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.