title: Online narratives and peer support for colorectal cancer screening: a pilot randomized trial.
abstract: BACKGROUND
  Delivering personal narratives and peer support for CRC screening in an online weight-loss community could be an efficient approach to engaging individuals at increased risk, because obesity is associated with excess colorectal cancer (CRC) mortality and lower screening rates.
  
  
  OBJECTIVE
  Evaluate user engagement and impact of narratives and peer support for promoting CRC screening in an online weight-loss community.
  
  
  METHODS
  Pilot randomized trial.
  
  
  METHODS
  Members of an online weight-loss community who were not up-to-date with CRC screening were enrolled in the study in 2011.
  
  
  METHODS
  Basic and Enhanced groups (n=153 each) both received education. The Enhanced group also received narratives and peer support for CRC screening in online forums.
  
  
  METHODS
  The main measures were user engagement, psychosocial outcomes, and self-report CRC screening at 6 months. Analyses were conducted with (1) the full sample of participants and (2) a minimum dose sample of those who participated in their assigned intervention to a minimum degree. Analyses were completed in 2012.
  
  
  RESULTS
  Participants were mostly female (92%) with a mean age of 56 years. More than 90% in both groups viewed the educational information. Only 57% in the Enhanced group joined the online team. The Enhanced group had greater improvement in motivation for screening than the Basic group at 1 month (p=0.03). In the full sample, there was no difference in CRC screening at 6 months (Enhanced 19% vs Basic 16%, adjusted OR=1.33, 95% CI=0.73, 2.42). In the minimum dose sample, fecal occult blood testing was higher in the Enhanced (14%) vs Basic (7%) group (adjusted OR=2.49, 95% CI=1.01, 6.17).
  
  
  CONCLUSIONS
  Although no between-group differences in CRC screening were seen at 6 months, this study did demonstrate that it is feasible to deploy a narrative and peer support intervention for CRC screening in a randomized trial among members of an online community. However, modifications are needed to improve user engagement.
  
  
  BACKGROUND
  This study is registered at ClinicalTrials.gov NCT01411826.
authors.affiliation: Department of Internal Medicine and the University of Texas-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School at Houston. Electronic address: Kevin.o.hwang@uth.tmc.edu.
authors.forename: Kevin O
authors.initials: KO
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine and the University of Texas-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School at Houston.
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Ottenbacher
authors.affiliation: The Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, Department of Oncology, Georgetown University Medical Center / Lombardi Comprehensive Cancer Center, Washington DC.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Graham
authors.affiliation: Department of Internal Medicine and the University of Texas-Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School at Houston.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Thomas
authors.affiliation: Department of Communication, Texas A&M University, College Station, Texas.
authors.forename: Rick L
authors.initials: RL
authors.lastname: Street
authors.affiliation: Division of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston.
authors.forename: Sally W
authors.initials: SW
authors.lastname: Vernon
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000523:psychology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000379:methods; D006801:Humans; D020407:Internet; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000523:psychology; D008875:Middle Aged; D009042:Motivation; D033262:Narration; D009780:Occult Blood; D017063:Outcome Assessment, Health Care; D010379:Peer Group; D010865:Pilot Projects; D012944:Social Support; D013997:Time Factors; D015431:Weight Loss