Impact of a health literacy intervention combining general practitioner training and a consumer facing intervention to improve colorectal cancer screening in underserved areas: protocol for a multicentric cluster randomized controlled trial

Abstract

Background Colorectal cancer (CRC) is a leading cause of cancer burden worldwide. In France, it is the second most common cause of cancer death after lung cancer. Systematic uptake of CRC screening can improve survival rates. However, people with limited health literacy (HL) and lower socioeconomic position rarely participate. Our aim is to assess the impact of an intervention combining HL and CRC screening training for general practitioners (GPs) with a pictorial brochure and video targeting eligible patients, to increase CRC screening and other secondary outcomes, after 1 year, in several underserved geographic areas in France. Methods We will use a two-arm multicentric randomized controlled cluster trial with 32 GPs primarily serving underserved populations across four regions in France with 1024 patients recruited. GPs practicing in underserved areas (identified using the European Deprivation Index) will be block-randomized to: 1) a combined intervention (HL and CRC training + brochure and video for eligible patients), or 2) usual care. Patients will be included if they are between 50 and 74 years old, eligible for CRC screening, and present to recruited GPs. The primary outcome is CRC screening uptake after 1 year. Secondary outcomes include increasing knowledge and patient activation. After trial recruitment, we will conduct semi-structured interviews with up to 24 GPs (up to 8 in each region) and up to 48 patients (6 to 12 per region) based on data saturation. We will explore strategies that promote the intervention’s sustained use and rapid implementation using Normalization Process Theory. We will follow a community-based participatory research approach throughout the trial. For the analyses, we will adopt a regression framework for all quantitative data. We will also use exploratory mediation analyses. We will analyze all qualitative data using a framework analysis guided by Normalization Process Theory. Discussion Limited HL and its impact on the general population is a growing public health and policy challenge worldwide. It has received limited attention in France. A combined HL intervention could reduce disparities in CRC screening, increase screening rates among the most vulnerable populations, and increase knowledge and activation (beneficial in the context of repeated screening). Trial registration Registry: ClinicalTrials.gov. Trial registration number: 2020-A01687-32. Date of registration: 17th November 2020.

Long-term benefits for lower socioeconomic groups by improving bowel screening participation in South Australia: A modelling study

“…Lack of social norms are also predictors of non-participation in cancer screening [ 41 ]. Improving health literacy will help patients increase their knowledge and understanding of bowel cancer screening, leading to an increase in screening uptake, a decrease in the social inequalities in screening and potential inequalities in survival [ 7 , 42 ].…”

“…The National Bowel Cancer Screening Program (NBSCP) was introduced in Australia in 2006. Age-specific participation rates of screening have been increasing however, Australians from the lowest socioeconomic group had a lower participation rate (40%) compared to those in the highest group (45%) in 2019 [ 7 ].…”

“…a low capacity to obtain, process, understand and use healthinformation) disproportionately affects people from lower socioeconomic positions [ 6 ]. Limited health literacy is a significant barrier to bowel screening that influences screening knowledge, beliefs and behaviour [ 7 ].…”

Effect of WeChat-Based Health Education Combined with Satir Model on Self-Management Behaviors and Social Adaptation in Colorectal Cancer Patients during the Perioperative Period

“…Scholars Austin George et al, found that health education can reduce the perioperative anxiety of patients before surgery and reduce their psychological stress, which is good for enhancing the perioperative nursing outcomes [ 7 ]. Information-based nursing has now become an important trend in the development of the nursing field, and hence, health education shall also be based on informatization to fully enhance its efficiency [ 8 ]. WeChat is the most commonly used communication software for Chinese residents.…”

Interventions for the promotion of health literacy in colorectal cancer screening: a scoping review

“…2 Health Literacy (HL), as a mediator in decision-making, can be fundamental in adhering to this screening. 3,4 Objective To map the interventions that promote Health Literacy within the scope of CCR screening.…”