title: A randomized controlled trial of a multicomponent, targeted, low-literacy educational intervention compared with a nontargeted intervention to boost colorectal cancer screening with fecal immunochemical testing in community clinics.
abstract: BACKGROUND
  The objective of the current study was to improve colorectal cancer (CRC) screening uptake with the fecal immunochemical test (FIT). The current study investigated the differential impact of a multicomponent, targeted, low-literacy educational intervention compared with a standard, nontargeted educational intervention.
  
  
  METHODS
  Patients aged 50 to 75 years who were of average CRC risk and not up-to-date with CRC screening were recruited from either a federally qualified health center or a primary care community health clinic. Patients were randomized to the intervention condition (targeted photonovella booklet/DVD plus FIT kit) or comparison condition (standard Centers for Disease Control and Prevention brochure plus FIT kit). The main outcome was screening with FIT within 180 days of delivery of the intervention.
  
  
  RESULTS
  Of the 416 participants, 54% were female; the participants were racially and ethnically diverse (66% white, 10% Hispanic, and 28% African American), predominantly of low income, and insured (the majority had county health insurance). Overall, the FIT completion rate was 81%, with 78.1% of participants in the intervention versus 83.5% of those in the comparison condition completing FIT (P =  .17). In multivariate analysis, having health insurance was found to be the primary factor predicting a lack of FIT screening (adjusted odds ratio, 2.10; 95% confidence interval, 1.04-4.26 [P =  .04]).
  
  
  CONCLUSIONS
  The multicomponent, targeted, low-literacy materials were not found to be significantly different or more effective in increasing FIT uptake compared with the nontargeted materials. Provision of a FIT test plus education may provide a key impetus to improve the completion of CRC screening. The type of educational material (targeted vs nontargeted) may matter less. The findings of the current study provide a unique opportunity for clinics to adopt FIT and to choose the type of patient education materials based on clinic, provider, and patient preferences. Cancer 2017;123:1390-1400. © 2016 American Cancer Society.
authors.affiliation: Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, New Jersey.|Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Stacy N
authors.initials: SN
authors.lastname: Davis
authors.affiliation: Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.|Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Christy
authors.affiliation: Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.|Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors.forename: Enmanuel A
authors.initials: EA
authors.lastname: Chavarria
authors.affiliation: Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Rania
authors.initials: R
authors.lastname: Abdulla
authors.affiliation: Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.|Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Sutton
authors.affiliation: Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Alyssa R
authors.initials: AR
authors.lastname: Schmidt
authors.affiliation: Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Susan T
authors.initials: ST
authors.lastname: Vadaparampil
authors.affiliation: Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.|Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors.forename: Gwendolyn P
authors.initials: GP
authors.lastname: Quinn
authors.affiliation: Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.|Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors.forename: Vani N
authors.initials: VN
authors.lastname: Simmons
authors.affiliation: Florida Department of Health, St. Petersburg, Florida.
authors.forename: Chukwudi B
authors.initials: CB
authors.lastname: Ufondu
authors.affiliation: Florida Department of Health, St. Petersburg, Florida.
authors.forename: Chitra
authors.initials: C
authors.lastname: Ravindra
authors.affiliation: Premier Community HealthCare Group Inc, Dade City, Florida.
authors.forename: Ida
authors.initials: I
authors.lastname: Schultz
authors.affiliation: Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.|Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Roetzheim
authors.affiliation: Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.|Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.|Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: David
authors.initials: D
authors.lastname: Shibata
authors.affiliation: Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.|Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Meade
authors.affiliation: Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.|Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.
authors.forename: Clement K
authors.initials: CK
authors.lastname: Gwede
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D055088:Early Detection of Cancer; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016017:Odds Ratio; D010353:Patient Education as Topic; D012307:Risk Factors
keywords: colorectal cancer; early detection of cancer; fecal immunochemical test; health promotion; intervention studies; medically underserved