title: Final Results of a 3-Year Literacy-Informed Intervention to Promote Annual Fecal Occult Blood Test Screening.
abstract: This three arm study was designed to make CRC screening with FOBTs more accessible, understandable and actionable for patients cared for in predominantly rural Federally Qualified Health Centers. Patients in an enhanced version of usual care received an annual CRC recommendation and FOBT kit; those in the education arm additionally received brief literacy and culturally appropriate education and those in the nurse arm received the education by a nurse manager who followed up by telephone. Baseline FOBT rates in this population were 3 %. We evaluated if FOBT rates could be sustained over 3 years. A three-arm, quasi-experimental evaluation was conducted among eight clinics in Louisiana. Screening efforts included: (1) enhanced usual care, (2) literacy-informed education of patients, and (3) education plus nurse support. Overall, 961 average-risk patients, ages 50-85, eligible for routine CRC screenings were recruited. The primary outcome was completing three annual FOBT tests. Of 961 patients enrolled, 381 (39.6 %) participants did not complete a single FOBT, 60.4 % completed at least one FOBT of which 318 (33.1 %) completed only one, 162 (16.9 %) completed two and 100 (10.4 %) completed three FOBTs over the 3-year period (the primary study outcome). The primary outcome, return of three FOBT kits over the 3-year period, was achieved by 4.7 % in enhanced care, 11.4 % in education and 13.6 % in the nurse arm (p = 0.005). Overall 3-year FOBT screening rates were not sustained with any of the three interventions, despite reports of promising interim results at years 1 and 2. New strategies for sustaining FOBT screening over several years must be developed.
authors.affiliation: Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA. carnol@lsuhsc.edu.
authors.forename: Connie L
authors.identifier: 0000-0001-8961-2342
authors.initials: CL
authors.lastname: Arnold
authors.affiliation: Department of Preventive Medicine, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.affiliation: Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.affiliation: Department of Preventive Medicine, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
authors.forename: Dachao
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Lucas
authors.affiliation: Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Hancock
authors.affiliation: Department of Medicine, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA.
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006293:Health Promotion / Q000379:methods / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D008145:Louisiana; D008297:Male; D008875:Middle Aged; D009780:Occult Blood
keywords: Annual screening; Colon cancer screening; Federally Qualified Health Centers; Health literacy