Introduction This study sought to improve colorectal cancer (CRC) screening uptake with fecal immunochemical test (FIT) and investigated the differential impact of a multi-component targeted low-literacy educational intervention compared with a standard non-targeted educational intervention. Methods Patients aged 50–75 years, 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 + FIT kit) or comparison condition (standard CDC brochure + FIT kit). The main outcome was screening with FIT within 180 days of intervention delivery. Results Participants (n=416) were female (54%), racially and ethnically diverse (66% White; 10% Hispanic and 28% African American), predominantly low income, and insured (most had county health insurance). Overall, FIT completion rate was 81%, with 78.1% for intervention vs. 83.5% for comparison condition (p=.17). In multivariate analysis, having health insurance was the primary factor predicting lack of FIT screening (adjusted odds ratio = 2.10; confidence interval, 1.04–4.26, p=.04). Conclusion The targeted low-literacy multicomponent materials were not significantly different or more effective in increasing FIT uptake compared to the non-targeted materials. Provision of a FIT test plus education may provide a key impetus to improve completion of CRC screening. The type of educational material (targeted vs. non-targeted) may matter less. Findings 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.

BACKGROUNDWe assessed the effi cacy of the Cancer Screening Offi ce Systems (Cancer SOS), an intervention designed to increase cancer screening in primary care settings serving disadvantaged populations.METHODS Eight primary care clinics participating in a county-funded health insurance plan in Hillsborough County, Fla, agreed to take part in a cluster-randomized experimental trial. The Cancer SOS had 2 components: a cancer-screening checklist with chart stickers that indicated whether specifi c cancer-screening tests were due, ordered, or completed; and a division of offi ce responsibilities to achieve high screening rates. Established patients were eligible if they were between the ages of 50 and 75 years and had no contraindication for screening. Data abstracted from charts of independent samples collected at baseline (n = 1,196) and at a 12-month follow-up (n = 1,237) was used to assess whether the patient was up-to-date on one or more of the following cancer-screening tests: mammogram, Papanicolaou (Pap) smear, or fecal occult blood testing (FOBT). RESULTSIn multivariate analysis that controlled for baseline screening rates, secular trends, and other patient and clinic characteristics, the intervention increased the odds of mammograms (odds ratio [OR] = 1.62, 95% confi dence interval [CI], 1.07-9.78, P = .023) and fecal occult blood tests (OR = 2.5, 95% CI, 1.65-4.0, P <.0001) with a trend toward greater use of Pap smears (OR = 1.57, 95% CI, 0.92-2.64, P = .096).

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, currently not up-to-date with colorectal cancer (CRC) screening, at average CRC risk, and enrolled in a randomized controlled trial 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 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.

Background This study explored federally qualified health center (FQHC) patients’ perceptions about colorectal cancer screening (CRCS) tests, including immunochemical fecal occult blood tests (iFOBT), as well as preferences for receiving in-clinic education about CRCS. Methods Eight mixed-gender focus groups were conducted with 53 patients. Results Findings centered on three thematic factors: 1) motivators and impediments to CRCS, 2) test-specific preferences and receptivity to iFOBTs, and 3) preferences for entertaining and engaging plain language materials. Conclusion Results informed the development of educational priming materials to increase CRCS using iFOBT in FQHCs.

The intervention increased use of hats among fourth-grade students at school but had no effect on self-reported wide-brimmed hat use outside of school or on measures of skin pigmentation.