Cluster Randomized Trial of a Church-Based Peer Counselor and Tailored Newsletter Intervention to Promote Colorectal Cancer Screening and Physical Activity Among Older African Americans

Abstract

The ACTS of Wellness was a cluster-randomized controlled trial developed to promote colorectal cancer screening and physical activity (PA) within urban African-American churches. Churches were recruited from North Carolina (n=12) and Michigan (n=7) and were randomized to intervention (n=10) or comparison (n=9). Church members age 50 and older completed self-administered baseline and post-intervention surveys. Intervention participants received 3 mailed tailored newsletters addressing colorectal cancer screening and PA behaviors over approximately 6 months. Individuals who were not up-to-date for screening at baseline could also receive motivational calls from a peer counselor. Comparison churches received Body & Soul, a fruit and vegetable promotion program. The main outcomes were up-to-date colorectal cancer screening and Metabolic Equivalency Task (MET)-hours/week of moderate-vigorous PA. MET-hours/week of PA was calculated using frequency, duration and intensity of reported activities with a MET score>3 (i.e. moderate intensity or greater). Multivariate analyses examined changes in the main outcomes controlling for church cluster, gender, marital status, weight and baseline values. Baseline screening was high in both intervention (75.9%, n=374) and comparison groups (73.7%, n=338). Screening increased at follow-up: +6.4 and +4.7 percentage points for intervention and comparison respectively (p=0.25). Baseline MET-hours/week of PA was 7.8 (95%CL 6.8–8.7) for intervention and 8.7 (95%CL 7.6–9.8) for the comparison group. There were no significant changes (p=0.15) in PA for intervention (−0.30 MET-hours/week) compared to the comparison (−0.05 MET-hours/week). Among intervention participants, PA increased more for those who participated in church exercise programs and screening improved more for those who spoke with a peer counselor or recalled the newsletters. Overall, the intervention did not improve PA or screening in an urban church population. These findings support previous research indicating that structured PA opportunities are necessary to promote change in PA and churches need more support to initiate effective peer counselor programs.

Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis

“…Studies were published between 2000 and 2019, with most (n = 12) appearing between 2010 and 2012. Two authors published more than 1 study on the topic (11%), namely, Blumenthal (n = 2), and Leone (n = 2) [ 50 , 54 , 68 , 77 ]. Slightly more than half (56%; n = 23) of the studies included only participants aged 50 years and older, while five (12%) included participants starting at age 45 years, three (7%) included participants younger than 45.…”

“…Most studies (90%; n = 37) reported that intervention delivery occurred in a single geographic region, 2 articles reported delivery in 2 regions, and 2 articles did not report the location of their interventions. For example, Leone and colleagues performed their intervention in both Michigan and North Carolina, stating that the 2-state approach was as an effort to increase the generalizability of their results [ 54 ].…”

“…Interventions that took place outside of clinical or medical settings were conducted in churches (12%), local businesses (5%), and other communal spaces (e.g., community centers, social organizations) (~5%). Several studies justified using church-based settings because religion and faith are central themes of African-American culture; church settings are a natural venue to introduce faith-based intervention materials; previous church-based interventions have proven effective for addressing other health disparities in African-American populations; and church settings may be able to reach those with limited access to healthcare [ 54 , 60 , 78 ]. Cole and colleagues, who conducted their intervention in New York City barbershops, emphasized the community-based approach, stating that––as is commonly seen among African-American men––those with the greatest need are not accessing the healthcare system [ 57 ].…”

Enhancing capacity among faith-based organizations to implement evidence-based cancer control programs: a community-engaged approach

“…Acknowledging their potential to reach underserved audiences, many have recommended engaging FBOs as partners against cancer disparities [14]. Fortunately, today there are numerous interventions that have been implemented or tested within FBOs, many which specifically target behaviors related to cancer prevention and control [17][18][19][20][21][22][23][24][25][26][27][28][29]. However, most of these interventions have been implemented in African-American churches and by health professionals or high-skilled research personnel.…”

Insure Me Cancer Free: An Intervention Utilizing a Dynamic Communication Model

“…Tailoring based on behavioral models has evidenced improvement in cancer screening rates in medically-underserved populations (e.g., Leone et al, 2016). For example, tailoring can be accomplished by including salient message features that include cognitive and affective components, as well as barriers counseling.…”