Colorectal Cancer (CRC) mortality rates are 43% higher among African Americans (AAs) than whites. Onestrategy to reduce this disparity is to increase early detection. Ethnic differences exist in the determinants ofscreening behavior. For example, AAs may be more likely to prefer a 'physician-dominated' communicationstyle around CRC screening than whites and they may be more likely to rely on family than their physicians.Accounting for these differences through tailoring interventions could significantly potentiate interventionefficacy. Motivational Interviewing (Ml) may further help reduce resistance to CRC screening. The proposedrandomized trial will test three increasingly intensive interventions to increase CRC screening among AAmembers of an integrated health care system (Henry Ford Health System - HF). Adult AAs, of average CRCrisk but not meeting USPSTF recommendations for screening, ages 50-80 will be randomized to one of threegroups: 1) Basic Tailoring: Three CRC-related newsletters, individually-tailored on age, gender, healthhistory, and prior CRC screening. 2) Enhanced Tailoring: Basic tailoring PLUS screening preferences, ethnicidentity, communication style and motivational predisposition. 3) Enhanced Tailoring PLUS Ml: Enhancedtailoring PLUS one telephone counseling contact by trained health educators using Ml. Group 1 will receive aprint intervention individually tailored on variables already in the HF electronic medical record (EMR). Groups 2& 3 will receive a print intervention tailored on additional variables that necessitate new data collection. Group3 adds intervention intensity with the inclusion of a single Ml telephone contact. In our prior CECCR studies,we found tailoring on ethnic identity and motivational predisposition was feasible, and for identifiablesubgroups, efficacious. Approximately 1,400 subjects will be enrolled using the HF EMR. The primary outcomewill be CRC screening status at 1-year posttest determined by HF computerized records. Analyses will beperformed to determine the cost-effectiveness of the interventions. Throughout the study, we will work with theclinical, cultural competence, and administrative leadership at HF to maximize the likelihood of adoption by HFand others should the tailored programs be found to be effective.
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