title: A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial.
abstract: BACKGROUND
  Minority racial/ethnic groups have low colorectal cancer (CRC) screening rates.
  
  
  OBJECTIVE
  To evaluate a culturally tailored intervention to increase CRC screening, primarily using colonoscopy, among low income and non-English speaking patients.
  
  
  METHODS
  Randomized controlled trial conducted from January to October of 2007.
  
  
  METHODS
  Single, urban community health center serving a low-income, ethnically diverse population.
  
  
  METHODS
  A total of 1,223 patients 52-79 years of age overdue for CRC screening, randomized to intervention (n = 409) vs. usual care control (n = 814) groups.
  
  
  METHODS
  Intervention patients received an introductory letter with educational material followed by phone or in-person contact by a language-concordant "navigator." Navigators (n = 5) were community health workers trained to identify and address patient-reported barriers to CRC screening. Individually tailored interventions included patient education, procedure scheduling, translation and explanation of bowel preparation, and help with transportation and insurance coverage. Rates of colorectal cancer screening were assessed for intervention and usual care control patients.
  
  
  RESULTS
  Over a 9-month period, intervention patients were more likely to undergo CRC screening than control patients (27% vs. 12% for any CRC screening, p < 0.001; 21% vs. 10% for colonoscopy completion, p < 0.001). The higher screening rate resulted in the identification of 10.5 polyps per 100 patients in the intervention group vs. 6.8 in the control group (p = 0.04).
  
  
  CONCLUSIONS
  Patients were from one health center. Some patients may have obtained CRC screening outside our system.
  
  
  CONCLUSIONS
  A culturally tailored, language-concordant navigator program designed to identify and overcome barriers to colorectal cancer screening can significantly improve colonoscopy rates for low income, ethnically and linguistically diverse patients. ClinicalTrials.gov registration number: NCT00476970.
authors.affiliation: Chelsea HealthCare Center, Massachusetts General Hospital, Chelsea, MA 02150, USA. spercaclima@partners.org
authors.forename: Sanja
authors.initials: S
authors.lastname: Percac-Lima
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grant
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Green
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Ashburner
authors.forename: Gloria
authors.initials: G
authors.lastname: Gamba
authors.forename: Sarah
authors.initials: S
authors.lastname: Oo
authors.forename: James M
authors.initials: JM
authors.lastname: Richter
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D003151:Community Health Centers; D055088:Early Detection of Cancer; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*