) Women and members of minority groups have traditionally been under-represented in clinical research. This study is unique in that it is theory-driven and targets the most under-served and under-represented group for cancer screening. It is this study's aim to identify effective recruitment strategies for economically disadvantaged African-American women that will result in increased knowledge, positive attitudes and participation in a colorectal program. The quasi-experimental pretest, post-test, two-by-two design will investigate the effect of four recruitment strategies on attendance of a colorectal cancer educational program and participation in fecal occult blood test screening (FOBT). Social Learning Theory and the Social Marketing Process provide the theoretical framework and implementation guide for this research. The interventions are: (1) Targeted Health Messages Only (control group), (2) Targeted Health Messages with Incentives, (3) Targeted Health Messages with Project Liaison, and (4) Targeted Health Messages with Incentives and Project Liaison. The targeted health messages will use content on colorectal cancer available from the American Cancer Society adapted to the literacy level of the subjects and will be culturally sensitive. The Project Liaison will involve using a peer to encourage subjects' program attendance one week prior to the program and then encourage completing and returning the FOBT within one week of the program. The sample will consist of 520 economically disadvantaged African-American women, between 50 and 75 years old, who are residents of public housing in Richland County, South Carolina. Six weeks following the return of the FOBT the subjects will complete a post-test. The dependent variables will be attendance of the program and completion and return of the FOBT. The independent variable will be the four recruitment strategies. Control variables will be the knowledge of colorectal cancer, exposure to cancer demographic variables and previous experience with colorectal cancer screening procedures. Study instruments include pre- and post-test interviews, focus groups, one-to-one interviews and fecal occult blood test results. Logistic regression and multivariate categorical analyses will be performed. A process evaluation will provide ongoing feedback for implementation of the study. The research responds to the National Cancer Institute and American Cancer Society priorities of early cancer detection and targeting the socioeconomically disadvantaged, women and minorities in research endeavors. Products of this research will include tested recruitment methods for use with low-income African-American women and tested literacy, and culturally appropriate educational materials. Feasible, cost effective recruitment strategies such as those used in this study, if found to be effective, could be replicated nationwide.
