TY - JOUR
T1 - Repeat Annual Colorectal Cancer Screening in Rural Community Clinics
T2 - A Randomized Clinical Trial to Evaluate Outreach Strategies to Sustain Screening
AU - Davis, Terry C.
AU - Rademaker, Alfred
AU - Morris, James
AU - Ferguson, Laurie Anne
AU - Wiltz, Gary
AU - Arnold, Connie L.
N1 - Publisher Copyright:
© 2019 National Rural Health Association
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Purpose: The majority of colorectal cancer (CRC) research using the fecal immunochemical test (FIT) has studied short-term screening results in predominantly urban areas. The purpose of this study was to evaluate the effectiveness of 2 outreach strategies embedded in a health literacy intervention on repeat CRC screening in rural community clinics. Methods: A 2-arm randomized controlled trial was conducted in 4 rural clinics in Louisiana. During a regularly scheduled clinic visit, participants ages 50–75 received a FIT kit and brief educational intervention. Participants were randomized to receive an automated call or a personal call by a prevention counselor after 4 weeks and 8 weeks if FIT kits were not returned. In year 2, materials were mailed, and follow-up calls were conducted as in year 1. The primary outcome was repeat FIT—the return of the FIT kit in both years. Participants: Of 568 eligible participants, 55% were female, 67% were African American, and 39% had low health literacy. Findings: Repeat FIT rates were 36.5% for those receiving the automated call and 33.6% for those receiving a personal call (P =.30). No annual FITs were returned in 30% of participants, while only 1 FIT was returned by 35% of participants (31% only year 1 and 4% only year 2). Conclusion: Sustaining CRC screening with FIT is challenging in rural clinics. A lower cost automated call was just as effective as the personal call in promoting repeat annual screening. However, more intensive strategies are needed to improve long-term FIT screening among rural participants.
AB - Purpose: The majority of colorectal cancer (CRC) research using the fecal immunochemical test (FIT) has studied short-term screening results in predominantly urban areas. The purpose of this study was to evaluate the effectiveness of 2 outreach strategies embedded in a health literacy intervention on repeat CRC screening in rural community clinics. Methods: A 2-arm randomized controlled trial was conducted in 4 rural clinics in Louisiana. During a regularly scheduled clinic visit, participants ages 50–75 received a FIT kit and brief educational intervention. Participants were randomized to receive an automated call or a personal call by a prevention counselor after 4 weeks and 8 weeks if FIT kits were not returned. In year 2, materials were mailed, and follow-up calls were conducted as in year 1. The primary outcome was repeat FIT—the return of the FIT kit in both years. Participants: Of 568 eligible participants, 55% were female, 67% were African American, and 39% had low health literacy. Findings: Repeat FIT rates were 36.5% for those receiving the automated call and 33.6% for those receiving a personal call (P =.30). No annual FITs were returned in 30% of participants, while only 1 FIT was returned by 35% of participants (31% only year 1 and 4% only year 2). Conclusion: Sustaining CRC screening with FIT is challenging in rural clinics. A lower cost automated call was just as effective as the personal call in promoting repeat annual screening. However, more intensive strategies are needed to improve long-term FIT screening among rural participants.
KW - fecal immunochemical test
KW - health literacy
KW - repeat colorectal cancer screening
KW - rural community clinics
KW - telephone follow-up strategies
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U2 - 10.1111/jrh.12399
DO - 10.1111/jrh.12399
M3 - Article
C2 - 31523848
AN - SCOPUS:85073783484
SN - 0890-765X
VL - 36
SP - 307
EP - 315
JO - Journal of Rural Health
JF - Journal of Rural Health
IS - 3
ER -