Social Ecological Model

CDC adapted the social ecological model (SEM) of health promotion to represent the Colorectal Cancer Control Program's (CRCCP's) multi-level approach to colorectal cancer prevention. The SEM is a systems model with multiple bands of influence. A rainbow-like figure of five bands represents the SEM. At the core of the model is the individual, surrounded by four bands of influence representing the interpersonal, organizational, community, and policy levels. CRCCP grantees implement public health activities at these five levels to maximize synergies of intervention for the greatest impact. Each of these bands of influence in the model is described below.

Individual Level

The innermost band of the SEM rainbow represents the individual ultimately affected by the CRCCP. The CRCCP aims to increase the individual's knowledge and influence his or her attitudes toward, and beliefs regarding—

• The need for colorectal cancer screening.
• The intention to be screened.
• The risks and benefits of screening.
• Access to affordable and convenient colorectal cancer screening, diagnosis, and treatment.

The CRCCP SEM highlights the importance of providing individuals with high-quality, appropriate colorectal cancer screening and surveillance and ensuring timely initiation of treatment for people who are diagnosed with cancer.

Interpersonal Level

The second band of the SEM rainbow surrounds the individual band and represents colorectal cancer prevention activities implemented at the interpersonal level. These activities are intended to facilitate individual behavior change through interpersonal communication and support aimed at affecting social and cultural norms and overcoming individual-level barriers. Friends, family, health care providers, community health workers or promotoras, and patient navigators represent potential sources of interpersonal messages and support. The CRCCP SEM highlights several interventions appropriate for this level, including—

• Providers making screening recommendations to their patients.
• Patients receiving reminders about the need of screening.
• Patient navigators helping to remove logistical and other barriers to screening.

Organizational Level

The third band of the SEM rainbow surrounds the interpersonal band and represents colorectal cancer prevention activities implemented at the organization level. These activities are intended to facilitate individual behavior change through communication and support aimed at influencing organizational systems and policies. Health care systems, employers or worksites, health care plans, local health departments, tribal urban health clinics, and professional organizations represent potential sources of organizational messages and support. The CRCCP SEM highlights several interventions appropriate for this level, including—

• Promoting the use of client and provider reminder systems.
• Providing provider assessment and feedback.
• Encouraging the coverage and expansion of benefits.
• Adopting worksite policies that support preventive care.

Community Level

The fourth band of the SEM rainbow surrounds the organizational band and represents colorectal cancer prevention activities implemented at the community level. These activities are intended to facilitate individual behavior change through communication and support by leveraging resources and participation of community-level institutions such as comprehensive cancer control coalitions, tribal health departments, media, and community advocacy groups, which represent potential sources of community communication and support. The CRCCP SEM highlights several interventions appropriate for this level, including—

• Working with coalitions and collaboratives to promote colorectal cancer screening and expand resources.
• Conducting public awareness and educational campaigns.
• Collaborating with tribal health departments to expand colorectal cancer screening.

Policy Level

The fifth and outermost band of the SEM rainbow surrounds the community band and represents colorectal cancer prevention activities at the policy level. Theseactivities are intended to facilitate individual behavior change through regulation, communication, and support by promoting, developing, and implementing local, state, and federal policies and guidelines. Policy-level institutions and representatives such as federal government agencies, tribal governments, national advocacy groups, and local, state, and national legislators represent potential sources for regulation, communication, and support. The CRCCP SEM highlights several interventions appropriate for this level, including—

• Collaborating with the Indian Health Service to influence colorectal cancer-related policy.
• Supporting legislative changes for mandatory insurance coverage and reduced co-pays for colorectal cancer screening.