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Changes in Colorectal Cancer Screening Knowledge, Behavior, Beliefs, Self- Efficacy, and Barriers among Community Health Clinic Patients after a Health Literacy Intervention

Arnold CL, Rademaker A, Liu D and Davis TC

Objective: The objective in this pre- and post-survey assessment was to compare the effectiveness of a health literacy-directed intervention designed to increase knowledge, beliefs, barriers, self-efficacy and behavior associated with CRC screening with FOBT among patients cared for in predominantly rural community clinics and the change in these characteristics over the first 15 months after enrolling in a study designed to assess screening strategies.

Methods: Between 2008 and 2011, a quasi-experimental intervention was conducted in 8 predominantly rural Federally Qualified Health Centers. Patients were orally administered a 15-minute survey at enrollment by a clinic research assistant (RA) and at 15 months by phone by a central RA. Participants included 428 community clinic patients aged 50-85 (mean 58.5); the majority (79%) were female, 69% were African American, and 54% had limited health literacy.

Results: There was significant improvement across all groups with the number of patients reporting they had been given information /education on CRC testing (p<0.0001), been given an FOBT kit (p<0.0001), and completed an FOBT (p<0.0001) with significant improvement in having a doctor recommendation in all groups except usual care. Confidence in an FOBT’s potential to decrease chances of dying from CRC improved across all groups as well (p<0.002). In addition, patients ‘belief that they would get CRC in their lifetime’ decreased across all groups postintervention (p<0.03) as did their worry that they may find out they have CRC (p<0.04).

Conclusion: Overall these low income FQHC patients who were not up-to-date with screening had heard of CRC screening, had positive attitudes toward screening and wanted to know if they had cancer. Results demonstrate the value of giving patients a recommendation and a kit; patients in all groups reported significant increases at 15 months in completing CRC screening (>83%) as confirmed by study records.