Third Annual Fecal Occult Blood Testing in Community Health Clinics.
OBJECTIVE
Our objective was to determine the effectiveness of 3 approaches to encourage completion of fecal occult blood testing (FOBT) in the third year of the intervention.


METHODS
Between 2008 and 2011, a quasi-experimental intervention was conducted in 8 predominantly rural Federally Qualified Health Centers. Clinics were randomly assigned to enhanced care (screening recommendation and FOBT kit mailed annually), education (patients additionally received a health literacy appropriate pamphlet and simplified FOBT instructions), or nurse support (same as education but with nurse follow-up). Participants included 206 patients with negative FOBTs in years 1 and 2; ages 50-85, 80% female, 70% African American, and 52% had limited health literacy. The main outcome measure was completion of a third annual FOBT.


RESULTS
Third-year FOBT rates were 48% overall, 34.2% enhanced care, 59.6% education, and 47.4% nurse support (p = .21), even after adjustment for sex, marital status, and health literacy.


CONCLUSIONS
All mailed interventions were similarly effective in sustaining rates of FOBT screening. Post hoc analyses of the results analyzed by health literacy skills found that patients with both limited and adequate health literacy skills were more likely to complete FOBTs when mailed simplified instructions.
Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA. carnol@lsuhsc.edu.
Connie L
CL
Arnold
Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
Alfred
A
Rademaker
Medicine and Learning Sciences, Associate Chair, Department of Medicine, Associate Division Chief - Research, Department of General Internal Medicine and Geriatrics Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Michael S
MS
Wolf
Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
Dachao
D
Liu
Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Jill
J
Hancock
Department of Medicine and Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Terry C
TC
Davis
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003153:Community Health Services; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D057220:Health Literacy; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009780:Occult Blood; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D019035:Rural Health Services