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Table 5 Interventions for improving uptake of CRC screening in disadvantaged and minority groups

From: Australia's National Bowel Cancer Screening Program: does it work for Indigenous Australians?

Approach Study Type Screening type Population group targeted Observed changes in screening uptake or intent to screen for CRC
1. Organizational/system changes     
Patient navigators to overcome patient reported barriers from screening to treatment [123] RCT Any CRC screening Low income and non-English speaking Uptake of CRC screening post-intervention was 27% vs 12% (p‹ 0.001) before intervention.
Culturally sensitive patient navigators and physician recommendation [124] RCT Endoscopy and FOBT Low income, Hispanic patients attending primary care practice Completion of endoscopy 6 months post intervention was 15.8% in intervention group vs 5% in control (physician recommendation only) (p= 0.019)
Completion of FOBT 3 months post intervention was 42.1% in intervention group vs 25% in control group (p = 0.086)
Patient navigator combined with reminder letter [125] Intervention Any CRC screening English speaking, Immigrants from Brazil, Portugal & Haiti 31% of intervention group vs 9% control patients completed screening after 6 months
2. Targeting of healthcare users     
Culturally appropriate intervention using health educator and bilingual educational material [126] RCT FOBT Chinese Americans Uptake of FOBT after 6 months was 69.5% intervention group vs 27% control group
Personalized and tailored interventions [127, 128]
Four groups;
1-Tailored intervention
2-Standard intervention
3-Tailored intervention plus phone reminder
4-Control
RCT [128] Any CRC screening Mixture of African American (58%) and white Screening assessed 2 years post intervention:
Screening completion among those in the intervention groups ranged from 44-48% vs 33% control group (p‹0.05) [128]
Storytelling to promote CRC screening [110, 129] RCT Endoscopy Low SES Latino Intent to obtain CRC screening via endoscopy increased in those exposed to storytelling compared to those exposed to risk tool based information (p = 0.038)
Community based awareness and educational interventions [130] Participatory using intervention material developed through participatory approach Any CRC screening Rural white Intention to screen increased significantly in those exposed to educational materials and who had not been tested in the last 5 yrs compared to those that had (p = 0.025).
Community-based participatory [131]
Using culturally relevant approach and education held on a ‘family day'. Followed by intensive follow-up and encouragement of participants by letters and phone calls
Participatory Any CRC screening Rural Native Hawaiian in Hawaii Increase in compliance with CRC screening in both men and women.
CRC screening 6 months post intervention increased in men from 39% to 75% (p = 0.002) and in women 36% to 76% (p = 0.002)
Limitations- small sample size (28 men and 25 women)
Culturally appropriate education to enhance knowledge and screening [132]
Assigned to one of three groups:
1. Cultural & self-empowerment group
2. Traditional group
3. Modified cultural group
4. Control
Experimental/repeated measures FOBT African-American Elders Knowledge assessed at 6 and 12 months. FOBT screening assessed at 12 months and found greater participation in those in Cultural & Self Empowerment group.
Intensive one-on-one patient education [133] RCT FOBT Ethnically diverse group Proportion of patients returning FOBT was significantly higher in intensive education group compared with those receiving standard education (65.6% vs 51.3% p‹0.01)
Telephone support intervention [134] RCT Any CRC screening Minority, low income women Proportion of women completing CRC screening increased from 39% to 54% in the intervention group and 39% to 50% in the control group (p = 0.13)
Tailored telephone outreach [135] RCT Any CRC screening Minority CRC screening compliance 6 months post intervention was 27% in intervention group vs 6.1% in control group (mailed print material)
Education with Elderly Educators [136]
Four educational methods:
1. Elderly Educators
2. Elderly Educators plus Adaption for Aging Changes method
3. Adaption for Aging Changes method
4. Traditional method
2-by-2 factorial design FOBT Socioeconomically disadvantaged African Americans and White Participation in FOBT was 93% in those receiving combination of Elderly Educators plus Adaption for Aging Changes method, 63% in those exposed to Elderly Educators only and 43% participation in those receiving Adaptation for Aging changes method only and 56% exposed to traditional method.
Video-based education [137] RCT FOBT Majority had less than high school education 69.6% of intervention group returned FOBT vs 54.4% in control group (p = 0.035)