title: Implementation intentions and colorectal screening: a randomized trial in safety-net clinics.
abstract: BACKGROUND
  Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups.
  
  
  BACKGROUND
  The study aimed to test a theoretically based "implementation intentions" intervention for improving CRC screening among unscreened adults in urban safety-net clinics.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Adults (N=470) aged ≥50 years, due for CRC screening, from urban safety-net clinics were recruited.
  
  
  METHODS
  The intervention (conducted in 2009-2011) was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (Comparison group) or "implementation intentions" questions and planning (Experimental group) specific to the CRC screening test chosen (fecal immunochemical test or colonoscopy).
  
  
  METHODS
  The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted in 2012-2013).
  
  
  RESULTS
  The study population had a mean age of 57 years and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions-based intervention had higher odds (AOR=1.83, 95% CI=1.23, 2.73) of completing CRC screening than the Comparison group. Those with higher self-efficacy for screening (AOR=1.57, 95% CI=1.03, 2.39), history of asthma (AOR=2.20, 95% CI=1.26, 3.84), no history of diabetes (AOR=1.86, 95% CI=1.21, 2.86), and reporting they had never heard that "cutting on cancer" makes it spread (AOR=1.78, 95% CI=1.16, 2.72) were more likely to complete CRC screening.
  
  
  CONCLUSIONS
  The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low-income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors.
authors.affiliation: Department of Family Medicine; University of Kansas Cancer Center. Electronic address: agreiner@kumc.edu.
authors.forename: K Allen
authors.initials: KA
authors.lastname: Greiner
authors.affiliation: Department of Family Medicine; Center for American Indian Community Health; Department of Preventive Medicine; University of Kansas Cancer Center.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Daley
authors.affiliation: Department of Family Medicine.
authors.forename: Aaron
authors.initials: A
authors.lastname: Epp
authors.affiliation: Siteman Cancer Center, Washington University, St. Louis, Missouri.
authors.forename: Aimee
authors.initials: A
authors.lastname: James
authors.affiliation: Department of Biostatistics; University of Kansas Cancer Center.
authors.forename: Hung-Wen
authors.initials: HW
authors.lastname: Yeh
authors.affiliation: Department of Family Medicine; University of Kansas Cancer Center; Center of Excellence for Health Communications to Underserved Populations, William Allen White School of Journalism and Mass Communications.
authors.forename: Mugur
authors.initials: M
authors.lastname: Geana
authors.affiliation: Department of Family Medicine.
authors.forename: Wendi
authors.initials: W
authors.lastname: Born
authors.affiliation: Department of Preventive Medicine; University of Kansas Cancer Center.
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Engelman
authors.affiliation: School of Architecture Design and Planning, University of Kansas, Kansas City, Kansas.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Shellhorn
authors.affiliation: Department of Family Medicine; University of Kansas Cancer Center.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Hester
authors.affiliation: Department of Family Medicine.
authors.forename: Joseph
authors.initials: J
authors.lastname: LeMaster
authors.affiliation: Department of Internal Medicine, University of Kansas Medical Center.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Buckles
authors.affiliation: Department of Preventive Medicine; University of Kansas Cancer Center.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
mesh_terms: D001741:Black or African American; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology; D003194:Computer-Assisted Instruction / Q000379:methods / Q000706:statistics & numerical data; D003936:Diagnosis, Computer-Assisted / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D033182:Intention; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D017063:Outcome Assessment, Health Care; D011203:Poverty; D064876:Safety-net Providers / Q000379:methods; D014481:United States; D044465:White People