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A community-based approach to address lung cancer screening disparities in the black community using the Witness Project庐 framework: development and pilot trial

成人头条 volume听25, Article听number:听379 (2025) Cite this article

Abstract

Background

Disparities in lung cancer outcomes persist among Black Americans, necessitating targeted interventions to address screening inequities. This paper reports the development and refinement of Witness Project庐 Lung, a community-based initiative tailored to the specific needs of the Black community, aiming to improve awareness and engagement with lung cancer screening.

Methods

Utilizing a user-centered design and guided by the original Witness Project庐 framework 鈥� an evidence-based lay health advisor intervention program originally developed to increase knowledge and awareness about breast cancer risk and screening in the Black community and later trans-created to the cervical and colorectal cancer screening contexts - Witness Project庐 Lung was developed and refined through qualitative input from key stakeholders in the Black faith community. Guided by the PEN-3 model and the Conceptual Model for Lung Cancer Screening Participation, the program underwent a rigorous development process to ensure cultural relevance and was pilot tested in the New York City metropolitan area in faith-based and community-based organizational sites in the Black community.

Results

Pilot testing conducted in New York and New Jersey demonstrated high acceptability, satisfaction, and increased knowledge among participants. The community-based approach, culturally sensitive messaging, and partnerships with faith-based organizations were critical to the refinements of Witness Project庐 to Witness Project庐 Lung. The program鈥檚 focus on addressing social determinants of health and its delivery by trained lay health advisors showcased feasibility and potential effectiveness. Witness Project庐 Lung presents a promising alternative to traditional health system-based interventions for improving lung screening rates among Black Americans.

Conclusions

The community-based, culturally tailored approach, coupled with the involvement of trusted community leaders, has the potential to reduce disparities in lung cancer outcomes. Further research is needed to assess the long-term impact and cost-effectiveness of Witness Project庐 Lung in promoting lung screening uptake and improving health outcomes within underserved populations.

Peer Review reports

A community-based approach to address

Lung cancer screening disparities in the black community

Disparities in lung cancer exist, with Black Americans suffering disproportionately compared to any other racial/ethnic group [1, 2]. Lung cancer remains the leading cause of cancer deaths among Black men and women, characterized by higher incidence and mortality rates and lower survival rates when compared to Whites [2]. Epidemiological data show worse prognosis among Blacks, largely related to later diagnostic stage, resulting in a 5-year relative survival rate of 16% for Blacks versus 19% for Whites [2]. While overall survival rates are low, Blacks are 15% less likely to be diagnosed at an early stage of lung cancer compared to Whites [3].

Considered a breakthrough in preventing mortality from lung cancer, annual screening with chest low-dose computed tomography (LDCT) has the potential to reduce lung cancer-related mortality at a population level by 20% because lung tumors can be detected at earlier, more treatable stages in individuals eligible for lung cancer screening [4]. Despite the U.S. Preventive Services Task Force (USPSTF) issuing a Grade B recommendation for lung screening a decade ago [5], the population-level benefit remains unrealized as the population at greatest risk remain largely unaware of screening as an option. Furthermore, racial disparities in screening uptake exacerbate these inequities: while 5.8% of eligible Whites participate in screening, uptake among Black Americans is only 1.7% [6]. Population-level screening efforts are effective only when target populations are adequately informed, engaged, and empowered [7].

The USPSTF recommends chest LDCT for high-risk individuals aged 50 to 80 years who have at least a 20 pack-year smoking history and currently smoke or have quit within the past 15 years [5]. Population-level screening efforts are only effective when the desired population is aware, informed and engaged. Over 14听million Americans are eligible for lung screening [1], but less than 10% of screening-eligible individuals are aware that a lung screening test exists [8]. The original USPSTF lung screening guidelines were based upon evidence from a predominately older White male sample that did not adequately capture the risk experienced in women or underrepresented minorities such as Blacks [5]. In 2021, the USPSTF revised the guidelines to lower the age and pack-year history to 50 years and 20 pack-years, respectively [9]. The revised eligibility criteria set a promising stage for reducing racial inequities in lung screening by increasing the potential to engage more Black high-risk patients who have a lower pack-year history but a greater risk of lung cancer-related mortality.

Multi-level barriers contributing to low screening uptake in Black communities include low awareness, historical mistrust of medical systems, and stigmatizing communication about lung cancer. Community-engaged research has emerged as a transformative approach to addressing these challenges, promoting health equity through active collaboration with communities most affected by health disparities [7, 10]. Grounded in principles of mutual respect and shared decision-making, community-engaged research ensure that research and interventions reflect the lived experiences, priorities, and cultural contexts of the community. Evidence from long-term studies shows that community-engaged research not only improves the design and implementation of health interventions but also fosters trust, enhances relevance, and builds sustainable community capacity to address health inequities [7, 10].

Low public awareness and knowledge of lung screening, particularly within the Black community, remains one of the leading, modifiable barriers to reducing lung cancer morbidity. Most screening-eligible individuals are unaware or misinformed about: (1) screening guidelines; (2) how screening is performed; (3) its benefits; and (4) risk factors for developing lung cancer [11,12,13]. In addition, the current state of lung screening messages are rooted in communication that is fear-arousing and based upon communication scare tactics that contribute to the pervasive stigma surrounding lung cancer and screening [14, 15]. Historical medical mistrust within the Black community has continued to proliferate with widespread acknowledgement of present day structural racism [16]. A generic health campaign focused on lung screening developed for the general population cannot simply be rolled out without thoughtful and meaningful integration of the sociocultural perspective of the Black community. Public health interventions cannot treat the Black community as homogenous and 鈥渙ne size fits all鈥�. This sentiment is supported by decades of research showing that culturally-appropriate messaging and community-engaged approaches are essential for effective and equitable adoption of health interventions by the Black community [17,18,19,20,21].

Of equal importance, community-based interventions delivered upstream prior to an encounter in the health system are critical as individuals who are more likely to use tobacco are less likely to be actively engaged with the health system and subsequently less likely to seek preventive/screening services and primary care [22]. Public health interventions aimed at increasing screening uptake in Black communities must therefore prioritize culturally appropriate messaging and community-based partnerships. Therefore, it is critical to increase awareness and knowledge about lung screening in the Black community in the context of a community-based intervention that respects the community for which it is intended and is informed by cultural identity, relationships and expectations, and cultural empowerment. These efforts should integrate the principles of cultural empowerment and collective action, ensuring that interventions respect and align with community values and experiences. By leveraging the insights and active participation of community members, such approaches can disrupt longstanding inequities, foster trust, and advance public health outcomes [7, 10].

Witness Project庐

The National Witness Project庐 is an evidenced-based, lay health advisor intervention program originally developed to increase knowledge and awareness about breast cancer risk and screening in the Black community [23]. Lay health advisors are trained community members who deliver health education, perform navigation to resources, and provide social support in community settings. The National Witness Project庐 was founded by Black breast cancer survivors to reduce cancer stigma, increase medical trust, and address inequities in early detection behaviors among Black women who experience greater structural barriers to health care access and screening, including experiences of discrimination, structural racism, and medical mistrust [23,24,25]. This program has been successfully adapted to cervical and colorectal cancer screening and leverages underlying guiding principles of faith to intervene in community-based settings [24, 26, 27].

The purpose of this paper is to describe the refinement of the Witness Project庐 model, shown effective for increasing breast, cervical and colorectal cancer screening among Blacks, to address lung screening and to pilot test Witness Project庐 Lung for feasibility, acceptability, and satisfaction.

Methods

We developed Witness Project庐 Lung using a multi-phase user-centered design. The study protocol was reviewed and approved by the Hackensack Meridian Health Institutional Review Board prior to participant involvement. Our diverse study team used a qualitative approach to elicit relevant Black faith community key stakeholder perspectives and make refinements to the Witness Project庐 model to ensure that the adapted program addresses the cultural, equity, learning style and informational needs of the Black community including specific lung screening barriers. Program refinements were guided by Airhihenbuwa鈥檚 PEN-3 model [20, 28], a well-established methodology for collecting and analyzing qualitative information to inform the sociocultural adaptation of health interventions as well as the Conceptual Model for Lung Cancer Screening Participation [29], that includes key psychosocial variables (stigma, mistrust, fatalism, fear, worry) that influence an individual鈥檚 decision to screen, or not, for lung cancer. Prior research testing the Conceptual Model for Lung Cancer Screening Participation in a diverse sample of screening eligible Americans highlighted several perceived barriers as significant predictors for non-screening behavior including lack of knowledge about the screening process, perceived stigma, worry about finding lung cancer, lack of symptoms, and worry about cost [30].

The PEN-3 model emphasizes perceived cultural identity, relationships, external social and environmental factors, expectations and the positive and negative interactions of these domains on the desired health behavior. Airhihenbuwa outlines three primary domains for consideration: [1] Cultural Identity; [2] Relationships and Expectations, and [3] Cultural Empowerment. Each domain includes three factors that form the acronym PEN: Perceptions, Enablers, Nurturers (cultural identity domain); Positive, Existential, Negative (relationships and expectations domain); and Person, Extended Family, Neighborhood (cultural empowerment domain) [20, 28]. Guided by our team鈥檚 prior experience refining the original Witness Project庐, the relevance of critical constructs for Witness Project庐 Lung focusing on the unmet needs of Black screening-eligible individuals were examined. The aim of this pilot project was to examine the cultural, equity, learning style and informational needs specific to lung screening barriers among members of the Black community. To do this, we conducted key stakeholder interviews as discussed briefly below.

Key stakeholder interviews

Key stakeholder interviews were conducted with 11 screening-eligible Black individuals in the New York metropolitan area. Full details of this qualitative component are described in a separate manuscript currently under review, and the authors will provide these details to interested readers upon request until the manuscript is published. Briefly, these interviews revealed a consistent observation of 鈥�seeing screening activities geared toward other cancers like breast and colon, but nothing toward lung in the Black community鈥� as well as suggestions such as 鈥�Black individuals should convey lung screening messages to Black folk in the community because they may be more willing to listen to people who look and sound like them鈥�. Interview data from these interviews and themes from the Conceptual Model for Lung Cancer Screening Participation were categorized using the PEN-3 categories in preparation for eliciting feedback during an in-person retreat of community key stakeholders identified as partners in the co-design of Witness Project庐 Lung.

Briefly, applying the PEN-3 framework to key findings from qualitative interviews suggested the following intervention and program strategies to present to our Community Advisory Council:

PEN-3 Cultural Empowerment Domain.

  • To address low knowledge, mistrust and stigma, the program should focus on reaching (a) individuals at risk (Person), but also include (b) Extended Family (to help influence at-risk members and friends); and (c) be placed and delivered in Neighborhoods.

PEN-3 Cultural Identity and Relationships and Expectations Domains.

  • To address negative Perceptions (individually held beliefs), facts and experiences delivered by personal narrative communication messages could address targeted worries, fears, disregard of need, and competing conditions.

  • To address Enablers (societal and systemic influences) such as transportation, lack of primary care referral and medical mistrust, local screening resources and specific appointment and screening opportunities can be shared.

  • To address Nurturers (supportive and discouraging influences from significant others), methods for obtaining referrals to screening, stories and messages of positive screening outcomes, and educating extended family and non-tobacco users at programs should be included.

The PEN-3 analysis of primary barriers found through our interviews and in the published literature --fears, worry, stigma, mistrust and especially, lack of knowledge and information on which to act鈥攑rovided specific, culturally appropriate, narrative messaging for us to explore within a Witness Project庐 Lung program.

Community advisory council and co-design of Witness Project庐 Lung

We invited 10 community leaders, faith-based leaders and key stakeholders to establish a Witness Project庐 Lung Community Advisory Council (WPL-CAC). These individuals represented key stakeholders who had been involved in prior iterations of the Witness Project庐 (breast, cervical, colon), local faith-based leaders, local minority-serving community organizations, men and women who had participated in lung screening or were eligible, and a lung cancer survivor. We held a day-long hybrid retreat in July 2023 under the direction of four cancer control researchers (LC-B, DOE, LJ, JSO) with expertise addressing cancer screening inequities to co-create Witness Project庐 Lung. Leveraging user-centered design [19, 21], we asked members of the WPL-CAC to provide iterative feedback on message framing, specific wording, and imagery based on PEN-3 categories and qualitative findings during the retreat. We also asked members of the WPL-CAC about presentation format including the preferred order of educational content and preferences for the 鈥榣ook and feel鈥� of the didactic material. WPL-CAC members provided feedback on what should and should not be included, wording for content of the program, specific imagery and engaged in a real-time iterative process to name the educational program as Witness Project庐 Lung. The WPL-CAC retreat was audiotaped to fully capture feedback and facilitate the development of an initial version of the Witness Project庐 Lung educational program slides. Digital audio recordings and field notes taken during the retreat were reviewed by the scientific team (LC-B, DOE, LJ, JSO, DJ, ENS, MB, FV). Members of the WPL-CAC received a $50 honorarium in appreciation for their time and contribution to the process.

Guided by the Witness Project庐 model [31], key stakeholder qualitative interview data, PEN-3 results and feedback from the WPL-CAC retreat, the curriculum for Witness Project庐 Lung was developed including the following components: [1] Welcome/Objectives [2], Lung Structure and Function [3], Definition of Cancer [4], Risk Factors for Lung Cancer [5], Myths about Lung Cancer and Screening [6], Stigma [7], Medical Mistrust [8], Lung Screening Specifics [9], Who Should Get Screened [10], How to Get Screened [11], Tobacco Treatment Resources, and [12] Take-Home Points. In addition, a role model testimony video was created that featured the diagnosis story of a Black female lung cancer survivor to empower individuals to advocate for their health. The draft slides and role model testimony video were subsequently reviewed by the WPL-CAC and iterative feedback elicited on the perceived relevance and impact of the 60-minute Witness Project庐 Lung educational program.

Pilot testing

We then conducted a two-phase pilot study focusing first on the feasibility of reaching the target community of Black Americans regardless of screening-eligibility for lung cancer, and then program acceptability and satisfaction [19, 21]. In the first phase, we contacted four community-based sites in the New York metropolitan area. We focused on recruiting sites that would offer the opportunity to present Witness Project庐 Lung broadly to the Black community regardless of screening-eligibility. We assessed acceptability and satisfaction with the program and used feedback from attendees to make minor refinements to the Witness Project庐 Lung presentation. In the second phase of the pilot, we conducted three additional Witness Project庐 Lung programs at Black churches in New Jersey.

Procedures: phase 1 pilot testing

Phase 1 pilot testing took place in September 2023 at four community-based sites in New York City (two Black churches in Harlem and two minority-serving community-based organizations in NYC) to conduct the one-hour community-based Witness Project庐 Lung program. The program was presented by an experienced community health educator (MB) who was familiar with presenting Witness Project庐 for other types of cancer screening. Upon program completion, participants completed a 6-item, 5-point Likert response option questionnaire assessing acceptability and satisfaction (Table听1).

Table 1 Acceptability and satisfaction questionnaire items
Full size table

Procedures: phase 2 pilot testing

Based upon our demonstrated ability to reach screening-eligible Black American individuals from Black American churches and minority-service organizations in Phase 1 of the pilot testing, Phase 2 pilot testing took place in New Jersey in Black American churches using purposive sampling. Informed consent was obtained from all Phase 2 pilot testing participants included in the study. Three programs led by an experienced health educator (ES) were held at community faith-based sites. These programs involved coordination with the church pastor who assisted with outreach to the congregation. The church pastor made an announcement during the Sunday service of the week a Witness Project庐 Lung program was scheduled of the upcoming educational program for parishioners who wanted to learn more about lung cancer screening and shared the eligibility criteria during his announcement (aged 50鈥�80 years, currently smokes cigarettes or quit within the past 15 years). Because broad education and awareness within the Black community is critical, all individuals who wished to attend the program were welcomed regardless of screening eligibility. A 6-item knowledge pre-test about lung cancer risk and screening was administered to all attendees followed by the 60-minute Witness Project庐 Lung program (see Table听2). Upon program completion, participants completed the 6-item knowledge post-test about lung cancer risk and screening. To ensure confidentiality of participant data, all study data was de-identified and identifiable information was securely stored on a passphrase protected server. In addition, identifiable data was only accessible by study team members involved in the consenting process with restricted access protocols in place in accordance with institutional and regulatory guidelines for the protection of human subjects.

Table 2 Witness project lung knowledge: lung cancer and screening items
Full size table

Measures and data analysis

Sociodemographic and Health Status. Participants completed an 11-item questionnaire assessing sociodemographic and health status characteristics at the beginning of the program. This questionnaire assessed age, race/ethnicity, preferred language, zip code, physical activity level, alcohol and tobacco use.

Social Determinants of Health. Social determinants of health (SDOH) was assessed with an 11-item screening questionnaire assessing six areas of health-related social needs (HRSN) including [1] transportation [2], stress [3], financial strain [4], food insecurity [5], intimate partner violence, and [6] immigration concerns. This questionnaire was adapted from the Centers for Medicare and Medicaid Services Accountable Health Community HRSN Screening Tool [32] to identify areas of HRSN that require further exploration.

Knowledge: Lung Cancer and Screening. A 6-item test assessing knowledge of nonmodifiable risk factors for lung cancer, how screening is performed, and screening eligibility was administered pre- and post-programming. Total scale scores ranged from 0 (low knowledge) to 6 (high knowledge).

Acceptability and Satisfaction. Upon Witness Project庐 Lung program completion, participants completed the 6-item, 5-point Likert response questions on acceptability and satisfaction. Descriptive statistics were performed to identify means, standard deviations, and frequency distributions to examine the data. Participants received a $10 gift card incentive to thank them for their time.

Results

Phase 1 pilot testing

A total of 113 participants attended one of the four programs (~鈥�28/program) and 88 (~鈥�22/program) completed the post program survey. Overall, program acceptability and satisfaction was well received with 93% (n鈥�=鈥�82) stating that they were very satisfied with the program; 93% (n鈥�=鈥�82) reporting that the presentation provided sufficient information on lung cancer to increase awareness and sufficient information about screening resources to meet the needs of Blacks in the NYC area. When asked about cultural sensitivity, 95% (n鈥�=鈥�84) felt the presentation was sensitive to the issues and potential barriers faced by Blacks in the healthcare system. When asked about culturally-relevant content, 97% (n鈥�=鈥�85) noted the content presented featured relevant information for the Black community. Finally, 97% (n鈥�=鈥�85) felt confident in their knowledge to take action about lung screening. Key feedback included participants noting 鈥�the presentation moved along at a nice pace, allowed for interactions from participants, language was understandable鈥ot clinical鈥�, 鈥減resentation was amazing鈥t really helped with understanding my options and preventative measures鈥�, and 鈥�I am excited about the move forward鈥�.

Phase 2 pilot testing

Twenty-eight participants attended the three programs. Fifteen of the 28 (53.6%) were aged 50 years or older and eligible for lung cancer screening. All attendees (n鈥�=鈥�28, 100%) self-identified as Black (Table听3).

Table 3 Phase 2 Pilot Testing Sociodemographic Variables (N鈥�=鈥�28)
Full size table

Social Determinants of Health. Of the 28 participants, most (75.1%; n鈥�=鈥�21) noted some level of financial strain indicating it was somewhat hard (n鈥�=鈥�8), hard (n鈥�=鈥�8) or very hard (n鈥�=鈥�5) to pay for basic necessities and 32.1% (n鈥�=鈥�9) indicated they worried that their food would run out before getting money to buy more; 28.6% (n鈥�=鈥�8) noted their food did not last. Further, a fair number of participants (32.1%, n鈥�=鈥�9) noted that lack of transportation kept them from medical appointments, getting medications, or getting things needed for daily living (Table听4). All participants were contacted post programming and connected to community resources tailored to their identified needs.

Table 4 Phase 2 pilot testing: social determinants of health assessment
Full size table

Knowledge: Lung Cancer and Screening. Mean knowledge pre-test scores were 4.11 (SD 1.18) compared to mean knowledge post-test scores of 4.86 (SD 1.33) indicating higher levels of knowledge about lung cancer and screening post-programming. Acceptability and Satisfaction. Of the 28 participants, acceptability and satisfaction with the program was high with 27 (96.4%) stating they were either very satisfied (n鈥�=鈥�24) or satisfied (n鈥�=鈥�3) with the program. In addition, all participants reporting feeling the presentation provided sufficient information on lung cancer to increase awareness and screening resources to meet the needs of Blacks in the New Jersey area. When asked about cultural sensitivity, all participants (100%, n鈥�=鈥�28; 10鈥�=鈥塻atisfied, 18鈥�=鈥塻trongly satisfied) felt the presentation was sensitive to the issues and potential barriers faced by Blacks in the healthcare system and all (100%, n鈥�=鈥�28; 5鈥�=鈥塻atisfied, 23鈥�=鈥塻trongly satisfied) noted the program content featured information that is relevant to the Black community. Finally, after participating in the Witness Project庐 Lung program, 96.4% (n鈥�=鈥�28; 5鈥�=鈥塻atisfied, 23鈥�=鈥塻trongly satisfied) felt confident in their knowledge to take action about lung screening. Key feedback included participants noting 鈥�Wonderful presentation; educational鈥nd enlightening鈥�, 鈥�This project is a great opportunity for Blacks. Grateful for the chance to be taught about lung cancer [because] breast cancer runs strong in my family鈥�, and 鈥�presentation was very informative鈥 would like to bring this program to our school district鈥�.

Discussion

Witness Project庐 Lung pilot testing demonstrated promising feasibility, acceptability, and satisfaction as a culturally-appropriate intervention design for increasing lung screening awareness among Blacks. The intervention design was well-received by participants, who reported feeling informed, satisfied, and confident about seeking lung screening. Several key findings emerged from pilot testing:

(1) High acceptability and satisfaction: Over 90% of participants were very satisfied with the Witness Project庐 Lung program design and content feeling it provided helpful information about lung cancer and screening resources.

(2) Cultural sensitivity: Participants appreciated the program鈥檚 sensitivity to the specific issues and barriers faced by Blacks in the healthcare system.

(3) Culturally relevant content: The program鈥檚 content was deemed relevant and relatable to the Black community.

(4) Increased confidence in screening: Participants reported feeling more confident about seeking lung screening after attending the program.

Findings suggest that Witness Project庐 Lung has the potential to be an effective community-based intervention for increasing the Black community鈥檚 awareness and knowledge about lung screening.

Further, Witness Project庐 Lung aligns with existing conceptual frameworks such as the PRECEDE-PROCEED Model [33] and Social Cognitive Theory [34] by directly addressing the psychosocial determinants of health behavior change within the context of lung screening in Black communities. Its focus on building personal and community-level knowledge, attitudes, and skills through culturally-tailored education and role models complements the PRECEDE-PROCEED model鈥檚 emphasis on predisposing, enabling, and reinforcing factors [33]. Similarly, the program鈥檚 incorporation of social norms, self-efficacy, and outcome expectations resonates with Social Cognitive Theory鈥檚 focus on individual beliefs and social influences [34].

However, Witness Project庐 Lung goes beyond these existing frameworks by addressing limitations. Traditional interventions frequently lack attention to cultural sensitivity, leading to messages that resonate less with the Black community. Witness Project庐 Lung鈥檚 co-design process with Black key stakeholders along with its theoretical grounding in the PEN-3 model [20, 28] facilitated culturally relevant content and delivery. Existing models often prioritize individual-level interventions, neglecting the powerful influence of social, neighborhood and environmental factors on health behaviors. Witness Project庐 Lung鈥檚 community-based approach, including integral partnerships with faith-based organizations has the potential to foster social support and reduce stigma, potentially leading to greater sustained behavior change. Ultimately, Witness Project庐 Lung builds upon existing evidence-based strategies while addressing their limitations through cultural sensitivity and a strong community-based focus. This unique approach shows promise for effectively promoting lung screening among Blacks, a population disproportionately affected by lung cancer and facing significant barriers to screening access and utilization.

Unlike interventions designed for the general population, Witness Project庐 Lung is targeted and culturally-tailored to the specific needs of Blacks regarding lung cancer and screening. This cultural relevance is highlighted through three key elements: [1] trusted messaging; [2] community-based partnerships; and [3] addressing intersectionality. Witness Project庐 Lung avoids the fear-mongering and stigma-laden narratives often associated with lung screening. Instead, it draws on the powerful storytelling format through a Black cancer survivor鈥檚 role model testimony as well as the importance of community by utilizing culturally-representative health educators and trusted messengers [17, 23, 24, 27, 35], fostering empathy and understanding within the community. This approach directly addresses the historical medical mistrust and stigma surrounding lung cancer within Black communities, which generic interventions often fail to acknowledge and navigate, having the potential to resonate more deeply. Community-based partnerships are highlighted in the program鈥檚 partnership with Black faith-based organizations that have established social capital leveraging a trusted and central cornerstone of many Black communities. This partnership facilitates access to individuals who may not readily engage with traditional healthcare settings, promoting outreach, relationship-building, and building trust. Partnering with faith-based organizations 鈥� trusted pillars within Black communities 鈥� contributes to bridge-building. Witness Project庐 Lung also addresses critical intersectionality contexts. While designed specifically for Blacks, Witness Project庐 Lung was guided by an adaptable framework that can be modified to address the needs of other underserved populations facing challenges associated with low socioeconomic status, language barriers, or rurality. For example, the Witness Project庐 co-design process can be replicated with different community stakeholders such as those from Latino or Native American communities, incorporating culturally relevant messaging and imagery. Addressing language barriers through translated materials and interpreters can increase accessibility, while utilizing trusted community leaders and organizations within rural areas can bridge the geographic gap. This adaptability holds immense potential for increasing lung screening equity across diverse populations with low screening uptake. Witness Project庐 Lung was designed to empower individuals and communities to overcome cultural and social barriers, leading to increased understanding, trust, and ultimately, greater uptake of lung screening among Blacks and other underserved populations.

Witness Project庐 Lung鈥檚 delivery in community settings to people directly at risk as well as community members not personally at risk but who may be connected to those at risk offers distinct advantages over traditional clinical settings in fostering trust and accessibility. Delivering culturally-specific direct messaging to a broader audience may increase general knowledge about lung screening within the wider Black community. By engaging individuals in familiar spaces like churches and community centers, the program breaks down barriers associated with healthcare institutions, which can be intimidating and exacerbate existing mistrust, particularly among Black communities historically marginalized within the health system.

Furthermore, the community-based approach leverages existing social networks and trusted community leaders, acting as bridges between individuals and healthcare resources. Witness Project庐 Lung鈥檚 reliance on trained lay health advisors and health educators lowers costs compared to public health campaigns and digital interventions requiring expensive marketing, specialized personnel and digital literacy. A localized approach can achieve meaningful outreach and engagement at a lower overall cost, making it a sustainable and scalable solution for addressing lung screening inequities.

It is important to acknowledge study limitations. The pilot testing involved a relatively small number of participants, which limits the generalizability of the findings. While the study successfully engaged members of the Black faith community, it is critical to recognize that this subset may not fully represent the broader Black community. Individuals unaffiliated with faith-based organizations may have provided differing perspectives or raised unique challenges that were not captured in this pilot study. Future efforts should seek to include a more diverse representation of the Black community, including those not affiliated with faith communities, to ensure that the intervention reflects the full spectrum of experiences and needs. In addition, the pilot test assessed immediate acceptability, satisfaction and self-efficacy to take next steps to be screened but did not evaluate actual lung screening uptake. Future studies should include longer-term follow-up and assessment of actual screening uptake to determine the sustained effectiveness and impact of the program. Expanding the scope and duration of future studies will be essential for refining and scaling the intervention to address lung cancer screening disparities comprehensively.

Conclusion

Witness Project庐 Lung鈥檚 community-based delivery fosters trust, accessibility, and potential cost-effectiveness, offering a promising alternative to traditional clinical settings and centralized interventions. Witness Project庐 Lung also addresses the need to reach people upstream prior to health system engagement by meeting individuals where they work, live, and play to bring all individuals to the table equitably in the context of lung screening awareness and education and build a trustworthy bridge from the community to lung screening. By leveraging existing community resources and social networks, the program has the potential to significantly improve lung screening rates among underserved populations, ultimately leading to better outcomes and reducing disparities. Future research is needed to test the effectiveness, including cost-related, of Witness Project庐 Lung on lung screening uptake.

Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at the Center for Discovery & Innovation at Hackensack Meridian Health.

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Acknowledgements

The authors would like to thank the National Witness Project庐, Inc. Board of Directors and Witness Role Models and Lay Health Advisors in New Jersey and New York as well as The First Ladies of Western New York and the Second Ecclesiastical Jurisdiction-Eastern New York Church of God in Christ for their partnership in the creation of the Witness Project庐 Lung educational intervention.

Funding

Funding support for this project was received from a pilot grant from ScreenNJ (PI: Carter-Bawa). ScreenNJ is a collaborative organization in the state of New Jersey that partners with, connects, and supports healthcare provider agencies, public health agencies, and community organizations throughout the state that provide education on, refer patients to, or directly provide screening services for cancer. ScreenNJ also helps organizations initiate or expand these types of outcomes-oriented, evidence-based screening and outreach services.

Author information

Authors and Affiliations

  1. Center for Discovery & Innovation at Hackensack Meridian Health, Nutley, NJ, USA

    Lisa Carter-Bawa,听Elan N. Shoulders听&听Francis Valenzona

  2. Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA

    Lisa Carter-Bawa

  3. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jamie S. Ostroff

  4. Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Deborah O. Erwin听&听Detric Johnson

  5. The National Witness Project庐, Buffalo, NY, USA

    Deborah O. Erwin听&听Detric Johnson

  6. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Mikhalya Brown听&听Lina Jandorf

  7. Center for Discovery & Innovation at Hackensack Meridian Health, Cancer Prevention Precision Control Institute, 123 Metro Blvd, 6th Floor, 6400 Pod, Nutley, NJ, 07110, USA

    Lisa Carter-Bawa

Authors
  1. Lisa Carter-Bawa

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  2. Jamie S. Ostroff

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  3. Deborah O. Erwin

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  4. Elan N. Shoulders

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  5. Detric Johnson

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  6. Mikhalya Brown

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  7. Francis Valenzona

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  8. Lina Jandorf

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Contributions

Author Contributions: All authors (LC-B, JSO, DOE, ENS, DJ, MB, FV, LJ) contributed to the study conception and design. Material preparation, data collection and analysis were performed by LC-B and LJ. The first draft of the manuscript was written by LC-B and all co-authors (JSO, DOE, ENS, DJ, MB, FV, LJ) commented and provided edits of the manuscript prior to its finalization. All authors (LC-B, JSO, DOE, ENS, DJ, MB, FV, LJ) read and approved the final manuscript.

Corresponding author

Correspondence to Lisa Carter-Bawa.

Ethics declarations

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Hackensack Meridian Health (09/25/2023; Pro2023-0374). Informed consent was obtained from all participants in the pilot study. To ensure confidentiality, all participant study data was de-identified, identifiable information was securely stored on a passphrase protected server, and restricted access protocols in place in accordance with institutional and regulatory guidelines for the protection of human subjects.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Carter-Bawa, L., Ostroff, J.S., Erwin, D.O. et al. A community-based approach to address lung cancer screening disparities in the black community using the Witness Project庐 framework: development and pilot trial. 成人头条 25, 379 (2025). https://doi.org/10.1186/s12889-025-21623-9

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  • DOI: https://doi.org/10.1186/s12889-025-21623-9

Keywords

成人头条

ISSN: 1471-2458

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