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Arevalo M, Sutton SK, Abdulla R, Christy SM, Meade CD, Roetzheim RG, Gwede CK. Longitudinal adherence to annual colorectal cancer screening among Black persons living in the United States enrolled in a community-based randomized trial. Cancer 2024; 130:1684-1692. [PMID: 38150285 PMCID: PMC11009071 DOI: 10.1002/cncr.35169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND This study examined repeat colorectal cancer screening rates at 12 and 24 months as part of a randomized intervention trial among Black persons living in the United States and factors associated with screening adherence. METHODS Participants completed a survey assessing demographics and Preventive Health Model (PHM) factors (e.g., self efficacy, susceptibility) and received either a culturally targeted photonovella plus free fecal immunochemical test (FIT) kits (intervention group) or a standard educational brochure plus free FIT kits (comparison group). FIT return was assessed at 6, 12, and 24 months. Descriptive statistics summarized patterns of repeat screening. Logistic regression models assessed FIT uptake overtime, and demographic and PHM factors associated with screening adherence. RESULTS Participants (N = 330) were U.S.-born (93%), non-Hispanic (97%), and male (52%). Initial FIT uptake within 6 months of enrollment was 86.6%, and subsequently dropped to 54.5% at 12 months and 36.6% at 24 months. Higher FIT return rates were observed for the brochure group at 24 months (51.5% vs 33.3% photonovella, p = .023). Multiple patterns of FIT kit return were observed: 37% completed FIT at all three time points (full adherence), 22% completed two of three (partial adherence), 29% completed one of three (partial adherence), and 12% did not return any FIT kits (complete nonadherence). Predictors of full adherence were higher levels of education and self-efficacy. CONCLUSIONS Full adherence to repeat screening was suboptimal. Most participants had partial adherence (one or two of three) to annual FIT screening. Future studies should focus on strategies to support repeat FIT screening.
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Affiliation(s)
- Mariana Arevalo
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Steven K. Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
| | - Rania Abdulla
- NTRO Non-Therapeutic Research Office, Moffitt Cancer Center, Tampa, FL, USA
| | - Shannon M. Christy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Cathy D. Meade
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Richard G. Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Clement K. Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Hornbuckle K, Williams A, Joseph JJ, Nolan TS, Gray DM, Gregory J, Ewing AP. Cardiovascular Health and Colorectal Cancer Screening in Black Men: A Cross-Sectional Analysis. Am J Mens Health 2024; 18:15579883241249642. [PMID: 38721788 PMCID: PMC11084979 DOI: 10.1177/15579883241249642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
African American/Black (henceforth Black) men face disproportionate risks of morbidity and mortality from both cardiovascular disease (CVD) and colorectal cancer (CRC). The American Heart Association's Life's Simple 7 (LS7) tool was designed to examine predictors of CVD with included behaviors also linked to CRC risk (i.e., smoking status, weight, diet, and physical activity). However, no studies have combined LS7 assessment alongside CRC screening history, which serves as a proxy for assessing CRC risk, in Black men. In this study, Black men aged 45-75 participating in annual community wellness events were screened for 6 of 7 LS7 measures (excluding diet, LS6) and self-reported CRC screening. Analyses conducted using R 4.0.5. revealed that Black men (N = 680), with an average age of 57.3 years (SD = 7.5), reported poor (39.7%), intermediate (34.6%), or ideal (25.7%) LS6 scores with higher scores corresponding to lower risk for CVD. However, for every 1-point increase in LS6 scores (0-6), there was a 26% lower odds of reported CRC screening (p = .001). In the fully adjusted model, men with 4+ ideal LS6 behaviors had a 60% lower odds of self-reported CRC screening compared to those with two ideal LS6 behaviors (p < .001). These findings underscore the need for culturally relevant interventions for Black men across all levels of cardiovascular health (CVH) to increase CRC screening uptake.
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Affiliation(s)
- Kasey Hornbuckle
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Amaris Williams
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joshua J. Joseph
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Timiya S. Nolan
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - John Gregory
- National African American Male Wellness Agency, National Center for Urban Solutions, Columbus, OH, USA
| | - Aldenise P. Ewing
- The Ohio State University College of Public Health, Division of Epidemiology, Columbus, OH, USA
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Gutstein L, Arevalo M, Reich RR, Fan W, Vadaparampil ST, Meade CD, Abdulla R, Lawrence E, Roetzheim RG, Lopez D, Collier A, Deak E, Ewing AP, Gwede CK, Christy SM. Factors associated with prior completion of colorectal cancer and hepatitis C virus screenings among community health center patients: a cross-sectional study to inform a multi-behavioral educational intervention. J Behav Med 2024; 47:295-307. [PMID: 38127175 DOI: 10.1007/s10865-023-00460-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/17/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) and liver cancer are two of the leading causes of cancer death in the United States and persistent disparities in CRC and liver cancer incidence and outcomes exist. Chronic hepatitis C virus (HCV) infection is one of the main contributors to liver cancer. Effective screening for both CRC and HCV exist and are recommended for individuals based upon age, regardless of gender or sex assigned at birth. Recommendations for both screening behaviors have been recently updated. However, screening rates for both CRC and HCV are suboptimal. Targeting adoption of multiple screening behaviors has the potential to reduce cancer mortality and disparities. OBJECTIVE To examine psychosocial factors associated with completion of CRC and HCV screenings in order to inform a multi-behavioral educational intervention that pairs CRC and HCV screening information. METHODS A cross-sectional survey was conducted with participants (N = 50) recruited at two community health centers in Florida (United States). Kruskal-Wallis and Fisher's exact tests were used to examine associations between completion of both CRC and HCV screening, CRC and HCV knowledge, Preventive Health Model constructs (e.g., salience and coherence, response efficacy, social influence), and sociodemographic variables. RESULTS Most participants were White (84%), female (56%), insured (80%), and reported a household income of $25,000 or less (53%). 30% reported ever previously completing both CRC and HCV screenings. Prior completion of both screening behaviors was associated with higher educational attainment (p = .014), having health insurance (p = .022), being U.S.-born (p = .043), and higher salience and coherence scores for CRC (p = .040) and HCV (p = .004). CONCLUSIONS Findings demonstrate limited uptake of both CRC and HCV screenings among adults born between 1945 and 1965. Uptake was associated with multiple sociodemographic factors and health beliefs related to salience and coherence. Salience and coherence are modifiable factors associated with completion of both screening tests, suggesting the importance of incorporating these health beliefs in a multi-behavioral cancer education intervention. Additionally, health providers could simultaneously recommend and order CRC and HCV screening to improve uptake among this age cohort.
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Affiliation(s)
- Lila Gutstein
- Morsani School of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | - Mariana Arevalo
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Richard R Reich
- Biostatistics and Bioinformatics Shared Resources, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Wenyi Fan
- Biostatistics and Bioinformatics Shared Resources, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Susan T Vadaparampil
- Morsani School of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Cathy D Meade
- Morsani School of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Rania Abdulla
- Non-Therapeutic Research Office, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Elizabeth Lawrence
- Turley Family Care Center, Baycare, 807 N. Myrtle Ave., Clearwater, FL, 33755, USA
| | - Richard G Roetzheim
- Morsani School of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | - Diana Lopez
- Suncoast Community Health Center, 313 S Lakewood Dr., Brandon, FL, 33511, USA
| | - Aaron Collier
- Formerly with Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Emalyn Deak
- Formerly with Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Aldenise P Ewing
- College of Public Health, The Ohio State University, 1841 Neil Ave., Building 293 Cunz Hall, Columbus, OH, 43210, USA
| | - Clement K Gwede
- Morsani School of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Shannon M Christy
- Morsani School of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612, USA.
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
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Gadd N, Lee S, Sharman MJ, Obamiro K. Educational interventions to improve bowel cancer awareness and screening in Organisation for Economic Co-operation and Development countries: A scoping review. Prev Med Rep 2024; 39:102653. [PMID: 38384964 PMCID: PMC10879007 DOI: 10.1016/j.pmedr.2024.102653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
Objectives Summarise theory informed educational interventions for improving bowel cancer awareness and screening. Methods A search was conducted in PubMed, EMBASE, Web of Science and CINAHL. English studies from 2016 to 2022 which implemented community-based bowel cancer awareness and/or screening education interventions for adults in Organisation for Economic Co-operation and Development countries were included. Results Sixty-two studies were included, 32 measured both screening and awareness (24 measured screening only, 6 measured awareness only). Education interventions were grouped and summarised in five education types: lay community health education/counselling (n = 28), education material (n = 5), health professional education/counselling (n = 10), mass media (n = 5) and other (n = 19). Other included education interventions which did not fit into the four types previously mentioned. Six studies tested more than one education type. Each type within these studies were reported/summarised separately within the appropriate education type. Lay educators resulted in improved awareness and screening. Brochures were effective education materials for screening and combined with lay educators resulted in increased awareness. State-wide mass media campaigns significantly improved screening uptake for up to 2-months post-campaign. Fear and loss-framed messaging improved screening intentions compared to humour or gain-based messaging. Decision aids had limited improvements in awareness. Facebook campaign and telephone counselling had limited improvements in screening. Conclusions Lay community health educators, brochures, and mass media campaigns occurring multiple times a year may be effective interventions in improving screening and/or awareness. Such approaches should be considered when developing community education. Education interventions should include multiple components suggested above to maximise improvements of awareness and screening.
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Affiliation(s)
- Nicola Gadd
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Simone Lee
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Matthew J Sharman
- School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Kehinde Obamiro
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
- Central Queensland Centre for Rural and Remote Health, James Cook University, Emerald, Queensland, Australia
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Belon AP, McKenzie E, Teare G, Nykiforuk CIJ, Nieuwendyk L, Kim MO, Lee B, Adhikari K. Effective strategies for Fecal Immunochemical Tests (FIT) programs to improve colorectal cancer screening uptake among populations with limited access to the healthcare system: a rapid review. BMC Health Serv Res 2024; 24:128. [PMID: 38263112 PMCID: PMC10807065 DOI: 10.1186/s12913-024-10573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the leading causes of cancer death globally. CRC screening can reduce the incidence and mortality of CRC. However, socially disadvantaged groups may disproportionately benefit less from screening programs due to their limited access to healthcare. This poor access to healthcare services is further aggravated by intersecting, cumulative social factors associated with their sociocultural background and living conditions. This rapid review systematically reviewed and synthesized evidence on the effectiveness of Fecal Immunochemical Test (FIT) programs in increasing CRC screening in populations who do not have a regular healthcare provider or who have limited healthcare system access. METHODS We used three databases: Ovid MEDLINE, Embase, and EBSCOhost CINAHL. We searched for systematic reviews, meta-analysis, and quantitative and mixed-methods studies focusing on effectiveness of FIT programs (request or receipt of FIT kit, completion rates of FIT screening, and participation rates in follow-up colonoscopy after FIT positive results). For evidence synthesis, deductive and inductive thematic analysis was conducted. The findings were also classified using the Cochrane Methods Equity PROGRESS-PLUS framework. The quality of the included studies was assessed. RESULTS Findings from the 25 included primary studies were organized into three intervention design-focused themes. Delivery of culturally-tailored programs (e.g., use of language and interpretive services) were effective in increasing CRC screening. Regarding the method of delivery for FIT, specific strategies combined with mail-out programs (e.g., motivational screening letter) or in-person delivery (e.g., demonstration of FIT specimen collection procedure) enhanced the success of FIT programs. The follow-up reminder theme (e.g., spaced out and live reminders) were generally effective. Additionally, we found evidence of the social determinants of health affecting FIT uptake (e.g., place of residence, race/ethnicity/culture/language, gender and/or sex). CONCLUSIONS Findings from this rapid review suggest multicomponent interventions combined with tailored strategies addressing the diverse, unique needs and priorities of the population with no regular healthcare provider or limited access to the healthcare system may be more effective in increasing FIT screening. Decision-makers and practitioners should consider equity and social factors when developing resources and coordinating efforts in the delivery and implementation of FIT screening strategies.
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Affiliation(s)
- Ana Paula Belon
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Emily McKenzie
- Provincial Population and Public Health, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Canada
- Health Evidence and Impact, Alberta Health Services, Calgary, Canada
| | - Gary Teare
- Provincial Population and Public Health, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Candace I J Nykiforuk
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Laura Nieuwendyk
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Minji Olivia Kim
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Bernice Lee
- Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Kamala Adhikari
- Provincial Population and Public Health, Alberta Health Services, Calgary, Canada.
- Department of Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Canada.
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Walker L, Burke S, McGeechan GJ. Understanding perceptions of the public and key stakeholders toward a localised cancer screening promotion campaign. PSYCHOL HEALTH MED 2024; 29:317-333. [PMID: 36907829 DOI: 10.1080/13548506.2023.2188230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
The aim of this study was to explore perceptions of members of the public and key stakeholders of a localised campaign to increase engagement with cervical cancer screening. Whilst numerous interventions have been trialled to increase engagement with cancer screening, the evidence for their effectiveness is somewhat mixed. In addition, few studies have explored the perceptions of members of the public targeted by such campaigns nor the perceptions of healthcare professionals who may be involved in delivering such campaigns in the United Kingdom. Members of the public who had potentially been exposed to the campaign in the North-East of England were approached to take part in individual interviews whilst stakeholders were invited to take part in a focus group. A total of 25 participants (13 members of the public, 12 stakeholders) took part. All interviews were audio recorded, transcribed verbatim and analysed using applied thematic analysis. Four themes were identified, two of which were cross-cutting (barriers to screening and factors promoting screening), with one theme identified as specific to the public interviews (knowledge of and attitudes toward awareness campaigns) and one theme specific to the focus group (keeping campaigns relevant. Awareness of the localised campaign was limited; however, when made aware, participants were mostly positive towards the approach, although mixed responses were noted in relation to financial incentives. Members of the public and stakeholders identified some common barriers to screening although differed in their perceptions of promotional factors. This study highlights the importance of multiple strategies to promote cervical screening as one size fits all approach may limit engagement.
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Affiliation(s)
- Lauren Walker
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
| | - Shani Burke
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
| | - Grant J McGeechan
- Centre for Applied Psychological Science, Teesside University, Middlesbrough, UK
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Cho HL, Perni S, D'Amico AV, Yamoah K, Dee EC. The imperative for clinical trial diversity: Perspectives in the context of prostate-specific membrane antigen-targeted imaging. Prostate Cancer Prostatic Dis 2023; 26:511-515. [PMID: 36872319 DOI: 10.1038/s41391-023-00657-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Affiliation(s)
| | - Subha Perni
- Departments of Radiation Oncology and Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | - Kosj Yamoah
- Department of Radiation Oncology, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Salimzadeh H, Sauvaget C, Delavari A, Sadeghi A, Amani M, Salimzadeh S, Karimi A, Ghanbari Motlagh A, Lucas E, Basu P, Malekzadeh R. Colorectal Cancer Screening Pilot Project in Tehran-Iran, a Feasibility Study. ARCHIVES OF IRANIAN MEDICINE 2023; 26:138-146. [PMID: 37543936 PMCID: PMC10685729 DOI: 10.34172/aim.2023.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/23/2022] [Indexed: 08/08/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common cancer in Iran, where there is no organised CRC-screening programme. This study aimed to evaluate feasibility of CRC screening using a qualitative fecal immunochemical test (FIT) among Iranian average-risk adults. METHODS In this feasibility study, 7039 individuals aged 50-75 years were invited by community health workers (CHWs) in southern Tehran and its suburban districts between April 2018 and November 2019. The CHWs performed a qualitative FIT with cut-off level 50 ng Hb/mL buffer and referred those with positive-FIT for colonoscopy to the endoscopy center of Shariati hospital in Tehran. Outcomes included acceptance rate, FIT positivity rate, colonoscopy compliance, detection rates and positive predictive values (PPVs) with 95% confidence interval for CRC and advanced adenomas (AAs). RESULTS Acceptance rate at initial invitation was 71.7%. From 4974 average-risk adults (1600 males and 3374 females) who were offered FIT, 96.8% (n=4813) provided valid samples, of whom 471 (9.8%) tested positive. Among FIT-positive participants, 150 (31.8%) underwent colonoscopy; CRC was detected in 2.0% (n=3) and adenomas in 27.3% (n=41). Detection rate of CRC and AAs per 1000-FIT-screened participants was 0.6 (0.1-1.8) [males: 0.7 (0.01-3.6), females: 0.6 (0.07-2.0)] and 4.2 (2.5-6.4) [males: 5.9 (2.6-11.0), females: 3.4 (1.7-6.0)], respectively. PPVs were 2.0% (0.4-5.7) for CRC and 13.3% (8.3-19.8) for AAs. There was no association between gender and the studied outcomes. CONCLUSION Our results partially support the feasibility of scaling up organized CRC-screening through the existing healthcare system in Iran; it remains to be discussed carefully to ensure the capacity of healthcare system for adequate colonoscopy services.
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Affiliation(s)
- Hamideh Salimzadeh
- Digestive Oncology Research Centre, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Östra, 416 85, Gothenburg, Sweden
| | - Catherine Sauvaget
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Alireza Delavari
- Digestive Oncology Research Centre, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Sadeghi
- Digestive Oncology Research Centre, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amani
- Digestive Oncology Research Centre, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Salimzadeh
- Digestive Oncology Research Centre, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azita Karimi
- Deputy of Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Eric Lucas
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France
| | - Reza Malekzadeh
- Digestive Oncology Research Centre, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Richardson-Parry A, Baas C, Donde S, Ferraiolo B, Karmo M, Maravic Z, Münter L, Ricci-Cabello I, Silva M, Tinianov S, Valderas JM, Woodruff S, van Vugt J. Interventions to reduce cancer screening inequities: the perspective and role of patients, advocacy groups, and empowerment organizations. Int J Equity Health 2023; 22:19. [PMID: 36707816 PMCID: PMC9880917 DOI: 10.1186/s12939-023-01841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Health inequities lead to low rates of cancer screening in certain populations, such as low-income and ethnic minority groups. Different interventions to address this have been developed with mixed results. However, interventions are not always developed in collaboration with the people they target. The aim of our article is to present the viewpoint of patients, survivors, advocates, and lay persons on interventions to increase cancer screening from a health inequity perspective. METHODS We prepared talking points to guide discussions between coauthors, who included representatives from nine patient and survivor advocacy groups, organizations working for citizen/patient empowerment, and health equity experts. Perspectives and opinions were first collected through video conferencing meetings and a first draft of the paper was prepared. All authors, read through, revised, and discussed the contents to reach an agreement on the final perspectives to be presented. RESULTS Several themes were identified: it is important to not view screening as a discrete event; barriers underlying an individual's access and willingness to undergo screening span across a continuum; individually tailored interventions are likely to be more effective than a one-size fits-all approach because they may better accommodate the person's personal beliefs, knowledge, behaviors, and preferences; targeting people who are unknown to medical services and largely unreachable is a major challenge; including professional patient advocacy groups and relevant lay persons in the cocreation of interventions at all stages of design, implementation, and evaluation is essential along with relevant stakeholders (healthcare professionals, researchers, local government and community organizations etc). CONCLUSIONS Interventions to address cancer screening inequity currently do not adequately solve the issue, especially from the viewpoint of patients, survivors, and lay persons. Several core pathways should be focused on when designing and implementing interventions: advancing individually tailored interventions; digital tools and social media; peer-based approaches; empowerment; addressing policy and system barriers; better design of interventions; and collaboration, including the involvement of patients and patient advocacy organizations.
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Affiliation(s)
- Afua Richardson-Parry
- Viatris Global Healthcare UK, Building 4, Trident Place, Mosquito Way, Hatfield, London, AL10 9UL UK
| | - Carole Baas
- grid.470316.7Alamo Breast Cancer Foundation, 909 Midland Creek Drive, Southlake, TX 76092 USA
| | - Shaantanu Donde
- Viatris Global Healthcare, Building 4, Trident Place, Mosquito Way, Hatfield, London, AL10 9UL UK
| | - Bianca Ferraiolo
- Cittadinanzattiva - Active Citizenship Network, Rue Philippe Le Bon 46, 1000 Brussels, Belgium
| | - Maimah Karmo
- grid.430731.2Tigerlily Foundation, 42020 Village Center Plaza, #120-156, Stone Ridge, 20105 USA
| | - Zorana Maravic
- Digestive Cancers Europe, Rue de la Loi 235/27, 1040 Brussels, Belgium
| | - Lars Münter
- Danish Committee for Health Education, Classensgade 71, 5, 2100 Copenhagen, Denmark
| | - Ignacio Ricci-Cabello
- grid.507085.fBalearic Islands Health Research Institute (IdISBa) and CIBER de Epidemiología y Salud Pública (CIBERESP), C/ Escola Graduada 3, 07002 Palma, Balearic Islands Spain
| | - Mitchell Silva
- Esperity, Clos Chapelle-aux-Champs 30, 1200 Brussels, Belgium
| | - Stacey Tinianov
- Advocates for Collaborative Education, 824 Windsor Street, Santa Cruz, CA 95062 USA
| | - Jose M. Valderas
- grid.4280.e0000 0001 2180 6431National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228 Singapore
| | | | - Joris van Vugt
- Viatris, Aalsterweg 172, 5644 RH Eindhoven, The Netherlands
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Christy SM, Sutton SK, Abdulla R, Boxtha C, Gonzalez P, Cousin L, Ewing A, Montoya S, Lopez D, Beehler T, Sanchez J, Carvajal R, Meade CD, Gwede CK. A multilevel, low literacy dual language intervention to promote colorectal cancer screening in community clinics in Florida: A randomized controlled trial. Prev Med 2022; 158:107021. [PMID: 35305995 PMCID: PMC9018599 DOI: 10.1016/j.ypmed.2022.107021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/28/2022] [Accepted: 03/13/2022] [Indexed: 01/27/2023]
Abstract
One of the largest disparities in cancer mortality in the United States occurs with colorectal cancer (CRC). The objectives of this multilevel two-arm intervention trial were to compare the efficacy of two interventions to promote CRC screening (CRCS) with fecal immunochemical test (FIT) and examine sociodemographic and psychosocial predictors of FIT screening. Individuals ages 50-75 (n = 326) who were not up-to-date with CRCS, could understand English or Spanish, and were at average CRC risk were recruited from two federally qualified health centers (FQHCs) in Florida. Prior to intervention, CRCS rates in the FQHCs were 27.1% and 32.9%, respectively. Study enrollment occurred April 2018-November 2019. System-level intervention components included leveraging electronic medical record (EMR) systems and delivering patient reminders. Participants were randomized to C-CARES (education+FIT) or C-CARES Plus (C-CARES+personalized coaching [for those not completing FIT within 90 days]). Primary outcome was completed FIT returned <1 year. Primary outcome analyses were performed using logistic regression. 225 participants completed FIT (69.0% [95% CI: 64.0-74.0%]), with no significant difference in FIT uptake by intervention arm (67.3% C-CARES Plus vs. 70.8% C-CARES; p = .49). FIT uptake was significantly higher among patients who received intervention materials in Spanish (77.2%) compared to those who received materials in English (63.2%, p < .01). The personalized coaching in the C-CARES Plus arm did not appear to provide added benefit beyond the C-CARES intervention. Multilevel approaches that include EMR prompts, reminders, FIT access, and provision of low-literacy, language-concordant education can support efforts to improved community clinics' CRCS rates. Future efforts should focus on repeat FIT screening. Trial registration: The trial was registered at ClinicalTrials.gov (NCT03906110).
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Affiliation(s)
- Shannon M Christy
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America.
| | - Steven K Sutton
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Rania Abdulla
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Carol Boxtha
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Paola Gonzalez
- Formerly with H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Lakeshia Cousin
- Formerly with H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; University of Florida, Gainesville, Florida, United States of America
| | - Aldenise Ewing
- Formerly with H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Ohio State University, Columbus, Ohio, United States of America
| | - Samantha Montoya
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Diana Lopez
- Suncoast Community Health Centers, Inc., Brandon, Florida, United States of America
| | - Tina Beehler
- Premier Community HealthCare Group, Inc., Dade City, Florida, United States of America
| | - Julian Sanchez
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Rodrigo Carvajal
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Cathy D Meade
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Clement K Gwede
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
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Chavarria EA, Christy SM, Feng H, Miao H, Abdulla R, Gutierrez L, Lopez D, Sanchez J, Gwede CK, Meade CD. Online health information seeking and eHealth literacy among Spanish language- dominant Latinos receiving care in a community clinic (Preprint). JMIR Form Res 2022; 6:e37687. [PMID: 35238785 PMCID: PMC9614617 DOI: 10.2196/37687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background eHealth literacy is the ability to seek, obtain, and decipher online health information (OHI) for health and disease management. Rapid developments in eHealth (eg, health care services and online information) place increased demands on patients to have high eHealth literacy levels. Yet, greater emphasis on eHealth may disproportionately affect groups with limited eHealth literacy. Cultural background, language, and eHealth literacy are influential considerations affecting health care and information access, health care use, and successful eHealth resource use, and they may influence OHI seeking for behavioral change toward cancer prevention. Objective This study aimed to characterize the extent of OHI seeking and eHealth literacy among Spanish-dominant (SD) Latino adults aged 50 to 75 years. Further, we aimed to examine potential associations between sociodemographic characteristics, Preventive Health Model (PHM) constructs, OHI-seeking behaviors, and eHealth literacy, separately. Methods Participants (N=76) self-identified as Latino, were enrolled in a colorectal cancer (CRC) screening intervention, were aged 50 to 75 years, were at average risk for CRC, were not up to date with CRC screening, and preferred receiving health information in Spanish. We describe participants’ sociodemographic characteristics, PHM constructs, OHI-seeking behaviors, and eHealth literacy—among those seeking OHI—assessed at enrollment. Descriptive analyses were first performed for all variables. Next, primary univariate logistic analyses explored possible associations with OHI seeking. Finally, using data from those seeking OHI, exploratory univariate analyses sought possible associations with eHealth literacy. Results A majority (51/76, 67%) of the participants were female, 62% (47/76) reported not having graduated high school, and 41% (31/76) reported being unemployed or having an annual income of less than US $10,000. Additionally, 75% (57/76) of the participants reported not having health insurance. In total, 71% (54/76) of the participants reported not having sought OHI for themselves or others. Univariate logistic regression suggested that higher educational attainment was significantly associated with an increased likelihood of having sought OHI (odds ratio 17.4, 95% CI 2.0-150.7; P=.009). Among those seeking OHI (22/76, 29%), 27% (6/22) were at risk of having low eHealth literacy based on an eHealth Literacy Scale score of less than 26. Among OHI seekers (22/76, 29%), an examination of associations found that higher eHealth literacy was associated with greater self-efficacy for screening with the fecal immunochemical test (β=1.20, 95% CI 0.14-2.26; P=.02). Conclusions Most SD Latino participants had not sought OHI for themselves or others (eg, family or friends), thus potentially limiting access to beneficial online resources. Preliminary findings convey that higher eHealth literacy occurs among those with higher self-efficacy for CRC screening. Findings inform areas of focus for future larger-scale investigations, including further exploration of reasons for not seeking OHI among SD Latino adults and an in-depth look at eHealth literacy and cancer screening behaviors. Trial Registration ClinicalTrials.gov NCT03078361; https://clinicaltrials.gov/ct2/show/NCT03078361
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Affiliation(s)
- Enmanuel A Chavarria
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Cancer Prevention and Control Research Program, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Shannon M Christy
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Han Feng
- School of Medicine, Tulane University, New Orleans, LA, United States
| | - Hongyu Miao
- College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Rania Abdulla
- Non-Therapeutic Research Office, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | | | - Diana Lopez
- Suncoast Community Health Centers, Brandon, FL, United States
| | - Julian Sanchez
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Clement K Gwede
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Cathy D Meade
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
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Shah SK, McElfish PA. A Review of Cancer Screening Recommendations during the COVID-19 Pandemic. JMIR Cancer 2022; 8:e34392. [PMID: 35142621 PMCID: PMC8914792 DOI: 10.2196/34392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cancer screening tests are recommended to prevent cancer-associated mortality by detecting precancerous and cancerous lesions in early stages. The COVID-19 pandemic disrupted the utilization of preventive health care services. While there was a rise in the number of cancer screening tests beginning in late 2020, screenings remained 29%-36% lower than in the pre-pandemic era. OBJECTIVE The objective of this review article was to assist health care providers in identifying approaches for prioritizing patients and increasing breast, cervical, and colorectal cancer screening during the uncertainty of the COVID-19 pandemic. METHODS We used the scoping review framework to identify articles on PubMed and EBSCO databases. A total of 403 articles were identified, and 23 articles were selected for this review. Literature review ranged from January 1st, 2020 to September 30th, 2021. RESULTS The articles included two primary categories of recommendations: (1) risk stratification and triage to prioritize screenings and (2) alternative methods to conduct cancer screenings. Risk stratification and triage recommendations focused on prioritizing high-risk patients with an abnormal or suspicious result on the previous screening test, of certain age group and sex, having personal medical or family history of cancers, currently symptomatic, predisposed to hereditary cancers, and cancer-causing mutations. Other recommended strategies included: identifying areas facing most disparities, creating algorithms and using artificial intelligence to create cancer-risk scores, leveraging in-person visits to assess cancer risk, and providing the option of open access screenings where patients can schedule screenings and can be assigned a priority category by health care staff. Some recommended using telemedicine to categorize patients and determine screening-eligibility for patients with new complaints. Several articles noted the importance of implementing preventive measures such as COVID-19 screening prior to the procedures, maintaining hygiene measures, and social distancing in waiting rooms. Alternative screening methods which do not require an in-person clinic visit and can effectively screen patients for cancers included mailing self-collection sampling kits for cervical and colorectal cancers and implementing or expanding mobile screening units. CONCLUSIONS Although the COVID-19 pandemic had devastating effects on population health globally, it could be an opportunity to adapt and evolve cancer screening methods. Disruption often creates innovation, and focus on alternative methods for cancer screenings may help reach rural and under-resourced areas after the pandemic has ended. CLINICALTRIAL
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Affiliation(s)
- Sumit K Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, US
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, US
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Abstract
BACKGROUND Cultural background, language, and literacy are factors that may affect access, healthcare utilization, and cancer screening behaviors. OBJECTIVE This study aimed to characterize health literacy among Spanish-preferring Hispanic/Latino individuals ages 50-75 and examine associations between sociodemographic characteristics, health beliefs, and health literacy. METHODS Participants self-identified as Hispanic/Latino, preferring health information in Spanish, were ages 50-75 years old, at average risk for colorectal cancer (CRC), not up to date with CRC screening, and enrolled in a CRC screening education intervention trial. Sociodemographic characteristics, health beliefs, and health literacy (i.e., difficulty understanding written health information and confidence completing health forms) were assessed at baseline. Descriptive and logistic regression analyses were performed. RESULTS Fifty-three percent of participants reported either sometimes having difficulty or always having difficulty with written health information, and 25% reported always asking for help or being not so confident in completing health forms. Univariate predictors of adequate health literacy for written health information were lower cancer worry and lower religious beliefs. Higher educational attainment predicted confidence in completing health forms. CONCLUSIONS Findings highlight the need for interventions that address health beliefs and health literacy among Hispanic/Latino patients who have low confidence in completing written forms and difficulty understanding written information and reinforce the use of plain language and salient design features when developing patient education materials.
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Roy S, Dickey S, Wang HL, Washington A, Polo R, Gwede CK, Luque JS. Systematic Review of Interventions to Increase Stool Blood Colorectal Cancer Screening in African Americans. J Community Health 2021; 46:232-244. [PMID: 32583358 PMCID: PMC7313439 DOI: 10.1007/s10900-020-00867-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
African Americans experience colorectal cancer (CRC) related disparities compared to other racial groups in the United States. African Americans are frequently diagnosed with CRC at a later stage, screening is underutilized, and mortality rates are highest in this group. This systematic review focused on intervention studies using stool blood CRC screening among African Americans in primary care and community settings. Given wide accessibility, low cost, and ease of dissemination of stool-based CRC screening tests, this review aims to determine effective interventions to improve participation rates. This systematic review included intervention studies published between January 1, 2000 and March 16, 2019. After reviewing an initial search of 650 studies, 11 studies were eventually included in this review. The included studies were studies conducted in community and clinical settings, using both inreach and outreach strategies to increase CRC screening. For each study, an unadjusted odds ratio (OR) for the CRC screening intervention compared to the control arm was calculated based on the data in each study to report effectiveness. The eleven studies together recruited a total of 3334 participants. The five studies using two-arm experimental designs ranged in effectiveness with ORs ranging from 1.1 to 13.0 using interventions such as mailed reminders, patient navigation, and tailored educational materials. Effective strategies to increase stool blood testing included mailed stool blood tests augmented by patient navigation, tailored educational materials, and follow-up calls or mailings to increase trust in the patient-provider relationship. More studies are needed on stool blood testing interventions to determine effectiveness in this population.
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Affiliation(s)
- Siddhartha Roy
- Department of Family and Community Medicine, Pennsylvania State University Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Cancer Control, Penn State Cancer Institute, Hershey, PA, USA
| | - Sabrina Dickey
- College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Hsiao-Lan Wang
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Alexandria Washington
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Randy Polo
- University Libraries, University of South Florida, Tampa, FL, USA
| | - Clement K Gwede
- Division of Population Sciences, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - John S Luque
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA.
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Chavarria EA, Christy SM, Simmons VN, Vadaparampil ST, Gwede CK, Meade CD. Learner Verification: A Methodology to Create Suitable Education Materials. Health Lit Res Pract 2021; 5:e49-e59. [PMID: 34251862 PMCID: PMC8075101 DOI: 10.3928/24748307-20210201-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Learner verification and revision (LV&R) is a research methodological approach to inform educational message design with the aim of producing suitable, actionable, and literacy appropriate messages to aid in awareness, adoption of healthy behaviors, and decision-making. It consists of a series of participatory steps that engage users throughout materials development, revision, and refinement. This approach is congruent with Healthy People 2030 communication objectives to improve access to information among diverse, multicultural, multilingual populations, and enhance health care quality toward health equity. Brief description of activity: To illustrate LV&R, we describe its use in three cancer education projects that produced targeted information about (1) inherited breast cancer among African Americans (brochure); (2) colorectal cancer screening among Latinos (photo novella and DVD); and (3) smoking-relapse prevention among patients receiving cancer treatment (video). We discuss rationale for its application in the three exemplars and extrapolate lessons learned from our experiences when using this approach. Implementation: A qualitative approach entailing individual or group-based discussions helped to examine the elements of learner verification (i.e., attraction, comprehension, self-efficacy, cultural acceptability, persuasion). The following steps are reported: (1) preparation of materials, interview guide, and recruitment; (2) interviewing of participants; and (3) evaluation of responses. Data were analyzed by use of a coding system that placed participant responses from each of the elements into data summary matrices. Findings informed revisions and refinement of materials. Results: LV&R was effectively applied across the three cancer education projects to enhance the suitability of the materials. As a result, the materials were improved by using clearer, more salient language to enhance comprehension and cultural acceptability, by integrating design elements such as prompts, headers, and stylistic edits to reduce text density, incorporating preferred colors and graphics to improve aesthetic appeal, and including actionable terms and words to bolster motivation and self-efficacy. Lessons learned: Results suggest that LV&R methodology can improve suitability of education materials through systematic, iterative steps that engage diverse, multicultural, multilingual populations. This approach is a critical participa-tory strategy toward health equity, and is appropriate in a variety of education, research, and clinical practice settings to improve health communications. [HLRP: Health Literacy Research and Practice. 2021;5(1):e49–e59.] Plain Language Summary: This article describes the use of a systematic approach called “learner verification” used for developing educational materials. This approach involves obtaining feedback from audience members to ensure that the information is understandable, attractive in design, motivating, and culturally relevant.
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Affiliation(s)
| | | | | | | | | | - Cathy D. Meade
- Address correspondence to Cathy D. Meade, PhD, RN, FAAN, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL 33612;
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Shah SK, Nakagawa M, Lieblong BJ. Examining aspects of successful community-based programs promoting cancer screening uptake to reduce cancer health disparity: A systematic review. Prev Med 2020; 141:106242. [PMID: 32882299 PMCID: PMC7704699 DOI: 10.1016/j.ypmed.2020.106242] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 01/27/2023]
Abstract
Certain minorities in the US are disproportionately burdened with higher cancer incidence and mortality rates. Programs encouraging timely uptake of cancer screening measures serve to reduce cancer health disparities. A systematic literature review was conducted to assess the effectiveness and the qualities of these programs, and to elucidate characteristics of success programs to aid in designing of future ones. We focused on community-based programs rather than clinic-based programs as the former are more likely to reach disadvantaged populations, and on prevention programs for breast, cervical, and/or colon cancers as longstanding screening recommendations for these cancers exist. PubMed, CINAHL and EBSCO databases were searched for articles that utilized community organizations and community health workers. Fourteen programs described in 34 manuscripts were identified. While 10 of 14 programs reported statistically significant increases in cancer prevention knowledge and/or increase in screening rates, only 7 of them enrolled large numbers of participants (defined as ≥1000). Only 7 programs had control groups, only 4 programs independently verified screening uptake, and 2 programs had long-term follow-up (defined as more than one screening cycle). Only one program demonstrated elimination of cancer health disparity at a population level. While most community-based cancer prevention programs have demonstrated efficacy in terms of increased knowledge and/or screening uptake, scalability and demonstration in reduction at a population level remain a challenge.
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Affiliation(s)
- Sumit K Shah
- University of Arkansas for Medical Sciences, College of Medicine, Department of Pathology, 4301 W. Markham St. Slot 845, Little Rock, AR 72205, United States of America
| | - Mayumi Nakagawa
- University of Arkansas for Medical Sciences, College of Medicine, Department of Pathology, 4301 W. Markham St. Slot 845, Little Rock, AR 72205, United States of America
| | - Benjamin J Lieblong
- University of Arkansas for Medical Sciences, College of Medicine, Department of Pathology, 4301 W. Markham St. Slot 845, Little Rock, AR 72205, United States of America.
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Rogers CR, Matthews P, Xu L, Boucher K, Riley C, Huntington M, Le Duc N, Okuyemi KS, Foster MJ. Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis. PLoS One 2020; 15:e0238354. [PMID: 32936812 PMCID: PMC7494124 DOI: 10.1371/journal.pone.0238354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND African-American men have the lowest 5-year survival rate in the U.S. for colorectal cancer (CRC) of any racial group, which may partly stem from low screening adherence. It is imperative to synthesize the literature evaluating the effectiveness of interventions on CRC screening uptake in this population. MATERIALS AND METHODS In this systematic review and meta-analysis, Medline, CINAHL, Embase, and Cochrane CENTRAL were searched for U.S.-based interventions that: were published after 1998-January 2020; included African-American men; and evaluated CRC screening uptake explicitly. Checklist by Cochrane Collaboration and Joanna Brigg were utilized to assess risk of bias, and meta-regression and sensitivity analyses were employed to identify the most effective interventions. RESULTS Our final sample comprised 41 studies with 2 focused exclusively on African-American men. The most frequently adopted interventions were educational materials (39%), stool-based screening kits (14%), and patient navigation (11%). Most randomized controlled trials failed to provide details about the blinding of the participant recruitment method, allocation concealment method, and/or the outcome assessment. Due to high heterogeneity, meta-analysis was conducted among 17 eligible studies. Interventions utilizing stool-based kits or patient navigation were most effective at increasing CRC screening completion, with odds ratios of 9.60 (95% CI 2.89-31.82, p = 0.0002) and 2.84 (95% CI 1.23-6.49, p = 0.01). No evidence of publication bias was present for this study registered with the International Prospective Registry of Systematic Reviews (PROSPERO 2019 CRD42019119510). CONCLUSIONS Additional research is warranted to uncover effective, affordable interventions focused on increasing CRC screening completion among African-American men. When designing and implementing future multicomponent interventions, employing 4 or fewer interventions types may reduce bias risk. Since only 5% of the interventions solely focused on African-American men, future theory-driven interventions should consider recruiting samples comprised solely of this population.
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Affiliation(s)
- Charles R. Rogers
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Phung Matthews
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Lei Xu
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States of America
| | - Kenneth Boucher
- Cancer Biostatistics Shared Resource, Huntsman Cancer Institute, Salt Lake City, UT, United States of America
| | - Colin Riley
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Matthew Huntington
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Nathan Le Duc
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Kola S. Okuyemi
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Margaret J. Foster
- Medical Sciences Library, Texas A&M University, College Station, TX, United States of America
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Peer Support as an Ideal Solution for Racial/Ethnic Disparities in Colorectal Cancer Screening: Evidence from a Systematic Review and Meta-analysis. Dis Colon Rectum 2020; 63:850-858. [PMID: 32167969 DOI: 10.1097/dcr.0000000000001611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Low implementation of colorectal cancer screening in ethnic minorities is the main reason for racial and ethnic disparities in colorectal cancer morbidity and mortality. Peer support is widely used for promoting health care in ethnic minorities. However, whether it improves their acceptance to undergo the screening remains controversial. OBJECTIVE We performed a meta-analysis of the currently available studies to further explore its effectiveness. DATA SOURCES This meta-analysis was undertaken using PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for randomized controlled trials. STUDY SELECTION We included studies that compared peer support interventions among ethnic minorities versus other interventions to promote uptake of colorectal cancer screening. RESULTS Thirteen studies comprising 8090 participants met the eligibility criteria. Peer support intervention can increase colorectal cancer screening implementation and raise awareness and intention to undergo the screening in ethnic minorities more significantly than fecal occult blood test outreach, print, and usual care. Subgroup analysis showed that peer support intervention achieved great results in Asian Americans and intervention of peer counseling. LIMITATIONS The results of subgroup analysis had substantial heterogeneity, which may decrease the precision of our estimates. CONCLUSIONS Peer support can significantly improve the awareness about and the intention for receiving colorectal cancer screening in ethnic minorities and is an ideal choice for promoting the screening among ethnic minorities, particularly in a diverse community. Peer support intervention is recommended to promote the implementation of screening in Asian Americans. Peer counseling is worth promoting; however, church-based peer counseling programs require enhanced management to maintain their fidelity.
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Davis SN, Wischhusen JW, Sutton SK, Christy SM, Chavarria EA, Sutter ME, Roy S, Meade CD, Gwede CK. Demographic and psychosocial factors associated with limited health literacy in a community-based sample of older Black Americans. PATIENT EDUCATION AND COUNSELING 2020; 103:385-391. [PMID: 31466881 PMCID: PMC7012696 DOI: 10.1016/j.pec.2019.08.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/15/2019] [Accepted: 08/17/2019] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Individuals with limited health literacy often experience suboptimal health outcomes. This study examined the frequency of limited health literacy and demographic and psychosocial factors associated with limited health literacy in a sample of older Black Americans. METHODS Participants (n = 330) enrolled in a community-based intervention to promote colorectal cancer (CRC) screening completed baseline surveys assessing health literacy with the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) test, CRC awareness, cancer fatalism, Preventive Health Model (PHM) constructs, and demographics. RESULTS Approximately 52% of participants had limited health literacy, the REALM-R score was 5.4 (SD = 2.7). Univariable correlates of limited health literacy were gender, employment, income, prior screening, cancer fatalism, CRC awareness, and PHM constructs (religious beliefs, salience/coherence, perceived susceptibility). Multivariable correlates of limited health literacy were male gender (OR = 2.3, CI = 1.4-3.8), unable to work (OR = 2.8, CI = 1.3-6.1), lower household income (OR = 3.0, CI = 1.6, 5.5), and higher PHM religious beliefs (OR = 1.1, CI = 1.0-1.2). CONCLUSION Limited health literacy was associated with multiple complex factors. Interventions should incorporate patient health literacy and low-literacy materials that can be delivered through multiple channels. PRACTICE IMPLICATIONS Future studies are needed to understand the role of health literacy in an individual's health behavior and the provision of effective healthcare.
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Affiliation(s)
- Stacy N Davis
- Health Behavior, Society and Policy, Rutgers the State University of New Jersey, New Brunswick, USA; Formally affiliated with Moffitt Cancer Center, Tampa, USA.
| | - Jonathan W Wischhusen
- Formally affiliated with Moffitt Cancer Center, Tampa, USA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Steven K Sutton
- Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, USA; Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Shannon M Christy
- Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, USA; Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Enmanuel A Chavarria
- Formally affiliated with Moffitt Cancer Center, Tampa, USA; School of Public Health, University of Texas Health Science Center at Houston, Brownsville USA
| | - Megan E Sutter
- Formally affiliated with Moffitt Cancer Center, Tampa, USA; Department of Population Health, New York University, New York City, USA
| | - Siddhartha Roy
- Formally affiliated with Moffitt Cancer Center, Tampa, USA; Family and Community Medicine, Penn State College of Medicine, Hershey, USA
| | - Cathy D Meade
- Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, USA; Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Clement K Gwede
- Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, USA; Morsani College of Medicine, University of South Florida, Tampa, USA
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Individual and Geospatial Characteristics Associated With Use and Nonuse of the Fecal Immunochemical Test (FIT) for Colorectal Cancer Screening in an Urban Minority Population. J Clin Gastroenterol 2019; 53:744-749. [PMID: 30222644 DOI: 10.1097/mcg.0000000000001132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Initiatives by the Centers for Disease Control and Prevention as well as the National Colorectal Cancer Roundtable aim to increase the rate of colorectal cancer (CRC) screening. We assess individual and geographic characteristics associated fecal immunochemical test (FIT) CRC screening over 3 years. METHODS This is a retrospective study of 1500 FIT kits which were mailed or opportunistically handed to eligible participants in Brooklyn, New York from January 2014 to December 2016. Eligibility criteria included increased risk for colon cancer, uninsured or underinsured, and a minimum age of 50 years to warrant CRC screening. We looked at the association of individual demographic characteristics and FIT screening by logistic regression using SPPS version 23 software. In addition, using ArcGIS, we coded patients address and layered census tract population information to find associations. RESULTS In total, 1367 Cancer Services Participants met our study criteria. The study sample was predominantly female (95.2%) and minority (46% African American, 24.7% Hispanic, 17.3% Caucasian, 11.4% Asian) and on average 59 years old (SD, 5.7). A large majority (73%) had household incomes below $20,000/year. Approximately half (49.9%) of all Cancer Services Participants returned their FIT kit. In participants who did not return their FIT kit, the majority were African American (41%), followed by Hispanics (26.5%), Caucasians (20.6%), and Asians (11.8%). Multivariable logistic regression showed that a screening history of prior colonoscopy or FIT, gender, ethnicity, and educational attainment were significantly associated with FIT CRC screening uptake (P<0.05). Geospatial mapping showed clusters of low screening uptake in areas of high poverty. Hot-spot analysis identified areas of significant vulnerability. CONCLUSIONS FIT uptake remains suboptimal. Individual predictors as well as area poverty is associated with low screening uptake. Geospatial mapping is an effective tool for evaluating CRC screening uptake.
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Gwede CK, Sutton SK, Chavarria EA, Gutierrez L, Abdulla R, Christy SM, Lopez D, Sanchez J, Meade CD. A culturally and linguistically salient pilot intervention to promote colorectal cancer screening among Latinos receiving care in a Federally Qualified Health Center. HEALTH EDUCATION RESEARCH 2019; 34:310-320. [PMID: 30929015 PMCID: PMC7868960 DOI: 10.1093/her/cyz010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/24/2019] [Indexed: 06/09/2023]
Abstract
Despite established benefits, colorectal cancer (CRC) screening is underutilized among Latinos/Hispanics. We conducted a pilot 2-arm randomized controlled trial evaluating efficacy of two intervention conditions on CRC screening uptake among Latinos receiving care in community clinics. Participants (N = 76) were aged 50-75, most were foreign-born, preferred to receive their health information in Spanish, and not up-to-date with CRC screening. Participants were randomized to either a culturally linguistically targeted Spanish-language fotonovela booklet and DVD intervention plus fecal immunochemical test [FIT] (the LCARES, Latinos Colorectal Cancer Awareness, Research, Education and Screening intervention group); or a non-targeted intervention that included a standard Spanish-language booklet plus FIT (comparison group). Measures assessed socio-demographic variables, health literacy, CRC screening behavior, awareness and beliefs. Overall, FIT uptake was 87%, exceeding the National Colorectal Cancer Roundtable's goal of 80% by 2018. The LCARES intervention group had higher FIT uptake than did the comparison group (90% versus 83%), albeit not statistically significant (P = 0.379). The LCARES intervention group was associated with greater increases in CRC awareness (P = 0.046) and susceptibility (P = 0.013). In contrast, cancer worry increased more in the comparison group (P = 0.045). Providing educational materials and a FIT kit to Spanish-language preferring Latinos receiving care in community clinics is a promising strategy to bolster CRC screening uptake to meet national targets.
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Affiliation(s)
- Clement K Gwede
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Steven K Sutton
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Enmanuel A Chavarria
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Brownsville Regional Campus, Brownsville, TX, USA
| | - Liliana Gutierrez
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Rania Abdulla
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Shannon M Christy
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Diana Lopez
- Suncoast Community Health Centers, Inc., Brandon, FL, USA
| | - Julian Sanchez
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Cathy D Meade
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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22
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Christy SM, Sutton SK, Gwede CK, Chavarria EA, Davis SN, Abdulla R, Schultz I, Roetzheim R, Shibata D, Meade CD. Examining the Durability of Colorectal Cancer Screening Awareness and Health Beliefs Among Medically Underserved Patients: Baseline to 12 months Post-Intervention. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:297-303. [PMID: 29177920 PMCID: PMC6873805 DOI: 10.1007/s13187-017-1301-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The current study examines changes in awareness and health beliefs from baseline to 12 months post-intervention following receipt of one of two colorectal cancer (CRC) educational interventions that aimed to promote CRC screening among a racially and ethnically diverse and medically underserved population. Participants (N = 270) were enrolled in a randomized controlled trial to increase CRC screening and completed both baseline and 12-month follow-up assessments. Participants were aged 50-75, at average CRC risk, not up-to-date with CRC screening guidelines, and receiving care at one of three community-based clinics. Participants were randomized to receive either a targeted, low-literacy intervention informed by the Preventive Health Model [PHM] (photonovella and DVD plus fecal immunochemical test [FIT]) or a non-targeted intervention (standard educational brochure plus FIT). Changes in CRC awareness and health beliefs from baseline to 12 months were examined both within and between intervention groups using Student's t tests. Participants in both intervention conditions demonstrated an increase in CRC awareness, PHM social influence, and trust in the healthcare system (all p's < .0001), with no significant between-group differences. Among those receiving the targeted intervention, there also was an increase in PHM salience (p < .05). Among individuals receiving the non-targeted intervention, there was an increase in PHM response efficacy (p < .01) and PHM self-efficacy (p < .0001). Both CRC screening interventions promoted positive changes in awareness and several health beliefs from baseline to 12 months, suggesting important benefits of CRC education. Regardless of whether education was targeted or non-targeted, providing CRC screening education successfully promoted durable changes in awareness and health beliefs.
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Affiliation(s)
- Shannon M Christy
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Steven K Sutton
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Clement K Gwede
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Enmanuel A Chavarria
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX, USA
| | - Stacy N Davis
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- Department of Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Rania Abdulla
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
| | - Ida Schultz
- Premier Community HealthCare Group, Inc., Dade City, FL, USA
| | - Richard Roetzheim
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - David Shibata
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cathy D Meade
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA.
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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Recruitment Techniques and Strategies in a Community-Based Colorectal Cancer Screening Study of Men and Women of African Ancestry. Nurs Res 2019; 67:212-221. [PMID: 29698327 DOI: 10.1097/nnr.0000000000000274] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Recruiting ethnically diverse Black participants to an innovative, community-based research study to reduce colorectal cancer screening disparities requires multipronged recruitment techniques. OBJECTIVES This article describes active, passive, and snowball recruitment techniques, and challenges and lessons learned in recruiting a diverse sample of Black participants. METHODS For each of the three recruitment techniques, data were collected on strategies, enrollment efficiency (participants enrolled/participants evaluated), and reasons for ineligibility. RESULTS Five hundred sixty individuals were evaluated, and 330 individuals were enrolled. Active recruitment yielded the highest number of enrolled participants, followed by passive and snowball. Snowball recruitment was the most efficient technique, with enrollment efficiency of 72.4%, followed by passive (58.1%) and active (55.7%) techniques. There were significant differences in gender, education, country of origin, health insurance, and having a regular physician by recruitment technique (p < .05). DISCUSSION Multipronged recruitment techniques should be employed to increase reach, diversity, and study participation rates among Blacks. Although each recruitment technique had a variable enrollment efficiency, the use of multipronged recruitment techniques can lead to successful enrollment of diverse Blacks into cancer prevention and control interventions.
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24
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Kwaan MR, Jones-Webb R. Colorectal Cancer Screening in Black Men: Recommendations for Best Practices. Am J Prev Med 2018; 55:S95-S102. [PMID: 30670207 DOI: 10.1016/j.amepre.2018.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/30/2018] [Accepted: 05/08/2018] [Indexed: 12/28/2022]
Abstract
Screening for colorectal cancer has been demonstrated to reduce colorectal cancer mortality. Blacks have a higher mortality from this malignancy, particularly men, yet screening rates in this population are often found to be lower than in whites. A modest literature demonstrates effective interventions that can increase screening rates in blacks; however, results are not consistent and ongoing work is required. Most work has not addressed specific barriers to screening in black men. Given the lack of studies on black men only, this study evaluated the state of research in the black population using a PubMed search. The authors provide commentary that proposes increased (1) state and local government support for collaborative programs with healthcare organizations, including patient navigation; (2) augmented community-organizing efforts to generate more attention to the need for colorectal cancer screening in the black community, with a focus on black men; and (3) federal research funding to promote investigation into new interventions and evaluation of existing ones. Specific recommendations for black men include lowering the screening age to 45years, increasing access to health care, the use of patient navigators, and improved reporting and monitoring of colorectal cancer screening rates. SUPPLEMENT INFORMATION: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
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Affiliation(s)
- Mary R Kwaan
- Department of Surgery, University California, Los Angeles, Los Angeles, California.
| | - Rhonda Jones-Webb
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
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25
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Bakhai S, Ahluwalia G, Nallapeta N, Mangat A, Reynolds JL. Faecal immunochemical testing implementation to increase colorectal cancer screening in primary care. BMJ Open Qual 2018; 7:e000400. [PMID: 30397662 PMCID: PMC6203033 DOI: 10.1136/bmjoq-2018-000400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/14/2018] [Accepted: 09/22/2018] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer death in USA, and CRC screening remains suboptimal. The aim of this quality improvement was to increase CRC screening in the internal medicine clinic (IMC) patients, between the ages of 50–75 years, from a baseline rate of 50%–70% over 12 months with the introduction of faecal immunochemical test (FIT) testing. We used the Plan–Do–Study–Act (PDSA) method and performed a root cause analysis to identify barriers to acceptance of CRC screening. The quality improvement team created a driver diagram to identify and prioritise change ideas. We developed a process flow map to optimise opportunities to improve CRC screening. We performed eight PDSA cycles. The major components of interventions included: (1) leveraging health information technology; (2) optimising team work, (3) education to patient, physicians and IMC staff, (4) use of patient navigator for tracking FIT completion and (5) interactive workshops for the staff and physicians to learn motivational interview techniques. The outcome measure included CRC screening rates with either FIT or colonoscopy. The process measures included FIT order and completion rates. Data were analysed using a statistical process control and run charts. Four hundred and seven patients visiting the IMC were offered FIT, and 252 (62%) completed the test. Twenty-two (8.7%) of patients were FIT positive, 14 of those (63.6%) underwent a subsequent diagnostic colonoscopy. We achieved 75% CRC screening with FIT or colonoscopy within 12 months and exceeded our goal. Successful strategies included engaging the leadership, the front-line staff and a highly effective multidisciplinary team. For average-risk patients, FIT was the preferred method of screening. We were able to sustain a CRC screening rate of 75% during the 6-month postproject period. Sustainable annual FIT is required for successful CRC screening.
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Affiliation(s)
- Smita Bakhai
- Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Gaurav Ahluwalia
- Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Naren Nallapeta
- Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Amanpreet Mangat
- Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jessica L Reynolds
- Department of Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA
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26
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Hassan C, Kaminski MF, Repici A. How to Ensure Patient Adherence to Colorectal Cancer Screening and Surveillance in Your Practice. Gastroenterology 2018; 155:252-257. [PMID: 29964039 DOI: 10.1053/j.gastro.2018.06.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
| | - Michal F Kaminski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland
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27
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Understanding Cancer Worry Among Patients in a Community Clinic-Based Colorectal Cancer Screening Intervention Study. Nurs Res 2018; 67:275-285. [PMID: 29870517 DOI: 10.1097/nnr.0000000000000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To reduce colorectal cancer (CRC) screening disparities, it is important to understand correlates of different types of cancer worry among ethnically diverse individuals. OBJECTIVES The current study examined the prevalence of three types of cancer worry (i.e., general cancer worry, CRC-specific worry, and worry about CRC test results) as well as sociodemographic and health-related predictors for each type of cancer worry. METHODS Participants were aged 50-75, at average CRC risk, nonadherent to CRC screening guidelines, and enrolled in a randomized controlled trial to increase CRC screening. Participants completed a baseline questionnaire assessing sociodemographics, health beliefs, healthcare experiences, and three cancer worry measures. Associations between study variables were examined with separate univariate and multivariable logistic regression models. RESULTS Responses from a total of 416 participants were used. Of these, 47% reported experiencing moderate-to-high levels of general cancer worry. Predictors of general cancer worry were salience and coherence (aOR = 1.1, 95% CI [1.0, 1.3]), perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3), and social influence (aOR = 1.1, 95% CI [1.0, 0.1]). Fewer (23%) reported moderate-to-high levels of CRC-specific worry or CRC test worry (35%). Predictors of CRC worry were perceived susceptibility (aOR = 1.4, 95% CI [1.3, 1.6]) and social influence (aOR = 1.1, 95% CI [1.0, 1.2]); predictors of CRC test result worry were perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3) and marital status (aOR = 2.0, 95% CI [1.1, 3.7] for married/partnered vs. single and aOR = 2.3, 95% CI [1.3, 4.1] for divorced/widowed vs. single). DISCUSSION Perceived susceptibility consistently predicted the three types of cancer worry, whereas other predictors varied between cancer worry types and in magnitude of association. The three types of cancer worry were generally predicted by health beliefs, suggesting potential malleability. Future research should include multiple measures of cancer worry and clear definitions of how cancer worry is measured.
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28
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Ramai D, Etienne D, Reddy M. Does mistrust still linger? A bioethical perspective on colorectal cancer screening. Int J Colorectal Dis 2018; 33:657-658. [PMID: 29556756 DOI: 10.1007/s00384-018-3029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Daryl Ramai
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, 121 Dekalb Avenue, Brooklyn, NY, 11201, USA.
| | - Denzil Etienne
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, 121 Dekalb Avenue, Brooklyn, NY, 11201, USA
| | - Madhavi Reddy
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, 121 Dekalb Avenue, Brooklyn, NY, 11201, USA
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29
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de Klerk CM, Gupta S, Dekker E, Essink-Bot ML. Socioeconomic and ethnic inequities within organised colorectal cancer screening programmes worldwide. Gut 2018; 67:679-687. [PMID: 28073892 DOI: 10.1136/gutjnl-2016-313311] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/14/2016] [Accepted: 12/18/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Colorectal cancer (CRC) screening programmes can reduce CRC mortality. However, the implementation of a screening programme may create or exacerbate socioeconomic and ethnic health inequities if participation varies by subgroup. We determined which organised programmes characterise participation inequities by socioeconomic and ethnic subgroups, and assessed the variation in subgroup participation among programmes collecting group-specific data. DESIGN Employing a literature review and survey among leaders of national or regional screening programmes, this study identified published and unpublished data on participation by socioeconomic status and ethnicity. We assessed programmes offering faecal occult blood tests (FOBT) for screening. Primary outcome was screening participation rate. RESULTS Across 24 organised FOBT-screening programmes meeting the inclusion criteria, participation rates ranged from 21% to 73%. Most programmes (13/24, 54%) did not collect data on participation by socioeconomic status and ethnicity. Among the 11 programmes with data on participation by socioeconomic status, 90% (28/31 publications) reported lower participation among lower socioeconomic groups. Differences across socioeconomic gradients were moderate (66% vs 71%) to severe (35% vs 61%). Only six programmes reported participation results by ethnicity. Ethnic differences were moderate, though only limited data were available for evaluation. CONCLUSIONS Across organised CRC screening programmes worldwide, variation in participation by socioeconomic status and ethnicity is often not assessed. However, when measured, marked disparities in participation by socioeconomic status have been observed. Limited data were available to assess inequities by ethnicity. To avoid exacerbating health inequities, screening programmes should systematically monitor participation by socioeconomic status and ethnicity, and investigate and address determinants of low participation.
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Affiliation(s)
- C M de Klerk
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Gupta
- Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, San Diego, California, USA
| | - E Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M L Essink-Bot
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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30
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Christy SM, Gwede CK, Sutton SK, Chavarria E, Davis SN, Abdulla R, Ravindra C, Schultz I, Roetzheim R, Meade CD. Health Literacy among Medically Underserved: The Role of Demographic Factors, Social Influence, and Religious Beliefs. JOURNAL OF HEALTH COMMUNICATION 2017; 22:923-931. [PMID: 29125435 PMCID: PMC6278594 DOI: 10.1080/10810730.2017.1377322] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The current study examined the sociodemographic and psychosocial variables that predicted being at risk for low health literacy among a population of racially and ethnically diverse patients accessing primary care services at community-based clinics. Participants (N = 416) were aged 50-75 years, currently not up-to-date with colorectal cancer (CRC) screening, at average CRC risk, and enrolled in a randomized controlled trial (RCT) aimed at promoting CRC screening. Participants completed a baseline interview that assessed health literacy as measured by Rapid Estimate of Adult Literacy in Medicine-Revised, sociodemographic factors, and psychosocial variables (e.g., health beliefs) prior to randomization and receipt of an intervention. Thirty-six percent of the participants were found to be at risk for low health literacy. Sociodemographic and psychosocial variables were assessed as predictors of being at risk for low health literacy using logistic regression. In the final model, predictors were male gender, being from a racial/ethnic minority group, being unable to work, having higher social influence scores, and having higher religious belief scores. These findings suggest several patient characteristics that may be associated with low health literacy, and highlight the importance of supporting all patients through simplified and clear communications and information to improve understanding of CRC screening information.
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Affiliation(s)
- Shannon M. Christy
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Clement K. Gwede
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Steven K. Sutton
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Enmanuel Chavarria
- University of Texas Health Science Center at Houston, School of Public Health, Department of Health Promotion and Behavioral Sciences, Brownsville, Texas, USA
| | - Stacy N. Davis
- Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Rania Abdulla
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Chitra Ravindra
- Florida Department of Health Pinellas County, St. Petersburg, Florida, USA
| | - Ida Schultz
- Premier Community HealthCare Group, Inc., Dade City, Florida, USA
| | - Richard Roetzheim
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Cathy D. Meade
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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31
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Davis SN, Christy SM, Chavarria EA, Abdulla R, Sutton SK, Schmidt AR, Vadaparampil ST, Quinn GP, Simmons VN, Ufondu CB, Ravindra C, Schultz I, Roetzheim RG, Shibata D, Meade CD, Gwede CK. A randomized controlled trial of a multicomponent, targeted, low-literacy educational intervention compared with a nontargeted intervention to boost colorectal cancer screening with fecal immunochemical testing in community clinics. Cancer 2016; 123:1390-1400. [PMID: 27906448 DOI: 10.1002/cncr.30481] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The objective of the current study was to improve colorectal cancer (CRC) screening uptake with the fecal immunochemical test (FIT). The current study investigated the differential impact of a multicomponent, targeted, low-literacy educational intervention compared with a standard, nontargeted educational intervention. METHODS Patients aged 50 to 75 years who were of average CRC risk and not up-to-date with CRC screening were recruited from either a federally qualified health center or a primary care community health clinic. Patients were randomized to the intervention condition (targeted photonovella booklet/DVD plus FIT kit) or comparison condition (standard Centers for Disease Control and Prevention brochure plus FIT kit). The main outcome was screening with FIT within 180 days of delivery of the intervention. RESULTS Of the 416 participants, 54% were female; the participants were racially and ethnically diverse (66% white, 10% Hispanic, and 28% African American), predominantly of low income, and insured (the majority had county health insurance). Overall, the FIT completion rate was 81%, with 78.1% of participants in the intervention versus 83.5% of those in the comparison condition completing FIT (P = .17). In multivariate analysis, having health insurance was found to be the primary factor predicting a lack of FIT screening (adjusted odds ratio, 2.10; 95% confidence interval, 1.04-4.26 [P = .04]). CONCLUSIONS The multicomponent, targeted, low-literacy materials were not found to be significantly different or more effective in increasing FIT uptake compared with the nontargeted materials. Provision of a FIT test plus education may provide a key impetus to improve the completion of CRC screening. The type of educational material (targeted vs nontargeted) may matter less. The findings of the current study provide a unique opportunity for clinics to adopt FIT and to choose the type of patient education materials based on clinic, provider, and patient preferences. Cancer 2017;123:1390-1400. © 2016 American Cancer Society.
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Affiliation(s)
- Stacy N Davis
- Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, New Jersey.,Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Shannon M Christy
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Enmanuel A Chavarria
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Rania Abdulla
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Steven K Sutton
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Alyssa R Schmidt
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Susan T Vadaparampil
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Gwendolyn P Quinn
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Vani N Simmons
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | | | - Ida Schultz
- Premier Community HealthCare Group Inc, Dade City, Florida
| | - Richard G Roetzheim
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - David Shibata
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Cathy D Meade
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Clement K Gwede
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
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