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

Abstract

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.

Health Literacy among Medically Underserved: The Role of Demographic Factors, Social Influence, and Religious Beliefs

“…This is a cross-sectional study based upon baseline data from a parent randomized controlled trial (RCT) called Colorectal Cancer Awareness, Research, Education, and Screening (CARES) (Davis et al, 2016). The trial aimed to assess the efficacy of a low-literacy, targeted educational CRC screening intervention (photonovella, DVD, and fecal immunochemical test [FIT] kit) informed by the Preventive Health Model (PHM) compared to a non-targeted Centers for Disease Control and Prevention brochure plus FIT kit to promote CRC screening among adults non-adherent to CRC screening guidelines.…”

“…The trial aimed to assess the efficacy of a low-literacy, targeted educational CRC screening intervention (photonovella, DVD, and fecal immunochemical test [FIT] kit) informed by the Preventive Health Model (PHM) compared to a non-targeted Centers for Disease Control and Prevention brochure plus FIT kit to promote CRC screening among adults non-adherent to CRC screening guidelines. Study procedures have been described in detail previously (Davis et al, 2016). Briefly, participants were patients receiving primary care services in a community clinic (one of two federally-qualified healthcare centers [FQHCs] or a county Department of Health clinic).…”

“…Baseline data collection was completed between July 2012 and 2014 and occurred prior to randomization to intervention group and intervention delivery. Of 497 individuals who were eligible to participate, 416 individuals were enrolled and randomized (an additional 4 individuals were enrolled, but not randomized and are not included in analyses) (Davis et al, 2016). …”

“…The University of South Florida and Florida Department of Health Institutional Review Boards approved the study procedures (Davis et al, 2016). Participants were eligible for the study if they met the following criteria: 1) between 50–75 years of age; 2) receiving care at one of the three participating community health clinics; 3) currently not up-to-date with CRC screening guidelines; 4) at average risk for CRC (i.e., no symptoms of CRC, no personal diagnosis of CRC or bowel diseases, no strong family history of CRC); and 5) able to speak and read English (Davis et al, 2016).…”

“…Twelve items measured awareness of CRC and CRC screening, including three yes-no items adapted from the Health Information National Trends Survey (National Cancer Institute, 2009) that assessed whether participants had previously heard of stool blood test, sigmoidoscopy, and colonoscopy and nine items that further assessed CRC and CRC screening knowledge (Christy et al, 2016; Davis et al, 2016). A total awareness score was calculated by summing the points earned for all 12 items.…”