Raising Colorectal Cancer Screening Among Adults Aged 45 to 49 at a Community Health Center: A Population Health Promotion Plan
[Author Name]
College of Nursing and Health Care Professions, Grand Canyon University
NRS-425 Health Promotion and Population Health
Topic 3 Assignment
[Instructor Name]
August 11, 2026
Composite community written as a model document. No real clinic, employer or patient is described.
Population, Setting and the Screening Gap
Vista Grande Community Health Center is a composite federally qualified health center built for this paper, serving a metropolitan county of roughly 340,000 residents from two clinic sites. Its adult primary care panel holds 11,400 patients. The population addressed here is narrower: adults aged 45 to 49 who have had at least one primary care visit in the past 24 months, excluding anyone already followed on a shortened interval for inflammatory bowel disease, a personal history of colorectal cancer or adenomatous polyps, or a first-degree relative diagnosed before age 60. That definition leaves 2,140 eligible adults. Stating the denominator first matters, because every rate below is read against that same 2,140.
Of the 2,140 adults aged 45 to 49 attributed to the center, 612 were up to date on colorectal cancer screening in the 12 months ending March 31, which is a screening rate of 28.6 percent. Up to date was defined as a completed fecal immunochemical test within the past 12 months, a stool DNA test within 3 years, or a colonoscopy within 10 years, taken from the electronic record rather than from patient report. The remaining 1,528 adults are the group this plan is written for. Two subgroups sit inside that number and behave differently: among the 762 patients who are uninsured or covered by the county indigent program the rate is 19.4 percent, while among the 1,378 with commercial or Medicaid coverage it is 33.7 percent.
The gap matters more now than it did a decade ago. Colorectal cancer incidence in adults under 50 has been rising while incidence in older adults has fallen, and younger patients more often present with regional or distant disease because nobody was looking earlier (American Cancer Society, 2024). The center's own registry, also a composite, recorded 6 colorectal cancers among panel members in the past 36 months, and 4 of the 6 were stage III or higher at diagnosis. Healthy People 2030 carries colorectal cancer screening as a national objective, and the distance between a 28.6 percent panel rate and that objective is the reason this plan exists rather than a general campaign about healthy eating.
Evidence Behind the Age Band, the Interval and the Design
The age band is not a local preference. The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years and carries that recommendation at grade B, having lowered the starting age from 50 in 2021 (USPSTF, 2021). The grade matters operationally as well, because it is the level at which most private plans must cover the service without cost sharing, which removes a barrier for the insured half of this panel. The American Cancer Society reached the same starting age in 2018. Two independent bodies naming 45 is why this plan spends no effort arguing about who is eligible.
The interval follows the test, and several tests are acceptable: a fecal immunochemical test every year, stool DNA testing every 1 to 3 years, flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years (Centers for Disease Control and Prevention, 2024a). The plan therefore sets annual fecal immunochemical testing as the default offer and keeps colonoscopy every 10 years as the alternative, because a test that is completed at home beats a better test that is declined. That choice carries a cost worth naming: an annual interval makes this a recurring obligation rather than a one-time push, so the budget below is written as a repeating line.
The design of the outreach follows what has already moved screening rates elsewhere. Mailed outreach with the kit enclosed, paired with reminders and a clinic-side standing order, raises completion more than education alone, and the federal Colorectal Cancer Control Program is built around that combination of client reminders, small media and provider workflow change (Centers for Disease Control and Prevention, 2024b). Pender's health promotion model supplies the messaging logic: perceived barriers fall when the kit arrives with return postage already paid, perceived benefit rises when the letter names the survival difference between early and late stage disease, and self-efficacy rises when instructions run to one page with pictures in the patient's preferred language (Pender et al., 2015).
The Plan: Reach, Sequence and Resources
The registry produces the outreach list on the first business day of each month: eligible adults aged 45 to 49 who are not up to date. Of the 1,528 patients in the gap, 1,410 have a deliverable address, and the remaining 118 are routed to phone outreach and to a standing order that fires at their next visit. Each patient in the mailed group receives three contacts across 90 days. Day 0 is a one-page advance letter in English and Spanish over the signature of their own primary care provider. Day 10 is the kit itself with a prepaid return envelope and pictorial instructions. Day 40 is a live call, and day 60 is a text message offering a replacement kit.
Clinic workflow carries the other half. A standing order lets a medical assistant hand a kit to any eligible patient aged 45 to 49 at any visit, so a patient who comes in for a blood pressure check does not leave without the offer. Returned kits are logged the day they arrive. Every abnormal result carries a scheduled colonoscopy referral within 10 business days, because a screening program that cannot close its own loop turns a positive test into false reassurance. The outreach coordinator holds the referral list and calls any patient whose colonoscopy is not yet scheduled inside that window. Results, normal and abnormal, are reported to the patient in the language recorded in the chart.
Resources are modest and are named so the plan can be approved rather than admired. Printing, kits and prepaid return postage cost $6.80 per packet, so 1,410 packets cost $9,588 in the first cycle. The outreach coordinator role is 0.4 of a full-time position, drawn from existing care-coordination staffing. A county cancer coalition supplies recorded reminder scripts in Spanish and Vietnamese at no charge. A gastroenterology group has agreed to hold 6 diagnostic colonoscopy slots each month at a reduced self-pay rate for uninsured patients with an abnormal result, and transportation vouchers of $25 per procedure come from the coalition's existing fund. Nothing here requires a new clinician position.
Evaluation: How the Center Will Know It Worked
The outcome measure is the rate the plan opened with, recomputed the same way. The proportion of eligible adults aged 45 to 49 who are up to date should rise from 28.6 percent to 45 percent within 12 months, using the identical registry query, the identical exclusions and the same reporting date each month. Holding the denominator definition still is what makes the comparison honest, since a rate can always be raised by narrowing who counts instead of by screening anyone. In absolute terms the target means 963 of 2,140 patients up to date, an increase of 351 people, and that is the number the outreach has to produce.
Two process measures show whether the plan is working while there is still time to change it. The first is kit return within 60 days of mailing, with a target of 55 percent of the 1,410 kits, or 776 returned kits, plotted on a run chart each month rather than reported once at the end. The second is colonoscopy completion within 60 days of an abnormal result, with a target of 80 percent. The second measure protects the first, because a program that raises testing while leaving abnormal results unscheduled has produced harm dressed as progress.
One measure exists to keep the plan honest about who benefits. A rate that rises while the uninsured subgroup stays flat is not success, so the plan reports the two subgroups side by side every month, with a target of narrowing the 14.3 point gap between insured and uninsured patients to under 7 points by month 12. Two decision rules are set in advance. If kit return in the first mailed group is under 35 percent at day 90, the phone contact moves earlier and a second kit is mailed automatically. If colonoscopy completion after an abnormal result falls under 70 percent for two consecutive months, mailing pauses for new patients until the referral backlog clears.
References
American Cancer Society. (2024). Colorectal cancer facts and figures 2023-2025. https://www.cancer.org/research/cancer-facts-statistics.html
Centers for Disease Control and Prevention. (2024a). Colorectal cancer screening tests. U.S. Department of Health and Human Services. https://www.cdc.gov/colorectal-cancer/screening/
Centers for Disease Control and Prevention. (2024b). Colorectal Cancer Control Program. U.S. Department of Health and Human Services. https://www.cdc.gov/colorectal-cancer/php/colorectal-cancer-control-program/
Office of Disease Prevention and Health Promotion. (n.d.). Cancer: Healthy People 2030. U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer
Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2015). Health promotion in nursing practice (8th ed.). Pearson.
U.S. Preventive Services Task Force. (2021). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(19), 1965-1977. https://www.uspreventiveservicestaskforce.org
How this NRS 425 Topic 3 example is structured
In many sections this topic asks for a population-focused health promotion plan built on a named group, an intervention drawn from national guidance and measures that would prove it worked; your classroom's instructions and rubric decide the exact form, so read the assignment page before you use this NRS 425 Topic 3 example as a shape. The paper is ordered the way a plan has to be defended. The population and its gap come first, with the denominator stated before the rate, so every later number has something to attach to. The evidence sheet follows, because the age band and the interval are borrowed rather than invented. The plan itself comes third, in the order it would be delivered, with dates and dollars. Evaluation comes last and names an outcome, a process and an equity measure. The health center is a composite.
NRS-425 Topic 3 questions, answered
What does NRS 425 Topic 3 usually ask for?
In many sections this topic asks for a population-focused health promotion plan: a named eligible group, an intervention drawn from national guidance, and measures that would show whether it worked. Your classroom's instructions and rubric decide the exact form, including length and required headings, so read the assignment page before you borrow the shape of an example like this one.
How specific does the population have to be?
Specific enough to count. A population is defined when a reader can say who is in, who is out and how many there are, as with the 2,140 adults aged 45 to 49 in this paper. Age band, setting, time window and exclusions all belong in that definition, because the denominator you state is what every rate you claim later depends on.
How do I show the plan worked when I have no real data?
Set the measures, the targets and the dates in advance. A model plan names an outcome measure with a baseline and a goal, a process measure that moves early enough to act on, and a safety or equity measure that would catch harm. Composite numbers are fine in a paper as long as you say plainly that they are composite.
Write yours, or have the desk draft it
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