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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) mortality disproportionately impacts those with low income. Few studies have addressed screening among low income individuals in primary care. Unique strategies may be needed to surmount the limited awareness, fear and perceived discomfort that some low-income individuals associate with CRC screening tests. This study will assess the efficacy of a novel tailored touch screen computer intervention based on an innovative integration of the Precaution Adoption Process Model (PAPM) and the concept of "implementation intentions," a highly significant recent elaboration of the Theory of Planned Behavior. The majority of the intervention will be delivered in primary care settings on low-cost touch screen computers through multimedia audio-narrative and video messages. Studies have not tested the effectiveness of tailored communications specified to stated "implementation intentions" for improving CRC screening. A randomized design will test a comparison condition of generic information versus a multimedia tailored intervention that specifically addresses each participant's screening test modality preference, current CRC screening decisional stage (PAPM), and CRC screening "implementation intentions" (the "when," "where" and "how" details of screening). Behavioral intervention materials in English and Spanish will be developed with the help of cultural experts, pilot tests, and from focus groups that will test salience and cultural appropriateness of audio, video and graphic messages for low-income minorities and whites. The study will be conducted with 460 patients eligible for CRC screening and recruited while presenting for care in urban clinics. All participants will receive a baseline touch screen administered assessment and, depending on stated preference, be offered either an immunochemical fecal occult blood test (iFOBT-lnSure(tm)), colonoscopy, or sigmoidoscopy. Participants will be randomized to either C (comparison group-computer delivered generic CRC information) or Tl2 (active intervention-computer delivered tailored messaging based on individual PAPM stage, behavioral constructs, and "Implementation Intentions"). A brief office exit survey will assess patient-provider discussions of CRC screening and satisfaction with computerized message materials. A 90-day post randomization follow-up telephone call assessment with all participants will reassess PAPM stage and perceived CRC screening barriers. The primary outcome will be CRC screening completion at 90 days. Secondary outcomes will assess 90-day PAPM stage and perceived barriers among participants preferring various screening methods (sigmoidoscopy, colonoscopy, iFOBT). This intervention will provide information on the utility of embedding a low-cost technologically advanced "Implementation Intentions" based behavioral intervention in primary care practice.