title: Testing Interventions to Motivate and Educate (TIME): A multi-level intervention to improve colorectal cancer screening.
abstract: OBJECTIVE
  To test the effectiveness of a colorectal cancer (CRC) screening intervention directed at three levels (clinic, provider, patient) in a primary care setting.
  
  
  METHODS
  We conducted a group randomized trial (Clinical Trials registration no. NCT01568151) among 10 primary care clinics in Columbus, Ohio that were randomized to a study condition (intervention or usual care). We determined the effect of a multi-level, stepped behavioral intervention on receipt of a CRC screening test among average-risk patients from these clinics over the study period.
  
  
  RESULTS
  Patients (n=527) who were outside of CRC screening recommendations were recruited. Overall, 35.4% of participants in the intervention clinics had received CRC screening by the end of the study compared to 35.1% of participants who were in the usual care clinics. Time to CRC screening was also similar across arms (HR=0.97, 95% CI=0.65-1.45).
  
  
  CONCLUSIONS
  The multi-level intervention was not effective in increasing CRC screening among participants who needed a test, perhaps due to low participation of patients in the stepped intervention. Future studies utilizing evidence-based strategies to encourage CRC screening are needed.
authors.affiliation: Comprehensive Cancer Center, The Ohio State University, 1590 N. High St., Suite 525, Columbus, Ohio, 43201 USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Krok-Schoen
authors.affiliation: Center for Biostatistics, The Ohio State University, 2012 Kenny Rd., Columbus, OH 43221, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Young
authors.affiliation: Division of Biostatistics, College of Public Health, The Ohio State University, 1841 Neil Ave., Columbus, OH 43210, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Pennell
authors.affiliation: Comprehensive Cancer Center, The Ohio State University, 1590 N. High St., Suite 525, Columbus, Ohio, 43201 USA ; Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, 395 W. 12 Ave., Columbus, OH 43210, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Reiter
authors.affiliation: Comprehensive Cancer Center, The Ohio State University, 1590 N. High St., Suite 525, Columbus, Ohio, 43201 USA ; Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, 395 W. 12 Ave., Columbus, OH 43210, USA ; Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, 1841 Neil Ave., Columbus, OH 43210, USA.
authors.forename: Mira L
authors.initials: ML
authors.lastname: Katz
authors.affiliation: Comprehensive Cancer Center, The Ohio State University, 1590 N. High St., Suite 525, Columbus, Ohio, 43201 USA ; Department of Family Medicine, College of Medicine, The Ohio State University, 2231 N. High St., Columbus, OH 43201, USA.
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Post
authors.affiliation: Comprehensive Cancer Center, The Ohio State University, 1590 N. High St., Suite 525, Columbus, Ohio, 43201 USA.
authors.forename: Cathy M
authors.initials: CM
authors.lastname: Tatum
authors.affiliation: Comprehensive Cancer Center, The Ohio State University, 1590 N. High St., Suite 525, Columbus, Ohio, 43201 USA ; Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, 395 W. 12 Ave., Columbus, OH 43210, USA ; Division of Epidemiology, College of Public Health, The Ohio State University, 1841 Neil Ave., Columbus, OH 43210, USA.
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
keywords: cancer prevention; cancer screening; colorectal cancer; lay health advisor; multi-level interventions