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INCREASING CRC SCREENING AMONG AFRICAN AMERICANS
Duhamel, Katherine N.
5R03CA84809-02
Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States. Results from clinical research indicate that a substantial number of CRC deaths could be prevented by appropriate screening. Although regular CRC screening has been recommended by a number of medical agencies, including the Agency for Healthcare Research and Quality, participation in CRC screening remains low, especially compared to screening for many other cancers. CRC screening is well below the year 2000 goals set in Healthy People 2000. Indeed, CRC screening is one of the most preventable, yet least prevented diseases.
This issue is particularly important for African-Americans, who are less likely to be screened for CRC and suffer a worse prognosis from this disease. Thus, systematic efforts are warranted to understand the barriers to CRC screening for African Americans, and intervention to increase screening.
Prior efforts to increase CRC screening participation by providing health information have been largely ineffective. One problem with previous was providing a single set of educational materials regardless of the individuals' socio-demographic background, level of knowledge, and other concerns. Interventions with other health-related changes in behavior (e.g., quitting smoking or participation in breast cancer screening) suggest the value of viewing such changes as the result of progression through stages, such as pre-contemplation, contemplation, preparation, action, and maintenance of changes in health behaviors, and then designing interventions individualized to each stage. Staged matched interventions designed to improve diet, increase mammography, and encourage smoking cessation have been found to be more effective than non-stage-matched interventions.
The goals of the proposed study are twofold:
- To assess the applicability of a stage-model to understand the barriers and facilitators of CRC screening in African Americans
- To develop a stage-matched intervention to increase CRC screening in African Americans
We propose to assess approximately 150 healthy African American men and women, 51 years or older, from an outpatient medical facility of a large urban teaching hospital. Study participants will be interviewed to assess their stage of readiness to undergo CRC screening. Additional factors include knowledge about CRC screening and relevant psychological and demographic variables (e.g., physician influence, perceived susceptibility, gender). Data analyses from this interview will lead to the development of a model of facilitators and barriers to CRC screening in African Americans from which intervention material to increase CRC screening will be designed. The intervention materials will then be evaluated in focus groups with ten participants from the initial 150. Based on the focus group evaluation, the intervention materials will be revised and re-evaluated in a second focus group.
All individuals in the study will be offered screening examination and their participation with the CRC screening test (Fecal Occult Blood Test (FOBT) over the course of the study) will be assessed. The intervention developed to increase CRC screening in African Americans will then be evaluated in a subsequent randomized clinical trial.
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