ColoNav: patient navigation for colorectal cancer screening in deprived areas – Study protocol

Allary, Camille; Bourmaud, Aurélie; Tinquaut, Fabien; Oriol, Mathieu; Kalecinski, J.; Dutertre, V.; Lechopier, Nicolas; Pommier, Marc; Benoist, Yann; Rousseau, Sally; Regnier, V.; Buthion, Valérie; Chauvin, Franck

doi:10.1186/s12885-016-2469-9

Cited by 6 publications

(7 citation statements)

References 27 publications

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“…The COLONAV study (2,4) found that peer navigators, unaffiliated with healthcare structures, succeeded in increasing participation in colorectal cancer screening in disadvantaged geographical areas. As opposed to studies in other countries, this study showed that deprived communities in France were inadequately identified using ethnicity or residential neighbourhood.…”

Section: Trial Resultsmentioning

confidence: 99%

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Which communication strategies can improve interventions aimed at tackling social inequalities in organized cancer screening in France?

Bourmaud

Chauvin

2021

Glob Health Promot

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Interventions to increase participation in cancer screening programs have been developed and evaluated by our research team. The results observed provide an opportunity to consider which methods of communication should be encouraged to improve those interventions. The objective of this commentary is to recommend communication strategies which should be adopted to efficiently reach and support disadvantaged individuals to engage in cancer screening, as a healthy behaviour.

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Section: Trial Resultsmentioning

confidence: 99%

“…In France, participation in screening programs (SP) for either colorectal or breast cancer does not meet objectives and varies significantly according to individuals' socioeconomic status (1,2). Interventions to increase participation in cancer SP have been developed and evaluated by our research team.…”

Section: Introductionmentioning

confidence: 99%

Which communication strategies can improve interventions aimed at tackling social inequalities in organized cancer screening in France?

Bourmaud

Chauvin

2021

Glob Health Promot

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“…In reality most realist evaluations in health are qualitative in nature and any quantitative analysis focuses on outcomes, tending to either be descriptive or use hypothesis testing to assess statistical significance before and after intervention implementation [ 28 ]. Few use more advanced statistical modelling techniques, such as interrupted time series or regression [ 29 , 30 ]. However, these techniques are used to compare outcomes across time or in different groups, rather than explore the relationship between context, mechanism and outcome configurations.…”

Section: Discussionmentioning

confidence: 99%

Access to primary care for socio-economically disadvantaged older people in rural areas: exploring realist theory using structural equation modelling in a linked dataset

Ford

Jones

Wong

et al. 2018

BMC Med Res Methodol

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BackgroundRealist approaches seek to answer questions such as ‘how?’, ‘why?’, ‘for whom?’, ‘in what circumstances?’ and ‘to what extent?’ interventions ‘work’ using context-mechanism-outcome (CMO) configurations. Quantitative methods are not well-established in realist approaches, but structural equation modelling (SEM) may be useful to explore CMO configurations. Our aim was to assess the feasibility and appropriateness of SEM to explore CMO configurations and, if appropriate, make recommendations based on our access to primary care research. Our specific objectives were to map variables from two large population datasets to CMO configurations from our realist review looking at access to primary care, generate latent variables where needed, and use SEM to quantitatively test the CMO configurations.MethodsA linked dataset was created by merging individual patient data from the English Longitudinal Study of Ageing and practice data from the GP Patient Survey. Patients registered in rural practices and who were in the highest deprivation tertile were included. Three latent variables were defined using confirmatory factor analysis. SEM was used to explore the nine full CMOs. All models were estimated using robust maximum likelihoods and accounted for clustering at practice level. Ordinal variables were treated as continuous to ensure convergence.ResultsWe successfully explored our CMO configurations, but analysis was limited because of data availability. Two hundred seventy-six participants were included. We found a statistically significant direct (context to outcome) or indirect effect (context to outcome via mechanism) for two of nine CMOs. The strongest association was between ‘ease of getting through to the surgery’ and ‘being able to get an appointment’ with an indirect mediated effect through convenience (proportion of the indirect effect of the total was 21%). Healthcare experience was not directly associated with getting an appointment, but there was a statistically significant indirect effect through convenience (53% mediated effect). Model fit indices showed adequate fit.ConclusionsSEM allowed quantification of CMO configurations and could complement other qualitative and quantitative techniques in realist evaluations to support inferences about strengths of relationships. Future research exploring CMO configurations with SEM should aim to collect, preferably continuous, primary data.Electronic supplementary materialThe online version of this article (10.1186/s12874-018-0514-x) contains supplementary material, which is available to authorized users.

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“…The study was approved by an institutional review board (Ethical Committee of Saint Etienne University Hospital, 10 th of January 2013), which waived the need for signed informed consent according to French law, since the study involved healthy people and proposed no treatment. The study protocol has been detailed elsewhere [20].…”

Section: Methodsmentioning

confidence: 99%

Patient navigation for colorectal cancer screening in deprived areas: the COLONAV cluster randomized controlled trial

et al. 2023

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Background The objective of this study was to assess the effectiveness of a Patient Navigation Intervention targeting deprived patients for Colo-Rectal Cancer (CRC) screening participation. Methods A cluster randomized controlled trial was conducted in 5 districts. Peer Lay Patient Navigators were recruited to operate in deprived areas. Eligible participants had to be between 50 and 74 years old, live in these deprived areas and receive an invitation to the nationally organized Colo-Rectal Cancer (CRC) screening during the study period. The theory-driven navigation intervention was deployed for 18 months. A population Health Intervention Research assessment method was used to assess effectiveness and context interaction. The primary criterion was screening participation at 12 months. Results Twenty-four thousand two hundred eighty-one individuals were included inside 40 clusters. The increase in participation in the intervention group was estimated at 23%, (ORa = 1.23, CI95% [1.07–1.41], p = 0.003). For the subgroup of individuals who participated, the time delay to participating was reduced by 26% (ORa = 0.74, CI95% [0.57–0.96], p = 0.021). Main factors modulating the effect of the intervention were: closeness of navigator profiles to the targeted population, navigators’ abilities to adapt their modus operandi, and facilitating attachment structure. Conclusion The ColoNav Intervention succeeded in demonstrating its effectiveness, for CRC screening. Patient Navigation should be disseminate with broader health promotion goals in order to achieve equity in health care. Trial registration clinicaltrials.gov NCT02369757 24/02/2015.

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ColoNav: patient navigation for colorectal cancer screening in deprived areas – Study protocol

Cited by 6 publications

References 27 publications

Which communication strategies can improve interventions aimed at tackling social inequalities in organized cancer screening in France?

Which communication strategies can improve interventions aimed at tackling social inequalities in organized cancer screening in France?

Access to primary care for socio-economically disadvantaged older people in rural areas: exploring realist theory using structural equation modelling in a linked dataset

Patient navigation for colorectal cancer screening in deprived areas: the COLONAV cluster randomized controlled trial

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