A Randomized Controlled Calendar Mail-Out to Increase Cancer Screening Among Urban American Indian and Alaska Native Patients

Abstract

This study seeks to ascertain whether a culturally tailored art calendar could improve participation in cancer screening activities. We conducted a randomized, controlled calendar mail-out in which a Native art calendar was sent by first class mail to 5,633 patients seen at an urban American Indian clinic during the prior 2 years. Using random assignment, half of the patients were mailed a “message” calendar with screening information and reminders on breast, colorectal, lung, and prostate cancer; the other half received a calendar without messages. The receipt of cancer screening services was ascertained through chart abstraction in the following 15 months. In total, 5,363 observations (health messages n=2,695; no messages n=2,668) were analyzed. The calendar with health messages did not result in increased receipt of any cancer-related prevention outcome compared to the calendar without health messages. We solicited clinic input to create a culturally appropriate visual intervention to increase cancer screening in a vulnerable, underserved urban population. Our results suggest that printed materials with health messages are likely too weak an intervention to produce the desired behavioral outcomes in cancer screening.

Should anti-tobacco media messages be culturally targeted for Indigenous populations? A systematic review and narrative synthesis

“…One study had a sophisticated measure of perceived effectiveness and confirmed recall 32. The assessment of smoking attitudes and behaviour varied across the studies and included measuring attitudes to quitting,33 46 intentions to quit or smoke,26 32 33 36 quit attempts,29 31 38 levels of consumption,26 42 perceptions about being influenced to quit by the message (including talking to others about quitting),31 33 35 calls to a Quitline,30 33 receipt of cessation advice,28 and quit rates 26 27 29 31 35 38 41 42…”

“…Effect of targeted campaigns for Indigenous or measures of cultural suitability 28 33 36–39 41 43–45…”

“…Some culturally targeted media interventions: the art calendar for American Indians/Alaska Natives,28 the video for pregnant Alaska Native women38 and the New Zealand video mobile phone intervention,29 were no more effective than the control intervention despite being collaboratively developed. The latter two studies were hampered with recruitment issues, with few Indigenous people being ready to quit.…”

The Influence of Health Disparities on Targeting Cancer Prevention Efforts

“…Other RCTs also focused on increasing breast and cervical cancer screening in diverse groups of African-American, Latina, Asian, Arab, and rural women using community-based participatory research (CBPR), faith-placed research intervention, patient navigators, and lay health workers with variably packaged educational modules. 34–39 …”

Cancer Journey for American Indians and Alaska Natives in the Pacific Northwest

“…However, these data were limited to ANs and southwestern AIs, with no AI/AN respondents in the Pacific Northwest (Schumacher et al, 2008). Another study, which described a telehealth project originating in the Seattle area and using a calendar mail-out to increase cancer screening, provides context for understanding the barriers to care (geographic and otherwise) described by AI/AN patients with cancer (Doorenbos, Demiris, et al, 2011; Doorenbos et al, 2010; Doorenbos, Jacobsen, Corpuz, Forquera, & Buchwald, 2011). However, these studies offer little information on patient perspectives.…”