Increasing Colorectal Cancer Screening in African Americans: Tailoring and MI

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Colorectal Cancer (CRC) mortality rates are 43% higher among African Americans (AAs) than whites. One strategy to reduce this disparity is to increase early detection. Ethnic differences exist in the determinants of screening behavior. For example, AAs may be more likely to prefer a "physician-dominated" communication style around CRC screening than whites and they may be more likely to rely on family than their physicians. Accounting for these differences through tailoring interventions could significantly potentiate intervention efficacy. Motivational Interviewing (Ml) may further help reduce resistance to CRC screening. The proposed randomized trial will test three increasingly intensive interventions to increase CRC screening among AA members of an integrated health care system (Henry Ford Health System - HF). Adult AAs, of average CRC risk but not meeting USPSTF recommendations for screening, ages 50-80 will be randomized to one of three groups: 1) Basic Tailoring: Three CRC-related newsletters, individually-tailored on age, gender, health history, and prior CRC screening. 2) Enhanced Tailoring: Basic tailoring PLUS screening preferences, ethnic identity, communication style and motivational predisposition. 3) Enhanced Tailoring PLUS Ml: Enhanced tailoring PLUS one telephone counseling contact by trained health educators using Ml. Group 1 will receive a print intervention individually tailored on variables already in the HF electronic medical record (EMR). Groups 2 & 3 will receive a print intervention tailored on additional variables that necessitate new data collection. Group 3 adds intervention intensity with the inclusion of a single Ml telephone contact. In our prior CECCR studies, we found tailoring on ethnic identity and motivational predisposition was feasible, and for identifiable subgroups, efficacious. Approximately 1,400 subjects will be enrolled using the HF EMR. The primary outcome will be CRC screening status at 1-year posttest determined by HF computerized records. Analyses will be performed to determine the cost-effectiveness of the interventions. Throughout the study, we will work with the clinical, cultural competence, and administrative leadership at HF to maximize the likelihood of adoption by HF and others should the tailored programs be found to be effective.