Final Results of a 3-Year Literacy-Informed Intervention to Promote Annual Fecal Occult Blood Test Screening

Arnold, Connie L.; Rademaker, Alfred; Wolf, Michael S.; Liu, Dachao; Lucas, Geoff; Hancock, Jill; Davis, Terry C.

doi:10.1007/s10900-015-0146-6

Cited by 14 publications

(14 citation statements)

References 34 publications

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“…Previous studies have indicated that CRC screening completion is influenced not only by patients’ knowledge but their beliefs about screening and their confidence in being able to obtain and complete the test [16,36,40,41]. After the study intervention, patients in all three arms patients were more likely to view FOBTs positively, reporting that the test aids in decreasing the chances of dying from CRC.…”

Section: Discussionmentioning

confidence: 99%

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

Arnold¹,

Rademaker²,

Liu³

et al. 2017

J Community Med Health Educ

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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.

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Section: Discussionmentioning

confidence: 99%

“…Less than half reported that had ever received a physician recommendation for screening or been given an FOBT kit - two of the strongest determinants of screening completion [16,36,40–45]. In each of the study arms patients were given a recommendation for screening and an FOBT kit by study staff.…”

Section: Discussionmentioning

confidence: 99%

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

Arnold¹,

Rademaker²,

Liu³

et al. 2017

J Community Med Health Educ

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“…CRC screening completion is influenced not only by patients’ knowledge but their beliefs about screening and their confidence in being able to obtain and complete the test [12, 30–31]. Our finding that rural women wanted to know if they have CRC and have positive beliefs about FOBT suggests strengths that need to be utilized in future approaches to improve screening.…”

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators to Colorectal Cancer Screening Among Rural Women in Community Clinics by Heath Literacy

Davis¹,

Morris²,

Rademaker³

et al. 2017

J Womens Health, Issues Care

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Background Rural women lag rural men and urban women in colon cancer (CRC) screening completion. Objective To identify rural female patients’ knowledge, beliefs barriers, self-efficacy, prior recommendation and completion of CRC screening using an FOBT and to compare these factors by health literacy (HL) level. Methods This descriptive study was conducted between 2015 and 2016 in 4 rural community clinics in south Louisiana. Patients overdue for screening were given a structured interview by a research assistant. Results 339 women were enrolled, mean age 58.5, 32% had limited HL, 66% were African American. Most (91.7%) had heard of CRC, yet only 71% knew of any CRC screening tests. Women with adequate HL had greater knowledge of specific tests than those with limited HL (78.4% vs 56.6%, p<0.001). Only 25.7% had been given information on CRC testing; those with adequate HL were more likely to have received information (30.1% vs 16.8%; p=0.017). Most women (93.2%) indicated they would want to know if they had CRC, while 72.2% reported a provider had recommended CRC screening. Only 24.9% said a healthcare provider had ever given them an FOBT or that they had ever completed an FOBT (22.7%). There were no differences in women’s report of recommendation or completion by HL level. Self-efficacy for completing an FOBT was high; over 90% indicated they could get an FOBT, complete it and mail results to the lab. Level of confidence did not vary by literacy. Three of the four barrier items varied by HL with women with low HL being more likely to fear doing an FOBT because they thought FOBT instructions would be confusing (p=0.002), doing the test would be embarrassing (p=0.025) or messy (p=0.057). Conclusions Rural women are receptive to CRC screening and view FOBTs as effective. Rural community clinics need to provide low cost FOBTs with literacy, gender and culturally appropriate information.

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“…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.…”

Section: Structured Surveymentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Arnold

Rademaker

Morris

et al. 2019

Cancer

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BACKGROUND: Significant disparities exist in colorectal cancer (CRC) screening rates among those of low socioeconomic status, with fewer years of education, lacking health insurance, or living in rural areas. METHODS: A randomized controlled trial was conducted to compare the effectiveness of 2 follow-up approaches to a health literacy intervention to improve CRC screening: automated telephone call or personal call. Patients aged 50 to 75 years residing in 4 rural community clinics in Louisiana were given a structured interview that assessed demographic, health literacy and CRC screening barriers, knowledge, and attitudes. All were given health literacy-informed CRC education, a patient-friendly CRC screening pamphlet, simplified fecal immunochemical test (FIT) instructions, and a FIT kit, and a "teach-back" method was used to confirm understanding. Patients were randomized to 1 of 2 telephone follow-up arms. If they did not mail their FIT kit within 4 weeks, they received a reminder call and were called again at 8 weeks if the test still was not received. RESULTS: A total of 620 patients were enrolled. Approximately 55% were female, 66% were African American, and 40% had limited literacy. The overall FIT completion rate was 68%: 69.2% in the automated telephone call arm and 67% in the personal call arm. Greater than one-half of the patients (range, 58%-60%) returned the FIT kit without receiving a telephone call. There was no difference noted with regard to the effectiveness of the follow-up calls; each increased the return rate by 9%. CONCLUSIONS: Providing FIT kits and literacy-appropriate education at regularly scheduled clinic visits with a follow-up telephone call when needed was found to increase CRC screening among low-income, rural patients. The lower cost automated call was just as effective as the personal call. Cancer 2019;125:3615-3622.

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Final Results of a 3-Year Literacy-Informed Intervention to Promote Annual Fecal Occult Blood Test Screening

Cited by 14 publications

References 34 publications

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

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

Barriers and Facilitators to Colorectal Cancer Screening Among Rural Women in Community Clinics by Heath Literacy

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

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