Behavioral interventions to increase adherence in colorectal cancer screening

Area of Science:

• Public Health
• Preventive Medicine
• Health Services Research

Background:

• Colorectal cancer (CRC) screening rates remain suboptimal, particularly for mailed fecal occult blood tests (FOBTs).
• Understanding factors influencing FOBT adherence is crucial for improving CRC screening program effectiveness.

Purpose of the Study:

• To evaluate the impact of various health education interventions on FOBT adherence in a randomized controlled trial.
• To identify which intervention components most effectively increase FOBT return rates.

Main Methods:

• A randomized controlled trial involving 2,201 individuals aged 50-74 years within an HMO.
• Four groups were compared: usual care (control), usual care plus reminder call, usual care plus booklet and reminder call, and usual care plus booklet, instruction call, and reminder call.
• Adherence rates were analyzed using bivariate and logistic regression, considering age and sex interactions.

Main Results:

• FOBT adherence varied significantly across groups: Control (27%), Group 1 (37%), Group 2 (37%), Group 3 (48%).
• Age was positively associated with adherence.
• Interventions significantly increased adherence, particularly for men. Group 3 showed the highest adherence for both men and women, with men in Group 3 adhering more than those in Group 2 or 1.

Conclusions:

• Multi-component health education interventions, including detailed instructions and reminder calls, substantially enhance FOBT adherence.
• Addressing perceived inconvenience is key to improving CRC screening participation.
• Targeted interventions may be necessary to optimize screening rates in diverse populations.