Our primary aims are to: 1) test the effectiveness of a clinic-wide, health literacy (HL) intervention to improve initial and repeat use of colorectal (CRC) and breast cancer screening among eligible patients at Federally Qualified Health Centers (FQHCs) and 2) compare the effectiveness of the HL intervention, with and without a Prevention Nurse Case Manager (PNCM), on the screening rates of FQHC patients. The secondary aims are to: 3) evaluate the efficacy of the HL interventions to improve understanding, readiness, beliefs and self- efficacy toward CRC and breast cancer screening among patients at these FQHCs and 4) explore patient, provider, and system factors that facilitate or impede initial and repeat use of CRC and breast cancer screening among these low income patients. Eliminating disparities in cancer screening and outcomes is a national priority. Individuals with lower income and lower literacy skills have less knowledge and poorer attitudes concerning CRC and breast cancer screening and are at greater risk for not having received appropriate screening. African Americans and adults with low income have significantly higher rates of limited literacy skills. Recent reports by federal health agencies have called for evidence based strategies and longer-term system-level interventions to address health literacy barriers and improve health outcomes. Further, interventions to improve cancer screening need to move beyond initial screening and focus on improving repeat screening. This application addresses these concerns. We propose a five year multi-site, randomized controlled trial to evaluate the effectiveness of a patient and provider/ system-directed intervention to overcome barriers to breast and CRC screening caused by limited health literacy and cultural influences. Specifically, in the three arm study FQHCs are randomly assigned to receive either 1) the HL Intervention (patient education and ongoing provider training, prompting with a checklist, and CQI, as well as implementation of a computerized tracking system for cancer screening 2) the HL Intervention plus a PNCM (HL+ PNCM) to provide case management to overcome system-level barriers and to provide patients ongoing support to improve understanding, readiness, self-efficacy, and completion of initial and repeat cancer screening or 3) standard care with computer tracking system only. The health literacy interventions build off of extensive previous research by the investigators and are grounded in a multi-theoretical model.
| Arnold, Connie L; Rademaker, Alfred; Liu, Dachao et al. (2017) Changes in Colorectal Cancer Screening Knowledge, Behavior, Beliefs, Self-Efficacy, and Barriers among Community Health Clinic Patients after a Health Literacy Intervention. J Community Med Health Educ 7: |
| Arnold, Connie L; Rademaker, Alfred; Wolf, Michael S et al. (2016) Third Annual Fecal Occult Blood Testing in Community Health Clinics. Am J Health Behav 40:302-9 |
| Arnold, Connie L; Rademaker, Alfred; Wolf, Michael S et al. (2016) Final Results of a 3-Year Literacy-Informed Intervention to Promote Annual Fecal Occult Blood Test Screening. J Community Health 41:724-31 |
| Davis, Terry C; Arnold, Connie L; Wolf, Michael S et al. (2015) Joint breast and colorectal cancer screenings in medically underserved women. J Community Support Oncol 13:47-54 |
| Davis, Terry C; Arnold, Connie L; Bennett, Charles L et al. (2015) Sustaining mammography screening among the medically underserved: a follow-up evaluation. J Womens Health (Larchmt) 24:291-8 |
| Davis, Terry C; Rademaker, Alfred; Bennett, Charles L et al. (2014) Improving mammography screening among the medically underserved. J Gen Intern Med 29:628-35 |
| Davis, Terry C; Arnold, Connie L; Bennett, Charles L et al. (2014) Strategies to improve repeat fecal occult blood testing cancer screening. Cancer Epidemiol Biomarkers Prev 23:134-43 |
| Davis, Terry C; Rademaker, Alfred; Bailey, Stacy Cooper et al. (2013) Contrasts in rural and urban barriers to colorectal cancer screening. Am J Health Behav 37:289-98 |
| Davis, Terry; Arnold, Connie; Rademaker, Alfred et al. (2013) Improving colon cancer screening in community clinics. Cancer 119:3879-86 |
| Davis, Terry C; Arnold, Connie L; Rademaker, Alfred et al. (2012) Differences in barriers to mammography between rural and urban women. J Womens Health (Larchmt) 21:748-55 |
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