Research Project 3

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Test Up Now Education Program (TUNE-UP). Project Summary African Americans experience higher incidence and mortality from colorectal cancer (CRC) than non-Hispanic whites. While CRC cancer death rates across the US have declined, in Southern states the decline has been slower compared to other regions. CRC cancer deaths could be prevented with increased CRC screening. Epidemiological data indicate cancer health disparities for African Americans compared to whites. To address these disparities, this research project will test the effectiveness of a Community Health Advisor (CHA) educational intervention to increase CRC screening among African Americans. According to the results of a randomized trial focused on CRC screening for African Americans, patient education using a personal phone call and navigation effectively increased screening by approximately 18% (Cole et al. 2017). Our research hypothesis is that an innovative CHA intervention using an adapted version of the National Cancer Institute Screen to Save materials and combining in-person, phone contact, and text messaging will increase CRC screening among those who are non-adherent by 15% or more compared to a control group who do not receive the CHA intervention. The hypothesis will be tested by pursuing three Specific Aims. The first aim is to evaluate the effectiveness of a CHA intervention for increasing CRC screening among a sample of African Americans who are not up-to-date with screening. The second aim is to explore the effect of the intervention on mediator and moderator variables associated with the receipt of CRC screening. The third aim is to conduct a cost- effectiveness analysis of the CHA intervention. Two African American CHAs will be recruited from the community to deliver the intervention. This research project proposes a randomized, two-arm, parallel study design to compare the effect of a CHA intervention on receipt of CRC screening after three and 12 months in the intervention group compared to an “information-only” control group. The primary outcome is receipt of any modality of CRC screening (e.g., colonoscopy or fecal immunochemical test, FIT). The researchers will also examine acceptability of the intervention as well as changes in other indicators (knowledge, self-efficacy, intention to screen and CRC screening preferences). The potential impact of this study will be the implementation and dissemination of an intervention to increase CRC screening among African Americans that is low-cost, effective, and easily implemented. The results will contribute to the research area of screening interventions through comparisons with other studies using clinic-oriented approaches and other client-oriented interventions. The project’s long-term objective is to provide justification for a future effectiveness trial using multiple sites in Florida experiencing CRC health disparities and examine implementation logistics in system-wide settings.