The disproportionate burden of CRC persists among racial-ethnic minorities and other medically underserved populations despite increased availability of beneficial screening tests. To address this gap, we propose an innovative theory-based educational intervention delivered in federally qualified health centers and health department clinics to improve patient awareness about colorectal cancer screening (CRCS), facilitate patient-provider discussion of CRCS, and increase uptake of CRCS among average risk individuals. We build on our established community-academic partnerships and the community-based participatory research framework as the foundation for a two-phase project entitled "Colorectal Cancer Awareness, Research, Education and Screening" (CARES).
The aim of Phase 1 (year 1) is to design and produce a CARES toolkit consisting of a DVD and photonovella booklet, screening readiness card, and reminder postcard intended for a diverse medically underserved population. A total of 107 individuals will take part in the formative research, which uses a health literacy framework as a basis for developing the educational tool kit. In Phase 11 (Years 2-5), the aims ofthe prospective, longitudinal, randomized communitybased intervention study are to: assess efficacy of CARES tool kit vs. a standard brochure intervention (SI) on CRCS uptake;assess whether Preventive Health Model variables mediate intervention effects;and examine cost-effectiveness. In this phase, a total of 420 men and women aged 50-75 years, will be recruited and randomized to either the CARES condition or SI (210 in each arm). Both groups will receive free immunochemical fecal occult blood test (1-FOBT) kits as part of the intervention. I-FOBT and overall (any test) screening uptake will be evaluated at 12 months and compared between conditions. It is expected that the CARES intervention will be associated with greater screening uptake (FOBT and other screening) and cost effectiveness that the SI condition. Multivariable regression analysis will be used to assess factors associated with intervention effects.
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