Background We evaluated the effectiveness and cost-effectiveness of two interventions designed to promote colorectal cancer (CRC) screening in safety-net settings. Methods A three-arm, quasi-experimental evaluation was conducted among 8 clinics in Louisiana. Screening efforts included: 1) enhanced usual care, 2) literacy-informed education of patients, and 3) education plus nurse support. Overall, 961 average-risk patients, ages 50–85 were eligible for routine CRC screening and recruited. Outcomes included CRC screening completion and incremental cost-effectiveness the latter two approaches versus enhanced usual care. Results Baseline screening rates were < 3%. After the interventions, screening rates were 38.6% with enhanced usual care, 57.1% with education and 60.6% with additional nurse support. After adjusting for age, race, gender, and literacy, patients receiving education were not more likely to complete screening than those receiving enhanced usual care; those additionally receiving nurse support were 1.60 fold more likely to complete screening than those receiving enhanced usual care (95% CI 1.06 – 2.42, p=0.024). The incremental cost per additional person screened was $1,337 for nurse over enhanced usual care. Conclusions FOBT rates were increased beyond enhanced usual care by providing brief education and nurse support but not education alone. More cost effective alternatives to nurse support need to be investigated.

This article examines the relationship between literacy and colorectal cancer (CRC) screening knowledge, beliefs, and experiences, with a focus on fecal occult blood tests (FOBTs). Participants were 975 patients in 8 Louisiana federally qualified health centers. Participants were 50 years of age or older and not up to date with CRC screening; approximately half (52%) had low literacy (less than a 9th-grade level). Participants with low literacy were less likely than were those with adequate literacy to be aware of advertisements promoting CRC screening (58.7% vs. 76.3%, p < .0001) or to believe it was very helpful to find CRC early (74.5% vs. 91.9%, p < .0001). The majority of participants had positive beliefs about the benefits of CRC screening using FOBTs. Participants with low literacy had more perceived barriers to FOBT completion and were more likely to strongly agree or agree that FOBTs would be confusing, embarrassing, or a lot of trouble; however, none of these remained significant in multivariate analyses controlling for relevant covariates. Confidence in being able to obtain an FOBT kit was high among those with low and adequate literacy (89.8% vs. 93.1%, respectively, p = .20); yet multivariate analyses revealed a significant difference in regard to literacy (p = .04) with low-literacy participants indicating less confidence. There was no significant difference by literacy in ever receiving a physician recommendation for CRC screening (38.4% low vs. 39.0% adequate, p = .79); however, multivariate analyses revealed significant differences in FOBT completion by literacy (p = .036). Overall, findings suggest that literacy is a factor in patients’ CRC knowledge, beliefs, and confidence in obtaining a FOBT.

Use of a visual aid improved mothers' knowledge and showed promise as a decision aid for counseling at the threshold of viability.

Most participants were unclear about when they should begin mammography. Rural participants reported stronger positive beliefs, higher self-efficacy, fewer barriers, and having a physician recommendation for mammography but were less likely to receive education or screening.

Objectives To contrast barriers to colon cancer (CRC) screening and Fecal Occult Blood Test (FOBT) completion between rural and urban safety-net patients. Methods Interviews were administered to 972 patients who were not up-to-date with screening. Results Rural patients were more likely to believe it was helpful to find CRC early (89.7% vs 66.1%, p < .0001), yet were less likely to have received a screening recommendation (36.4% vs. 45.8%, p = .03) or FOBT information (14.5% vs 32.3%, p < .0001) or to have completed an FOBT (22.0% vs 45.8%, p < .0001). Conclusions Interventions are needed to increase screening recommendation, education and completion, particularly in rural areas.