the literature and educational needs will be reviewed.
Weeks 4 through 6 will focus on development and translation. Weeks 7 through 9 will involve
clinical, language, and cultural review. Weeks 10 through 12 will include revisions, final
evaluation, formatting, and presentation.
The APRN will function as an evidence translator, educator, collaborator, and change
agent. The APRN will identify the practice problem, evaluate evidence, ensure that materials
reflect current recommendations, coordinate review, and evaluate the final product. Advanced
practice nurses contribute to translating evidence into clinical practice and supporting evidence-
based decisions.
The expected outcome is completion of a bilingual CRC screening teaching plan that
meets predetermined expert-review criteria for accuracy, completeness, readability, cultural
appropriateness, and consistency with current recommendations. The product may provide the
clinic with a sustainable educational resource for future preventive-care activities without
claiming that the project directly changes patient screening behavior.
Theoretical Framework/Nursing Theory
Pender’s Health Promotion Model will serve as the primary nursing framework. The
model emphasizes individual characteristics, previous experiences, perceived benefits, perceived
barriers, interpersonal influences, situational influences, and self-efficacy as factors affecting
7
health-promoting behavior (Rojas-Torres et al., 2025). These concepts are relevant because CRC
screening decisions may be affected by knowledge, fear, perceived benefits, language, cultural
beliefs, financial concerns, and healthcare access.
The framework will guide development of educational content by addressing both
screening benefits and barriers. The teaching plan will explain how screening can identify cancer
or precancerous conditions early while addressing common concerns about screening
procedures. Bilingual communication will reduce language-related barriers, while culturally
appropriate explanations can improve relevance and understanding. Pender’s model therefore
supports the population, educational intervention, and expected outcome. Pender’s model
addresses beliefs, perceived barriers, benefits, and self-efficacy related to preventive behavior.
The framework supports an APRN-led project addressing CRC screening disparities among
Hispanic adults.
8
References
Aguiar-Ibáñez, R., Mbous, Y., Sharma, S., Chakali, R., & Chawla, E. (2025). Barriers to cancer
screening uptake and approaches to overcome them: A systematic literature review.
Frontiers in Oncology, 15, 1575820. PubMed Central.
https://doi.org/10.3389/fonc.2025.1575820
Ashad-Bishop, K. C., Baeker Bispo, J. A., Nahodyl, L., Balise, R. R., Kobetz, E. K., & Bailey, Z.
D. (2023). Hyperlocal disparities in breast, cervical, and colorectal cancer screening: An
ecological study of social vulnerability in Miami-Dade county. Preventive Medicine
Reports, 35, 102371. https://doi.org/10.1016/j.pmedr.2023.102371
Florida Department of Health. (2024). Colorectal cancer incidence – Florida Health CHARTS –
Florida Department of Health. Www.Flhealthcharts.Gov.
https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=NonVitalInd.D
ataviewer&cid=0445
Glascock, M., Wangen, M., Ferrari, R. M., O’Leary, M. C., Schwartz, J., Ndugulile, M., Unger, J.
M., Li, L., Marciniak, M. W., Reuland, D. S., Watabayashi, K., Brenner, A. T., Wheeler,
S. B., & Shah, P. D. (2026). Expanding access to colorectal cancer screening through
community pharmacies: Study protocol for the PharmFITTM randomized controlled trial.
Contemporary Clinical Trials, 170, 108443. https://doi.org/10.1016/j.cct.2026.108443
Jang, S. H., Cole, A., Brown, E. V. R., & Ko, L. (2021). Adaptation of a Mailed-FIT kit and
patient navigation intervention to increase colorectal cancer (CRC) screening among
Spanish-speaking hispanic/latino patients. Hispanic Health Care International, 20(2),
80–88. https://doi.org/10.1177/15404153211024116
9
King, S. C., King, J., Thomas, C. C., & Richardson, L. C. (2025). Baseline estimates of
colorectal cancer screening among adults aged 45 to 75 years, behavioral risk factor
surveillance system, 2022. Preventing Chronic Disease, 22.
https://doi.org/10.5888/pcd22.250175
Meade, C. D, Stanley, N. B., Arevalo, M., Tyson, D. M., Chavarria, E. A., Aguado, C. X., Rivera,
M., Gutierrez, L., Abdulla, R., Christy, S. M., & Gwede, C. K. (2023). Transcreation
matters: A learner centric participatory approach for adapting cancer prevention messages
for Latinos. Patient Education and Counseling, 115, 107888–107888.
https://doi.org/10.1016/j.pec.2023.107888
Montalvan-Sanchez, E. E., Beas, R., Karkash, A., Godoy, A., Norwood, D. A., & Dougherty, M.
(2024). Delays in colorectal cancer screening for latino patients: The role of immigrant
Healthcare in stemming the rising global incidence of colorectal cancer. Gastroenterology
Research, 17(1), 41–51. PubMed Central. https://doi.org/10.14740/gr1697
Rojas-Torres, I. L., Garizábalo Dávila, C. M., Ruidíaz Gómez, K. S., Fernández Aragón, S. P.,
Perea-Rojas, D. M., Rodelo Olmos, G. M., & Liñán Meléndez, N. I. (2025).
Effectiveness of Nola Pender’s health promotion model: A comprehensive approach for
enhancing healthy behaviors and quality of life in adults. International Journal of
Environmental Research and Public Health, 22(10), 1506.
https://doi.org/10.3390/ijerph22101506
Siddique, S., Wang, R., Yasin, F., Gaddy, J. J., Zhang, L., Gross, C. P., & Ma, X. (2024).
USPSTF colorectal cancer screening recommendation and uptake for individuals aged 45
to 49 years. JAMA Network Open, 7(10), e2436358–e2436358.
https://doi.org/10.1001/jamanetworkopen.2024.36358
10
**## capstoneintrucction.docx**
Did you find research to back up your statements on APRNS?
Missing Conclusion paragraph
For Part II and III discuss your findings and proposal in more details.
You are on the right track.
Capstone Part II: Review of Literature
**CAPSTONE: PART II due 10/4/2025 by 11:59pm**
1. Review of Literature:
– Review and discuss literature: Synthesize at least 10 primary research studies and/or systematic reviews; do not include summary articles. This section is all about the scientific evidence rather than someone else's opinion of the evidence. Do not use secondary sources; you need to get the article, read it, and make your own decision about quality and applicability to your question even if you did find out about the study in a review of the literature. This is a synthesis rather than a study-by-study review. Address the similarities, differences, and controversies in the body of evidence.
2. Analyze and apply knowledge directly to your PICOT- The studies that you cite in this section must relate directly to your PICOT question.
3. Provide precise body of evidence for your Practice Change- Include Nurses as leaders in this project, statistics, cost, impact on healthcare.
4. Discuss objectives for your practice change, Why is change necessary?
5. Discuss where the problem exists, why it exists, what is the preposition for change. Include information from your PICOT.
6. Apply all that is relevant to the problem. For example: Pros vs Cons, current state of problem
NOTE: It should not reflect your opinion, but rather Evidence Based Practice should be applied
-After completing a literature search on interventions addressing your chosen health problem, write a review that evaluates the strengths and weaknesses of all the sources you have found, compare anc constrast.
-Use appropriate APA 7th Ed. Scholarly, peer-reviewed, and research articles cited should be within the last five years.
-This section should be minimum 4-6 pages long (not including the title and reference page).
-Use proper in-text citations with a properly formatted reference list.
-All papers must be written APA in the 3rd person.
**Rubric Capstone II.docx**
1. Integration of Knowledge — 25 points
Thoroughly select and present an appropriate evidence-based practice intervention for the identified health problem and proposed change. Clearly explain how the evidence supports the intervention.
2. Topic Focus — 25 points
Choose a health problem narrow enough for the assignment’s scope. Include a clear topic statement that provides direction for the paper. Maintain a consistent focus, develop thoughtful insights, and support the discussion with cited evidence.
3. Depth of Discussion and Cohesiveness — 25 points
Provide an in-depth discussion throughout the paper. Integrate information from all sources and demonstrate an understanding of the relationships among their findings. Ensure that ideas flow logically from one issue to the next. The rubric specifically requires the paper’s body to flow without headings.
4. Spelling and Grammar — Category Listed as 10 Points
Meet the required word count and include fewer than five grammatical, spelling, capitalization, or punctuation errors. Carefully proofread the paper before submission.
5. Sources — 10 points
Use at least six current sources, including at least three peer-reviewed journal articles or scholarly books. Include both general background information and specialized evidence. All websites must be authoritative. Identify special-interest sources or popular literature appropriately if used.
6. Citations — 5 points
Follow APA formatting consistently, with fewer than five errors involving citations, quotations, or formatting. Ensure that in-text citations and reference entries are complete and accurate.
Scoring clarification: The spelling and grammar category is labeled as worth 10 points, but the Outstanding column awards 8 points. This discrepancy should be clarified with the instructor.
**## CapstonePartIPICOTAssignment1.pdf**
1
Capstone Part I: PICOT Assignment: Bilingual Colorectal Cancer Screening Education for
Hispanic Adults
Mirlenys Diaz
Florida National University
MSN Capstone Project
Dr. Carmen Lazo
September 16, 2026
2
Bilingual Colorectal Cancer Screening Education for Hispanic Adults
Introduction to your proposed problem
Colorectal cancer (CRC) is an important public health problem and a major cause of
cancer morbidity and mortality in the United States. Screening is important because it may detect
precancerous tissue and cancer before it can advance to a more serious or even deadly stage. The
U.S. Preventive Services Task Force (USPSTF) advises CRC screening in average-risk adults
ages 45 to 75 (Siddique et al., 2024). However, disparities in screening rates continue to be
significant for Hispanic adults, despite these recommendations.
The extent of the issue is reflected in the national data. In 2022, 61.4% of all adults aged
45-75 were up-to-date with CRC screening. However, only 52.4% of Hispanic adults were
current compared with 63.5% of non-Hispanic White adults, while 41.7% of Hispanic adults had
never been screened (King et al., 2025). Of the adults aged 45-49, 29.8% were up to date with
screening and 65.7% had never been screened (King et al., 2025). The results are significant
because adults as young as age 45 are now part of the regular screening guidelines.
The problem also affects Miami-Dade County. In 2023, there were approximately 1,320
new cases of CRC and an age-adjusted incidence of 36.5 cases per 100,000 population. The
number of CRC cases died in 2024 was about 456, and the age adjusted mortality rate was 12.2
deaths per 100,000 (Florida Department of Health, 2024). Screening also varies by
neighborhood. According to Ashad-Bishop et al., (2023) the average screening rates in Miami-
Dade County were approximately 59% but dropped to 53.3% in communities with higher social
vulnerability.
CRC costs are incurred due to diagnosis, treatment, hospitalisation, medications,
specialist services, loss of productivity, as well as early death. Cancer screening also utilizes a
3
considerable amount of health care resources, but could decrease later disease burden through
early detection and prevention (Aguiar-Ibáñez, 2025). The total estimated cost for this project is
between $300 and $500 for bilingual printing, educational materials, and professional review.
The program that is being proposed would consist of creating a culturally responsive
bilingual English-Spanish teaching plan for Hispanic adults 45 to 75 at a community clinic
located in Hialeah, FL. The resource will cover the significance of screening, age, types of
screening, preparation, misconceptions, and early detection. The goal is to enhance the quality
and comprehensiveness of CRC screening education. Since patients will not be recruited or
directly treated, the project will quantify the development and expert review of the education
product instead of screening behavior.
PICOT
The PICOT question is: In Hispanic adults aged 45 to 75 receiving care at a community
clinic in Hialeah, Florida (P), how does development of a bilingual English-Spanish teaching
plan about colorectal cancer screening (I), compared with standard educational information (C),
improve the quality and completeness of colorectal cancer screening education (O) over 12
weeks (T)?
The population includes Hispanic adults aged 45 to 75 receiving care at the community
clinic that was selected and who are eligible for average-risk CRC screening. The intervention is
development of a bilingual teaching plan that provides screening information in English and
Spanish. Content will cover screening eligibility, screening methods available, benefits of early
detection, preparation prior to screening, common misconceptions, and follow-up after abnormal
screening.
4
The comparison is standard educational information that is routinely used as part of the
standard clinical practice. The result is the quality and completeness of educational product.
Evaluation of accuracy, readability, cultural appropriateness, bilingual consistency, and current
screening recommendations will be done by experts. The time frame is 12 weeks for literature
review, development, translation, evaluation, revision and presentation.
The PICOT directly links the practice problem and the proposed change. Nationally,
Hispanic adults are less likely to participate in screening and communities in Miami-Dade show
differences based on social vulnerability. A bilingual educational resource is thus a viable answer
to remediable knowledge and communication barriers.
Describe the vulnerable population and setting
The target population is Hispanic adults (ages 45-75) attending their primary care in a
community clinic in Hialeah, FL. Social determinants of health in the population that can affect
preventive screening may include income, insurance status, health literacy, language,
transportation, employment demands and primary care access. Other barriers may be fear,
embarrassment, cultural beliefs, lack of knowledge, and uncertainty about screening procedures.
Materials provided only in English may limit understanding among patients with limited
English proficiency. An essential information bilingual resource that enhances access to
understandable screening education.
Social vulnerability also accounts for disparities in preventive care. Miami-Dade
Community Based Research noted that CRC screening rates differed by community social
vulnerability, the more vulnerable communities having lower CRC screening participation
(Ashad-Bishop et al., 2023). The national evidence also indicates that CRC screening rates are
lower among Hispanic adults (King et al., 2025).
5
Change is important because the failure to do the screening can lead to late detection,
more complicated treatment, higher healthcare costs, poorer quality of life and early death.
Education cannot eliminate every structural barrier, but it can address knowledge and
communication barriers. Limited awareness, language differences, and healthcare-access issues
are identified as associated with delayed screening with Latino populations during research
(Montalvan-Sanchez et al., 2024).
Proposal
The proposed intervention involves a bilingual CRC screening education program that
will teach Hispanic adults ages 45 to 75 years old. The teaching will involve the reasons behind
screening, time to start screening, screening methods, how to prepare, misconceptions, and
follow up on abnormal findings. There is enough evidence regarding structured and culturally
tailored CRC screening education. According to research conducted among Hispanic and Latino
patients who speak Spanish, cultural tailoring of cancer screening educational material is
necessary (Jang et al., 2022). Meade et al. (2023) have also stressed the need for culturally-
tailored cancer prevention communication among Latinos. Structured outreach within
underserved primary care settings has further demonstrated the value of organized approaches to
screening support (Glascock et al., 2026). These findings support development of a bilingual
educational product.
The project will not recruit patients, administer surveys, collect identifiable health
information, or directly implement a screening intervention. The APRN will review literature,
identify educational needs, develop the English content, prepare the Spanish version, obtain
professional feedback, revise the materials, and complete final evaluation. The preceptor will
6
review clinical accuracy, while bilingual personnel may assess language clarity and cultural
relevance.
Resources will include a computer, scholarly literature, current guidelines, bilingual
templates, printing supplies, visual resources, and staff review time. The project is feasible
because it does not require new equipment, medications, laboratory testing, or major
expenditure. During weeks 1 through 3, the literature and educational needs will be reviewed.
Weeks 4 through 6 will focus on development and translation. Weeks 7 through 9 will involve
clinical, language, and cultural review. Weeks 10 through 12 will include revisions, final
evaluation, formatting, and presentation.
The APRN will function as an evidence translator, educator, collaborator, and change
agent. The APRN will identify the practice problem, evaluate evidence, ensure that materials
reflect current recommendations, coordinate review, and evaluate the final product. Advanced
practice nurses contribute to translating evidence into clinical practice and supporting evidence-
based decisions.
The expected outcome is completion of a bilingual CRC screening teaching plan that
meets predetermined expert-review criteria for accuracy, completeness, readability, cultural
appropriateness, and consistency with current recommendations. The product may provide the
clinic with a sustainable educational resource for future preventive-care activities without
claiming that the project directly changes patient screening behavior.
Theoretical Framework/Nursing Theory
Pender’s Health Promotion Model will serve as the primary nursing framework. The
model emphasizes individual characteristics, previous experiences, perceived benefits, perceived
barriers, interpersonal influences, situational influences, and self-efficacy as factors affecting
7
health-promoting behavior (Rojas-Torres et al., 2025). These concepts are relevant because CRC
screening decisions may be affected by knowledge, fear, perceived benefits, language, cultural
beliefs, financial concerns, and healthcare access.
The framework will guide development of educational content by addressing both
screening benefits and barriers. The teaching plan will explain how screening can identify cancer
or precancerous conditions early while addressing common concerns about screening
procedures. Bilingual communication will reduce language-related barriers, while culturally
appropriate explanations can improve relevance and understanding. Pender’s model therefore
supports the population, educational intervention, and expected outcome. Pender’s model
addresses beliefs, perceived barriers, benefits, and self-efficacy related to preventive behavior.
The framework supports an APRN-led project addressing CRC screening disparities among
Hispanic adults.
8
References
Aguiar-Ibáñez, R., Mbous, Y., Sharma, S., Chakali, R., & Chawla, E. (2025). Barriers to cancer
screening uptake and approaches to overcome them: A systematic literature review.
Frontiers in Oncology, 15, 1575820. PubMed Central.
https://doi.org/10.3389/fonc.2025.1575820
Ashad-Bishop, K. C., Baeker Bispo, J. A., Nahodyl, L., Balise, R. R., Kobetz, E. K., & Bailey, Z.
D. (2023). Hyperlocal disparities in breast, cervical, and colorectal cancer screening: An
ecological study of social vulnerability in Miami-Dade county. Preventive Medicine
Reports, 35, 102371. https://doi.org/10.1016/j.pmedr.2023.102371
Florida Department of Health. (2024). Colorectal cancer incidence – Florida Health CHARTS –
Florida Department of Health. Www.Flhealthcharts.Gov.
https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=NonVitalInd.D
ataviewer&cid=0445
Glascock, M., Wangen, M., Ferrari, R. M., O’Leary, M. C., Schwartz, J., Ndugulile, M., Unger, J.
M., Li, L., Marciniak, M. W., Reuland, D. S., Watabayashi, K., Brenner, A. T., Wheeler,
S. B., & Shah, P. D. (2026). Expanding access to colorectal cancer screening through
community pharmacies: Study protocol for the PharmFITTM randomized controlled trial.
Contemporary Clinical Trials, 170, 108443. https://doi.org/10.1016/j.cct.2026.108443
Jang, S. H., Cole, A., Brown, E. V. R., & Ko, L. (2021). Adaptation of a Mailed-FIT kit and
patient navigation intervention to increase colorectal cancer (CRC) screening among
Spanish-speaking hispanic/latino patients. Hispanic Health Care International, 20(2),
80–88. https://doi.org/10.1177/15404153211024116
9
King, S. C., King, J., Thomas, C. C., & Richardson, L. C. (2025). Baseline estimates of
colorectal cancer screening among adults aged 45 to 75 years, behavioral risk factor
surveillance system, 2022. Preventing Chronic Disease, 22.
https://doi.org/10.5888/pcd22.250175
Meade, C. D, Stanley, N. B., Arevalo, M., Tyson, D. M., Chavarria, E. A., Aguado, C. X., Rivera,
M., Gutierrez, L., Abdulla, R., Christy, S. M., & Gwede, C. K. (2023). Transcreation
matters: A learner centric participatory approach for adapting cancer prevention messages
for Latinos. Patient Education and Counseling, 115, 107888–107888.
https://doi.org/10.1016/j.pec.2023.107888
Montalvan-Sanchez, E. E., Beas, R., Karkash, A., Godoy, A., Norwood, D. A., & Dougherty, M.
(2024). Delays in colorectal cancer screening for latino patients: The role of immigrant
Healthcare in stemming the rising global incidence of colorectal cancer. Gastroenterology
Research, 17(1), 41–51. PubMed Central. https://doi.org/10.14740/gr1697
Rojas-Torres, I. L., Garizábalo Dávila, C. M., Ruidíaz Gómez, K. S., Fernández Aragón, S. P.,
Perea-Rojas, D. M., Rodelo Olmos, G. M., & Liñán Meléndez, N. I. (2025).
Effectiveness of Nola Pender’s health promotion model: A comprehensive approach for
enhancing healthy behaviors and quality of life in adults. International Journal of
Environmental Research and Public Health, 22(10), 1506.
https://doi.org/10.3390/ijerph22101506
Siddique, S., Wang, R., Yasin, F., Gaddy, J. J., Zhang, L., Gross, C. P., & Ma, X. (2024).
USPSTF colorectal cancer screening recommendation and uptake for individuals aged 45
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