| Course | NU 780 Population Health |
|---|---|
| Unit | Unit 5 |
| Paper type | Prevention program proposal |
| Length | About 1,000 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NU 780 Unit 5
Mailed Fecal Immunochemical Test Outreach to Raise Colorectal Cancer Screening at a Federally Qualified Health Center
Student Name
Department of Nursing, Herzing University
NU 780: Population Health
Instructor Name
February 20, 2026
Mailed Fecal Immunochemical Test Outreach to Raise Colorectal Cancer Screening at a Federally Qualified Health Center
The Problem and the Level of Prevention
A composite federally qualified health center serving 14,000 adults, 60% covered by Medicaid and 25% uninsured, reports that 38% of its patients aged 45 to 75 are up to date with colorectal cancer screening, compared with a national target near 70%. Current guidance advises screening from age 45 through 75, and stool-based tests, including an annual fecal immunochemical test (FIT), are among the recommended options (US Preventive Services Task Force, 2021). This proposal is for secondary prevention: detecting cancer and advanced precancerous lesions early in people without symptoms. It does not address primary prevention, such as diet or physical activity, or tertiary care for people already diagnosed. Staying at one level keeps the program focused on the gap the data show, which is uptake of screening.
The Evidence Behind the Choice
The program is adapted from published mailed outreach models rather than invented. In a randomized trial among uninsured patients in a safety-net health system, mailing a FIT kit with instructions produced substantially higher screening completion than offering colonoscopy by mail or usual care, with FIT outreach roughly tripling completion compared with usual care over one year (Gupta et al., 2013). A larger pragmatic trial in 26 community health clinics that implemented mailed FIT outreach through their own staff produced a smaller but real increase in completion, with wide variation between clinics that reflected how completely the program was implemented (Coronado et al., 2018). The lesson from the two trials together is that the approach works, and that its effect in a real clinic depends on execution. The proposal therefore puts as much detail into delivery as into design.
Adaptations for This Community
Three adaptations are made and defended. First, language: 30% of the center's patients prefer Spanish, and instructions, the letter, and follow-up calls are provided in Spanish and English; pictorial instructions reduce reliance on reading in either language. Second, returning the kit: the published programs relied mainly on mail return; the center adds drop-off boxes at its three sites and at two partner pharmacies, because many patients reported not trusting mail with a stool sample. Third, follow-up of positive results: the trials highlighted that a positive FIT is only useful if followed by colonoscopy; the center has arranged, through its hospital partner, reduced-cost colonoscopy for uninsured patients, which the original safety-net trial also had.
What Happens, Operationally
Who is eligible: patients aged 45 to 75 with a visit in the past two years, no colorectal cancer screening on record in the recommended interval, and no history of colorectal cancer or inflammatory bowel disease, identified monthly from the center's registry. What they receive: a letter from their own clinician explaining the test; a FIT kit with pictorial instructions and a prepaid return envelope, mailed two weeks after the letter; a reminder text or call from a medical assistant at two weeks; and a second reminder at four weeks. Who delivers it: a dedicated outreach medical assistant, 0.5 full-time equivalent, supervised by the nurse care manager. When: rolling monthly mailings of about 400 kits, beginning in April. Results: the laboratory sends results to the ordering clinician's inbox and to the nurse care manager's registry; normal results are sent to the patient by letter or portal; positive results are handled by the nurse care manager, who calls the patient within three business days and schedules colonoscopy through a patient navigator.
Resources and Cost
Estimated annual cost: outreach medical assistant salary and benefits, about $26,000; FIT kits and laboratory processing, about $22 per kit, or $105,600 for 4,800 kits; postage, about $12,000; patient navigator time for positive results, absorbed by the existing navigator. Many of the kit and lab costs are billable for insured patients. A state cancer control program grant will be sought for uninsured patients.
Expected Reach and Effect
About 4,800 of the center's patients are eligible and not up to date. If 30% complete a mailed FIT, a conservative estimate below the first trial's result and above the second's, about 1,440 additional patients would be screened in the first year, raising the center's screening rate from 38% to about 48%. With an expected positive rate of about 5% to 7%, 70 to 100 patients would need follow-up colonoscopy, which is within the capacity arranged with the hospital partner, who has agreed to review the number monthly.
Risks and How They Are Managed
Three risks could undermine the program. The first is incomplete follow-up of positive tests; a positive FIT that does not lead to colonoscopy offers little benefit and can cause anxiety. The nurse care manager will track every positive result until colonoscopy is completed or the patient declines after documented counseling, with a target of 80% completion within six months. The second is poor kit quality: samples that arrive too late or without a collection date cannot be processed. The instructions and the drop-off option are designed to reduce this, and the laboratory's rejection rate will be tracked monthly. The third is mailing to outdated addresses, which is common in a mobile population; the registry will be checked against the most recent visit address, and returned mail will prompt a phone call. A brief monthly review of these three process indicators, completion of follow-up, rejected samples, and returned mail, will show whether the program is being delivered as designed before any change in the screening rate can be expected.
Why This Program for This Community
The center's patients face the barriers the determinants for this population predict: cost, distance to specialty care, limited time off work, and language. Mailed FIT addresses several of these at once: it is inexpensive, done at home, requires no time off or bowel preparation, and can be explained in the patient's language. It is also the level of prevention with the clearest path to measurable change within a year, which matters for a center that must show results to funders.
References
Coronado, G. D., Petrik, A. F., Vollmer, W. M., Taplin, S. H., Keast, E. M., Fields, S., & Green, B. B. (2018). Effectiveness of a mailed colorectal cancer screening outreach program in community health clinics: The STOP CRC cluster randomized clinical trial. JAMA Internal Medicine, 178(9), 1174-1181. https://doi.org/10.1001/jamainternmed.2018.3629
Gupta, S., Halm, E. A., Rockey, D. C., Hammons, M., Koch, M., Carter, E., Valdez, L., Tong, L., Ahn, C., Kashner, M., Argenbright, K., Tiro, J., Geng, Z., Pruitt, S., & Sugg Skinner, C. (2013). Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved: A randomized clinical trial. JAMA Internal Medicine, 173(18), 1725-1732. https://doi.org/10.1001/jamainternmed.2013.9294
US Preventive Services Task Force. (2021). Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(19), 1965-1977. https://doi.org/10.1001/jama.2021.6238
NU 780 Unit 5 instructions, in plain terms
For Unit 5 you propose a prevention or health promotion program for a population identified in earlier units. Expect to define the problem and level of prevention, select an evidence-based intervention, explain adaptations for your community, describe operations, estimate resources and costs, project reach and effect, and identify risks. Many versions ask you to link the program to the determinants analysis from the previous unit. Check whether your section expects a logic model or a budget table. Adapting a tested program is usually stronger than inventing one, as long as you justify each change. Use the US Preventive Services Task Force or Community Guide to support the choice. Projections should be stated with assumptions so the grader can judge whether they are realistic.
How the NU 780 Unit 5 example is put together
The proposal begins with the center, its patients and its screening gap, then names secondary prevention as the level. The evidence section explains the trials behind mailed outreach and how this design follows them. Adaptations are listed and defended one by one, which shows the program was fitted to this community rather than copied. Operations describe who is eligible, what is mailed, when reminders go out and how positive results are followed. The cost section itemizes salary, kits, postage and processing. Reach and effect are projected with a conservative completion rate below the trial result, and the arithmetic is shown. Risks focus on the follow-up gap that would waste the program's benefit. The closing section ties the choice back to the barriers the determinants analysis predicted.
Where the points sit in the NU 780 Unit 5 rubric
Herzing tends to grade a prevention program proposal on the problem and population, the evidence base, the program design and adaptation, implementation, resources, expected outcomes, and writing. Evidence points require tested interventions with citations to trials or systematic reviews. Design and adaptation criteria reward changes justified by community characteristics. Implementation points go to operational detail, including roles and timelines. The resource criterion earns credit for an itemized budget with stated assumptions. Outcome projections are scored on realism and transparent calculation. Equity can appear as its own line. Cite the 2021 Task Force colorectal screening recommendation in APA 7, since writing and references close the rubric.
NU 780 Unit 5 help: mistakes that cost points
Students in Unit 5 most often lose credit for proposing a program without evidence that it works, or citing evidence for a different population without adapting it. Another frequent problem is operations described as a goal, such as increase screening, rather than steps. Budgets that give a single total are hard to credit. Reach estimates that assume trial results will be repeated exactly look optimistic. Follow-up after a positive test is often missing, though it decides whether screening helps. Adaptations listed without reasons do not show fit. Some proposals forget to name the level of prevention. Finally, connect the program to the determinants you identified earlier, because graders look for continuity across the course's units.
Get a NU 780 Unit 5 example written to your instructions
Send the Unit 5 instructions and the rubric from your NU 780 classroom, plus your community, your determinants analysis and the problem you are targeting. We write a custom example with the level of prevention held, the evidence attached and the reach estimated, returned in 24 to 48 hours. The first custom sample is free.
More NU 780 papers and MSN samples
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- NU 780 Unit 7: Culturally adapted implementation plan
- NU 780 Unit 8: Population outcome evaluation
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- NU 700 Unit 5: Evidence appraisal
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NU 780 Unit 5 questions, answered
How do I choose the level of prevention?
From what your determinants analysis found modifiable. If the burden comes from exposure nobody has addressed, primary prevention fits; if cases exist and are found late, screening does; if the problem is complications among people already diagnosed, tertiary work is the answer. Name the level, justify it from the analysis, and hold it through the whole proposal.
Can I adapt an evidence-based program?
Almost always you must, and the adaptation is worth writing about. Programs tested in urban clinics rarely transfer unchanged to rural churches, and changing the setting, the deliverer or the schedule is legitimate. What matters is saying what you changed, why the community required it, and which elements you preserved because the evidence suggests they carry the effect.
What if my program reaches only a small number?
Say so plainly and explain the choice. A program serving fifty people well is a legitimate proposal; the same program described as though it addressed the community's whole burden is not. State the reach, the proportion it represents, and what a scaled version would require. Honest sizing reads as competence rather than as modesty.
Where can I find a free NU 780 Unit 5 sample paper?
You can read the complete NU 780 Unit 5 mailed FIT proposal here at no cost, with evidence, adaptations, costs and projected reach. If you plan a different prevention program, a custom proposal can be built for your population.
Can I adapt an evidence-based program for my community in a nursing proposal?
Yes, and it is usually stronger than designing one from scratch. Keep the core components that produced the results and justify each change. This sample keeps mailed kits and reminders while adding Spanish-first materials and a follow-up navigator.