Colorectal cancer (CRC) is the second most common cancer among African Americans (AAs) in the United States and CRC mortality is greater for AAs than for Caucasians. Clinical research indicates that a substantial number of CRC deaths could be prevented through appropriate screening, followed by relatively simple surgical procedures to remove polyps. Unfortunately the majority of the population does not get screened. This problem is even worse for AAs, whose adherence to national screening recommendations is significantly lower than for white. Unfortunately, efforts to increase screening participation through the provision of educational materials have been largely ineffective. Growing evidence suggests that traditional interventions are not sensitive to the diverse levels of motivation, or differences in cultural values of those targeted for intervention. Traditional interventions present standard information in a single idiom and format, which do not insure a match between what is presented, and what the individual needs or can use. It comes down to the problem that one size does not fit all; one intervention is unlikely to be effective with all individuals. Interventions must be designed so that they can be individualized to meet the level of a person's motivation/readiness to change, and his/her cultural values and beliefs. Research suggests that these issues are especially important in the development of interventions to change preventive health behaviors in minority populations. This problem will be examined in the proposed randomized clinical trial of stage matched, culturally sensitive intervention to increase participation in CRC screening of AAs age 51 years or older. l_he proposed research builds on: the investigators' prior research on cancer screening in minority groups, their studies of staged-matched intervention in cancer prevention, and their research on barriers to adequate standards of care in minority groups. It will be conducted in collaboration with the East Harlem Partnership for Cancer Awareness, an NCI funded program seeking to: increase knowledge about cancer, its prevention and treatment among medically underserved minority groups and increase their participation in cancer prevention and control research.
Specific Aims : 1. Investigate the impact of the combination of culturally sensitive and stage-matched (CS/S-M) psychoeducational intervention to increase CRC screening in AAs 51 years of age and older on: a) their readiness to undergo endoscopic CRC screening (stage); b) their participation in endoscopic CRC screening; and c) their knowledge, attitudes and feeling about CRC and CRC. The impact of the CS/S-M intervention will be compared to that of culturally sensitive, stage-matched and standard CRC interventions. 2. Explore the influence of socio-demographic, health care, and cultural factors on the impact of the culturally sensitive and stage-matched intervention. 3. Develop a mediational model of how the interventions work (e.g., through their impact on knowledge or attitudes).
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