The long-term objective of this investigation is the development of efficacious and cost-effective methods to increase colorectal cancer screening adherence among men and women 50 or more years of age.
The specific aims of the study are to increase (1) fecal occult blood (FOB) test performance in an asymptomatic population, and (2) diagnostic evaluation appointment-keeping among persons found to have a """"""""positive"""""""" FOB test. We seek to achieve these goals by applying screening education and behavioral interventions in a population of more than 97,000 individuals who belong to HMO PA/NJ, and IPA/HMO, and who are mailed FOB tests annually in an established screening program known as US HEALTHCHECK. In Year 1 of the study, a random sample (n=18,236) of the target population will be selected into Panel A. Telephone surveys will be done with Panel A members prior to FOB test mailing, and with FOBT(+) test performers in order to establish baseline measures of health beliefs about colorectal cancer and screening. In Year 2, Panel A members will be assigned randomly to a control and two study groups. Control Group A will receive the normal US HEALTHCHECK measures ( a mailed FOB test kit and two FOB test performance reminders). Study Group 1A will be provided these measures, plus a self-held screening record (""""""""COLO-RECORD"""""""") and a FOBT (+) appointment-keeping phone call reinforcer. Study Group 2A will receive all of these measures and a FOB test performance phone call reinforcer. In Year 3, Panel B (n=18,236) will be randomly selected and assigned to new control and study groups. The intervention delivered to Control Group B and study Group 1B will be the same as in Year 1. However, Study Group 2B will receive and enhanced second version of the COLO-RECORD. In Year 4, Panel C (n=18,236) will be randomly drawn and allocated to control and study groups. Again, interventions to Control Group C and Study Group 1C will be the same as in the previous year. Study Group 2C, however, will be provided with a newly-revised third version of the COLO- RECORD. In Years 1, 2, 3 and 4, adherence will be measured in terms of FOB test performance and diagnostic evaluation appointment- keeping for population samples. Telephone survey data will be collected on selected population subsamples. Collection of these data will allow for (1) the testing of relationships among health beliefs, behavioral intention, health education, behavioral reinforcers and adherence. Data analysis will contribute to the development of interventions that may be applied at the community-level in populations at increased risk of colorectal cancer.