Changes in Colorectal Cancer Screening Knowledge, Behavior, Beliefs, Self- Efficacy, and Barriers among Community Health Clinic Patients after a Health Literacy Intervention

Abstract

Objective The objective in this pre- and post-survey assessment was to compare the effectiveness of a health literacy-directed intervention designed to increase knowledge, beliefs, barriers, self-efficacy and behavior associated with CRC screening with FOBT among patients cared for in predominantly rural community clinics and the change in these characteristics over the first 15 months after enrolling in a study designed to assess screening strategies. Methods Between 2008 and 2011, a quasi-experimental intervention was conducted in 8 predominantly rural Federally Qualified Health Centers. Patients were orally administered a 15-minute survey at enrollment by a clinic research assistant (RA) and at 15 months by phone by a central RA. Participants included 428 community clinic patients aged 50–85 (mean 58.5); the majority (79%) were female, 69% were African American, and 54% had limited health literacy. Results There was significant improvement across all groups with the number of patients reporting they had been given information /education on CRC testing (p<.0001), been given an FOBT kit (p<.0001), and completed an FOBT (p<.0001) with significant improvement in having a doctor recommendation in all groups except usual care. Confidence in an FOBT’s potential to decrease chances of dying from CRC improved across all groups as well (p<0.002). In addition, patients ‘belief that they would get CRC in their lifetime’ decreased across all groups post-intervention (p<0.03) as did their worry that they may find out they have CRC (p<0.04). Conclusion Overall these low income FQHC patients who were not up-to-date with screening had heard of CRC screening, had positive attitudes toward screening and wanted to know if they had cancer. Results demonstrate the value of giving patients a recommendation and a kit; patients in all groups reported significant increases at 15 months in completing CRC screening (>83%) as confirmed by study records.

The effect of knowledge and health beliefs about colorectal cancer on screening behaviour

“…However, no statistically significant relationship was found between gender and undergoing a CRC screening test according to the logistic regression analysis conducted (OR = 0.438, 95% CI 0.164-1.169). Some other studies have reported higher rates for female participation than males for CRC screening, similar to our results (Arnold, Rademaker, Liu, & Davis, 2017;Teixeira et al, 2018;Yılmaz et al, 2016), while there are also studies with the opposite finding (So et al, 2012). We believe our result is partly due to the higher rate of family health centre visits to use healthcare services by women.…”

Health Literacy among Medically Underserved: The Role of Demographic Factors, Social Influence, and Religious Beliefs

“…For example, prior studies conducted among FQHC patients in Louisiana found that between 52%−54% of participants had literacy skills at less than 9th grade level (Arnold et al, 2012; Arnold, Rademake, Liu, & Davis, 2017). Understanding relationships between health literacy and sociodemographic and psychosocial factors may help identify individuals at risk for low health literacy as well as help us to effectively target materials for individuals at risk for low health literacy receiving services in community clinics.…”

Follow‐up approaches to a health literacy intervention to increase colorectal cancer screening in rural community clinics: A randomized controlled trial

“…23,[30][31][32][33][34][35][36] The survey was written on a fourth-grade level and administered orally. 23,[30][31][32][33][34][35][36] The survey was written on a fourth-grade level and administered orally.…”

“…30,[38][39][40] The Health Belief Model and Social Cognitive theories guided the framing of the intervention to address the salience of CRC screening and the need to take action. 30,[38][39][40] The Health Belief Model and Social Cognitive theories guided the framing of the intervention to address the salience of CRC screening and the need to take action.…”

“…27,[30][31][32][33][34][35][36] Building on national recommendations and our previous heath literacy-directed CRC screening research, the purpose of the current study was to compare the effectiveness of a health literacy education strategy to promote CRC screening among patients at rural community clinics using the FIT combined with 2 telephone follow-up strategies: an automated telephone call (AC) or a personal call (PC). 27,[30][31][32][33][34][35][36] Building on national recommendations and our previous heath literacy-directed CRC screening research, the purpose of the current study was to compare the effectiveness of a health literacy education strategy to promote CRC screening among patients at rural community clinics using the FIT combined with 2 telephone follow-up strategies: an automated telephone call (AC) or a personal call (PC).…”