Colorectal cancer (CRC) mortality disproportionately impacts minorities. Few studies have addressed screening among specific minority populations such as American Indians (AI). This study will assess the efficacy of a novel tailored touch screen computer intervention based on an innovative integration of the Precaution Adoption Process Model (PAPM) and the concept of "implementation intentions," a recent elaboration of the Theory of Planned Behavior. The majority of the intervention will be delivered in tribal clinics and primary care settings on low-cost touch screen computers through multimedia audio-narrative and video messages. Studies have not tested the effectiveness of culturally tailored communications specified to stated "implementation intentions" for improving CRC screening in this group. A randomized design will test a comparison condition of generic information versus a multimedia tailored intervention that specifically addresses each participant's screening test modality preference, current CRC screening decisional stage (PAPM), and CRC screening "implementation intentions" (the "when", "where" and "how" details of screening). Behavioral intervention materials will be developed with the help of cultural experts, a pilot test, and from data gathered in a prior focus group study we used to assess key influences on CRC screening for AIs. The study will be conducted with 460 AI patients eligible for CRC screening and recruited while presenting for care in tribal or regional safety-net clinics. All participants will receive a baseline touch screen administered assessment and, depending on stated preference, be offered either an immunochemical fecal occult blood test (iFOBT-InSure TM) or colonoscopy. Participants will be randomized to either C (comparison group-computer delivered generic CRC information) or AI2 (active intervention-computer delivered culturally tailored messaging based on individual PAPM stage, behavior constructs, and "Implementation Intentions"). A brief office exit survey will assess patient-provider discussions of CRC screening and satisfaction with computerized message materials.
Colorectal Cancer is a major cause of cancer mortality and late stage presentation is common among minorities. American Indians, receive colorectal cancer screening at very low rates and face important cultural barriers to care in the health care system. This study is relevant to overarching approaches to reduce AI cancer health disparities because it tests a novel behavioral intervention and culturally tailored materials to improve rates of colorectal cancer screening in this underserved population group.