title: A randomized controlled trial of a multilevel intervention to increase colorectal cancer screening among Latino immigrants in a primary care facility.
abstract: BACKGROUND
  Latino immigrants face a higher burden of colorectal cancer (CRC) and screening rates are low.
  
  
  OBJECTIVE
  To assess the effectiveness of a multilevel intervention in increasing the rate of CRC screening among Latino immigrants.
  
  
  METHODS
  A randomized controlled trial, with randomization at the physician level.
  
  
  METHODS
  Pairs of 65 primary care physicians and 65 Latino immigrant patients participated, 31 in the intervention and 34 in the control group.
  
  
  METHODS
  CRC educational video in Spanish on a portable personal digital video display device accompanied by a brochure with key information for the patient, and a patient-delivered paper-based reminder for their physician.
  
  
  METHODS
  Completed CRC screening, physician recommendation for CRC screening, and patient adherence to physician recommended CRC screening.
  
  
  RESULTS
  The overall rate of completed screening for CRC was 55% for the intervention and 18% for the control group (p = 0.002). Physicians recommended CRC screening for 61% of patients in the intervention group versus 41% in the control group (p = 0.08). Of those that received a recommendation, 90% in the intervention group adhered to it versus 26% in the control group (p = 0.007).
  
  
  CONCLUSIONS
  The intervention was successful in increasing rates of completed CRC screening primarily through increasing adherence after screening was recommended. Additional efforts should focus on developing new strategies to increase physician recommendation for CRC screening, while employing effective patient adherence interventions.
authors.affiliation: Downstate Medical Center, School of Public Health, State University of New York, 450 Clarkson Av, box 43, Brooklyn, NY 11203, USA. abraham.aragones@downstate.edu
authors.forename: Abraham
authors.initials: A
authors.lastname: Aragones
authors.forename: Mark D
authors.initials: MD
authors.lastname: Schwartz
authors.forename: Nirav R
authors.initials: NR
authors.lastname: Shah
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Gany
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D054521:Cultural Competency; D055088:Early Detection of Cancer; D054242:Emigrants and Immigrants; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010353:Patient Education as Topic; D011320:Primary Health Care; D014505:Urban Population