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Ma GX, Zhu L, Tan Y, Do P, Guerrier G, Wang MQ, Nguyen M, Tran T, Pham P. Multilevel and multicomponent intervention to promote colorectal cancer screening among underserved Vietnamese Americans: A cluster randomized trial. RESEARCH SQUARE 2024:rs.3.rs-3934937. [PMID: 38405822 PMCID: PMC10889079 DOI: 10.21203/rs.3.rs-3934937/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Purpose The fecal immunochemical test (FIT) is a non-invasive method for colorectal cancer (CRC) screening, particularly effective in underserved Vietnamese American communities with low screening rates. This study reports on a culturally tailored multilevel intervention, incorporating FIT, aimed at increasing CRC screening among these populations aged 50 or above in the Greater Philadelphia metropolitan area. Methods From 2017 to 2020, we conducted a two-arm cluster randomized controlled trial to test the efficacy of a culturally tailored, multicomponent multilevel intervention aimed at increasing CRC screening uptake via enhanced self-awareness and self-efficacy, improved access to care, and changes in social norms and removal of stigma. The intervention group received multicomponent, multilevel CRC intervention including provision of a FIT self-sampling kit, with intervention approaches informed by the Centers for Disease Control's Clinical Preventive Services (CPS) Guidelines for adults 50+. The control group received only the CPS education. Results The study sample consisted of 746 eligible Vietnamese American participants recruited from 20 community-based organizations, with 95% having limited English proficiency. At 12-month follow-up, the intervention group showed substantially higher rates of FIT completion (89.56% vs. 7.59%, p < .001) and any CRC testing (91.48% vs. 42.41%, p < .001) compared to the control group. Conclusion The results suggest that the community-based, culturally-tailored multilevel intervention, which incorporates with FIT self-testing, effectively enhances CRC screening among low-income Vietnamese Americans. Additionally, these results underscore the significance of community-oriented strategies, like collaborating with relevant community-based organizations, in achieving CRC screening targets.
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Affiliation(s)
- Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Phuong Do
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Guercie Guerrier
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Min Qi Wang
- University of Maryland School of Public Health, College Park, MD
| | - Minhhuyen Nguyen
- Department of Medicine, Section of Gastroenterology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Tam Tran
- Asian American Buddhist Association, Philadelphia, PA
| | - Philip Pham
- Vietnamese International Baptist Church of Philadelphia, Philadelphia, PA
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2
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Crespi CM, Ziehl K. Cluster-randomized trials of cancer screening interventions: Has use of appropriate statistical methods increased over time? Contemp Clin Trials 2022; 123:106974. [PMID: 36343881 DOI: 10.1016/j.cct.2022.106974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/30/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In a cluster randomized trial, groups of individuals (e.g., clinics, schools) are randomized to conditions. The design and analysis of cluster randomized trials can require more care than individually randomized trials. Past reviews have noted deficiencies in the use of appropriate statistical methods for such trials. METHODS We reviewed cluster randomized trials of cancer screening interventions published 1995-2019 to determine whether appropriate statistical methods had been used for sample size calculation and outcome analysis and whether they reported intraclass correlation coefficient (ICC) values. This work expanded a previous review of articles published 1995-2010. RESULTS Our search identified 88 articles published 1995-2020 that reported outcomes of cluster randomized trials of breast, cervix, and colorectal cancer screening interventions. There was increased reporting of the trials' sample size calculations over time, with the percentage increasing from 31% in 1995-2004 to 77% in 2014-2019. However, the percentage of calculations failing to account for cluster randomization did not change over time and was 17% of studies in 2014-2019. There was a nonsignificant trend towards increased use of outcome analysis methods that accounted for the cluster randomized design. However, in lower impact journals, use of appropriate analysis methods was only 80% in 2014-2019. Only 33% of studies reported ICC values in 2014-2019. CONCLUSION For cluster randomized trials with cancer screening outcomes, there have been improvements in the reporting of sample size calculations but methodological and reporting deficiencies persist. Efforts to disseminate, adopt and report the use of appropriate statistical methodologies are still needed.
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Affiliation(s)
- Catherine M Crespi
- Department of Biostatistics, University of California, Los Angeles, School of Public Health, Center for the Health Sciences 51-254, Box 951772, Los Angeles, CA 90095-1772, United States.
| | - Kevin Ziehl
- Department of Biostatistics, University of California, Los Angeles, School of Public Health, Center for the Health Sciences 51-254, Box 951772, Los Angeles, CA 90095-1772, United States
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Singal AG, Chen Y, Sridhar S, Mittal V, Fullington H, Shaik M, Waljee AK, Tiro J. Novel Application of Predictive Modeling: A Tailored Approach to Promoting HCC Surveillance in Patients With Cirrhosis. Clin Gastroenterol Hepatol 2022; 20:1795-1802.e2. [PMID: 33662594 PMCID: PMC9048842 DOI: 10.1016/j.cgh.2021.02.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE There has been increased interest in interventions to promote hepatocellular carcinoma (HCC) surveillance given low utilization and high proportions of late stage detection. Accurate prediction of patients likely versus unlikely to respond to interventions could allow a cost-effective approach to outreach and facilitate targeting more intensive interventions to likely non-responders. DESIGN We conducted a secondary analysis of a randomized clinical trial evaluating a mailed outreach strategy to promote HCC surveillance among 1200 cirrhosis patients at a safety-net health system between December 2014 and March 2017. We developed regularized logistic regression (RLR) and gradient boosting machine (GBM) algorithm models to predict surveillance completion during each of the 3 screening rounds in a training set (n = 960). Model performance was assessed using multiple performance metrics in an independent test set (n = 240). RESULTS Among 1200 patients, surveillance was completed in 41-47% of patients over the three rounds. The RLR and GBM models demonstrated good discriminatory accuracy, with area under receiver operating characteristic (AUROC) curves of 0.67 and 0.66 respectively in the first surveillance round and improved to 0.77 by the third surveillance round after incorporating prior screening behavior as a feature. Additional performance characteristics including the Brier score, Hosmer-Lemeshow test and reliability diagrams were also evaluated. The most important variables for the predictive model were prior screening completion status and past primary care contact. CONCLUSIONS Predictive models can help stratify patients' likelihood to respond to surveillance outreach invitations, facilitating tailored strategies to maximize effectiveness and cost-effectiveness of HCC surveillance population health programs.
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Affiliation(s)
- Amit G. Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center and Parkland Health & Hospital, Dallas, Texas,Department of Population Sciences, University of Texas Southwestern Medical Center and Parkland Health & Hospital, Dallas, Texas,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center and Parkland Health & Hospital, Dallas, Texas
| | - Yixing Chen
- Mendoza College of Business, University of Notre Dame, Notre Dame, Indiana
| | - Shrihari Sridhar
- Mays Business School, Texas A&M University, College Station, Texas
| | - Vikas Mittal
- Jones Graduate School of Business, Rice University, Houston, Texas
| | - Hannah Fullington
- Department of Population Sciences, University of Texas Southwestern Medical Center and Parkland Health & Hospital, Dallas, Texas
| | - Muzeeb Shaik
- Mays Business School, Texas A&M University, College Station, Texas
| | - Akbar K. Waljee
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, Michigan
| | - Jasmin Tiro
- Department of Population Sciences, University of Texas Southwestern Medical Center and Parkland Health & Hospital, Dallas, Texas,Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center and Parkland Health & Hospital, Dallas, Texas
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4
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Kruse-Diehr AJ, Oliveri JM, Vanderpool RC, Katz ML, Reiter PL, Gray DM, Pennell ML, Young GS, Huang B, Fickle D, Cromo M, Rogers M, Gross D, Gibson A, Jellison J, Sarap MD, Bivens TA, McGuire TD, McAlearney AS, Huerta TR, Rahurkar S, Paskett ED, Dignan M. Development of a multilevel intervention to increase colorectal cancer screening in Appalachia. Implement Sci Commun 2021; 2:51. [PMID: 34011410 PMCID: PMC8136225 DOI: 10.1186/s43058-021-00151-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of "Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia," a 5-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics. METHODS Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs. RESULTS Key informant interviews identified multiple barriers to CRC screening, including fear of screening, test results, and financial concerns (patient level); lack of time and competing priorities (provider level); lack of reminder or tracking systems and staff burden (clinic level); and cultural issues, societal norms, and transportation (community level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events, all of which promoted stool-based screening (i.e., FIT or FIT-DNA). Variability among clinics, including differences in EHR systems, was the most salient barrier to EBI implementation, particularly in terms of tracking follow-up of positive screening results, whereas the development of clinic-wide screening protocols was found to promote fidelity to EBI components. CONCLUSIONS Lessons learned from year 1 included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years. TRIAL REGISTRATION Trial NCT04427527 is registered at https://clinicaltrials.gov and was registered on June 11, 2020.
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Affiliation(s)
- Aaron J Kruse-Diehr
- University of Kentucky College of Public Health, Lexington, KY, USA.
- University of Kentucky Markey Cancer Center, Lexington, KY, USA.
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | - Mira L Katz
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Paul L Reiter
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Darrell M Gray
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Michael L Pennell
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Gregory S Young
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Bin Huang
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - Darla Fickle
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Mark Cromo
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - Melinda Rogers
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
| | - David Gross
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | - Ashley Gibson
- Northeast Kentucky Area Health Education Center, Morehead, KY, USA
| | | | | | - Tonia A Bivens
- Lewis County Primary Care Center, Inc. dba PrimaryPlus, Vanceburg, KY, USA
| | - Tracy D McGuire
- Lewis County Primary Care Center, Inc. dba PrimaryPlus, Vanceburg, KY, USA
| | - Ann Scheck McAlearney
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Timothy R Huerta
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Saurabh Rahurkar
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Ohio State University College of Public Health, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark Dignan
- University of Kentucky Markey Cancer Center, Lexington, KY, USA
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Sarma EA, Silver MI, Kobrin SC, Marcus PM, Ferrer RA. Cancer screening: health impact, prevalence, correlates, and interventions. Psychol Health 2019; 34:1036-1072. [DOI: 10.1080/08870446.2019.1584673] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Elizabeth A. Sarma
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Michelle I. Silver
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Sarah C. Kobrin
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Pamela M. Marcus
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Rebecca A. Ferrer
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
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Katz ML, Young GS, Zimmermann BJ, Tatum CM, Paskett ED. Assessing Colorectal Cancer Screening Barriers by Two Methods. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:536-543. [PMID: 27933460 PMCID: PMC7076560 DOI: 10.1007/s13187-016-1148-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Colorectal cancer (CRC) is commonly diagnosed in the USA despite screening tests that have decreased CRC incidence and mortality. Finding the best method to identify patient-level screening barriers is important to improve CRC screening rates. A group-randomized trial was conducted among ten primary-care clinics. Clinics were randomized to a multi-level (clinic, provider, patient) CRC screening intervention or usual care (2007-2013). Subsequent to clinic- and provider-level interventions, a three-step, patient-level intervention was conducted. One step of the patient-level intervention was a CRC screening barriers counseling call conducted by a lay health advisor (LHA). During the call, two methods were used to identify CRC screening barriers. An open-ended question was used first to determine why participants had not completed screening (without probes). Subsequently, the LHA read a list of additional potential screening barriers and asked participants whether each barrier was applicable (with probes). A generalized estimating equation approach was used to compare the two methods. Participants (n = 109) were female (59%), had a mean age of 57.2 years, and were white (67%) or black (31%). Most participants had some college education or a college degree (79%), annual household income $30,000+ (60%), and health insurance (80%). The number of CRC screening barriers increased with probing compared to the open-ended question format (OR 2.10, 95% CI 1.92-2.31; p < 0.01). The ranking of reported CRC screening barriers did not vary by assessment method. However, the methodology used to document CRC screening barriers may influence the content of patient-directed interventions.
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Affiliation(s)
- Mira L Katz
- College of Public Health, The Ohio State University, Suite 525 1590 North High Street, Columbus, OH, 43201, USA.
- Comprehensive Cancer Center, The Ohio State University, Suite 525 1590 North High Street, Columbus, OH, 43201, USA.
- College of Medicine, The Ohio State University, Suite 525 1590 North High Street, Columbus, OH, 43201, USA.
| | - Gregory S Young
- Comprehensive Cancer Center, The Ohio State University, Suite 525 1590 North High Street, Columbus, OH, 43201, USA
| | - Barret J Zimmermann
- College of Public Health, The Ohio State University, Suite 525 1590 North High Street, Columbus, OH, 43201, USA
- Comprehensive Cancer Center, The Ohio State University, Suite 525 1590 North High Street, Columbus, OH, 43201, USA
| | - Cathy M Tatum
- Comprehensive Cancer Center, The Ohio State University, Suite 525 1590 North High Street, Columbus, OH, 43201, USA
| | - Electra D Paskett
- College of Public Health, The Ohio State University, Suite 525 1590 North High Street, Columbus, OH, 43201, USA
- Comprehensive Cancer Center, The Ohio State University, Suite 525 1590 North High Street, Columbus, OH, 43201, USA
- College of Medicine, The Ohio State University, Suite 525 1590 North High Street, Columbus, OH, 43201, USA
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7
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Thompson JH, Davis MM, Leo MC, Schneider JL, Smith DH, Petrik AF, Castillo M, Younger B, Coronado GD. Participatory Research to Advance Colon Cancer Prevention (PROMPT): Study protocol for a pragmatic trial. Contemp Clin Trials 2018; 67:11-15. [PMID: 29408304 PMCID: PMC5903679 DOI: 10.1016/j.cct.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/18/2018] [Accepted: 02/01/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colon cancer is the second leading cause of cancer deaths in the United States. The Participatory Research to Advance Colon Cancer Prevention (PROMPT) study is a collaboration between two research institutions and a federally qualified health center (FQHC). The study seeks to raise colon cancer screening rates using a direct-mail fecal immunochemical testing (FIT) and reminder program in an FQHC serving a predominantly Latino population in California. METHODS PROMPT is a pragmatic trial enrolling 16 clinics. The study will test automated and live prompts (i.e., alerts, reminders) to a direct-mail FIT program in two phases. In Phase I, we tailored and defined intervention components for the pilot using a community-based participatory research approach called boot camp translation. We then plan to conduct a three-arm patient-randomized comparative effectiveness trial in two pilot clinics to compare 1) automated prompts, 2) live prompts, and 3) a combination of automated plus live prompts to alert and remind patients to complete screening. In Phase II, the adapted best practice intervention will be spread to additional clinics within the FQHC (estimated population 27,000) and assessed for effectiveness. Patient and staff interviews will be conducted to explore receptivity to the program and identify barriers to implementation. DISCUSSION This pragmatic trial applies innovative approaches to engage diverse stakeholders and will test the effectiveness and spread of a direct-mail plus reminder program. If successful, the program will provide a model for a cost-effective method to raise colon cancer screening rates among Latino patients receiving care in FQHCs. TRIAL REGISTRATION National Clinical Trial (NCT) Identifier NCT03167125.
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Affiliation(s)
- Jamie H Thompson
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA.
| | - Melinda M Davis
- Oregon Rural Practice-based Research Network (ORPRN), Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, Oregon 97239, USA.
| | - Michael C Leo
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA.
| | - Jennifer L Schneider
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA.
| | - David H Smith
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA.
| | - Amanda F Petrik
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA.
| | | | | | - Gloria D Coronado
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, Oregon 97227, USA.
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Paskett ED, Krok-Schoen JL, Pennell ML, Tatum CM, Reiter PL, Peng J, Bernardo BM, Weier RC, Richardson MS, Katz ML. Results of a Multilevel Intervention Trial to Increase Human Papillomavirus (HPV) Vaccine Uptake among Adolescent Girls. Cancer Epidemiol Biomarkers Prev 2017; 25:593-602. [PMID: 27196093 DOI: 10.1158/1055-9965.epi-15-1243] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/12/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Uptake of the human papillomavirus (HPV) vaccine is low in Appalachian Ohio and areas with high cervical cancer rates. METHODS We conducted a group-randomized trial among 12 counties in Appalachian Ohio randomized to receive either an HPV vaccine (intervention counties) or influenza vaccine (comparison counties) multilevel intervention (MLI). Parents (n = 337) who had a daughter aged 9 to 17 years who had not received the HPV vaccine were recruited from commercial lists. Clinics (N = 24) and 119 providers from these clinics were also recruited. The primary outcome was medical record-confirmed receipt of the first shot of the HPV vaccine 3 months after receiving the intervention among daughters of parents enrolled in the study. Secondary outcomes included receipt of the first HPV vaccine shot by 6 months and changes in provider knowledge. RESULTS According to medical records, 10 (7.7%) daughters of intervention participants received the first shot of the HPV vaccine within 3 months of being sent the intervention materials compared with 4 (3.2%) daughters of comparison group participants (P = 0.061). By 6 months, 17 (13.1%) daughters of intervention participants received the first HPV vaccine shot compared with eight (6.5%) daughters of comparison group participants (P = 0.002). Provider knowledge about HPV increased (P < 0.001, from baseline to after education). CONCLUSIONS The MLI increased uptake of the HPV vaccine among girls aged 9 to 17 years; however, uptake was low. IMPACT To improve HPV vaccine uptake, attention to additional levels of influence (e.g., policy, community) and more elements within levels (e.g., reminders, automated prompts) may be needed. Cancer Epidemiol Biomarkers Prev; 25(4); 593-602. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".
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Affiliation(s)
- Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio.
| | | | - Michael L Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Cathy M Tatum
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Paul L Reiter
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Juan Peng
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | | | | | - Morgan S Richardson
- Department of Neurology, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Mira L Katz
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio. Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio
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9
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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: 36] [Impact Index Per Article: 4.5] [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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