Rural Appalachian Kentuckians suffer a disproportionate incidence and mortality from colorectal cancer (CRC), the second leading cause of cancer death. The Centers for Disease Control estimate that as many as 60 percent of CRC related deaths could be prevented if everyone age 50 and older were screened regularly. Rural Appalachian residents are currently being screened at suboptimal rates. The proposed intervention builds on our successful cancer prevention projects: Faith Moves Mountains: A CBPR Appalachian Wellness and Cancer Prevention Program and Promoting Mammography among African American Women Visiting the Emergency Departments. Both projects involve lay health advisor (LHA) delivered motivational interviewing interventions that have been culturally tailored. We propose to pilot test a culturally tailored intervention using brief motivational interviewing by LHAs to promote CRC screenings in an emergency department (ED) serving rural Appalachian Kentucky in order to (1) evaluate the feasibility of the intervention in this rurl Appalachian setting;and (2) assess the effects of the intervention on perceived barriers to CRC screening and subsequent cancer screening engagement. Consistent with our current Faith Moves Mountains and Promoting Mammography projects, we will train carefully selected community members (LHAs) to deliver a brief motivational interview while participants wait for non-urgent care in the ED or wait with a family member who is receiving care. Each participant, in conjunction with the LHA, will develop a written plan of action that addresses their identified barriers to screening. The brief intervention will take about 15 minutes and will be delivered in a private area of the ED. Control group participants will receive standard-of-care ED services that include brochure information identifying general cancer screening services provided by the hospital. Outcome measures will include assessment of barriers and receipt of CRC screening and will be measured at three and six months post intervention. The results will serve as preliminary data for a multisite rural ED-based clinical trial evaluating the cancer promotion intervention.
