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Sociopsychological tailoring to address colorectal cancer screening disparities: a randomized controlled trial
Anthony Jerant1, Richard L Kravitz, Nancy Sohler
1Department of Family and Community Medicine, University of California Davis, Sacramento, California (Jerant, Franks); Center for Healthcare Policy and Research, University of California Davis, Sacramento, California (Jerant, Kravitz, Tancredi, Franks); Division of General Internal Medicine, University of California Davis, Sacramento, California (Kravitz); Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education of The City College of New York, New York, New York (Sohler); Department of Family Medicine and Community and Preventive Medicine, University of Rochester, Rochester, New York (Fiscella); Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Romero); Department of Family Medicine, University of Colorado, Denver, Colorado (Parnes); Department of Pediatrics, University of California Davis, Sacramento, California (Tancredi); Department of Internal Medicine, University of California Davis, Sacramento, California (Aguilar-Gaxiola); Center for Reducing Health Disparities, University of California Davis, Sacramento, California (Aguilar-Gaxiola); University of California Davis Medical Center, Sacramento, California (Slee); IET-Academic Technology Services, University of California Davis, Davis, California (Dvorak, Turner); Sutter Medical Foundation, Sacramento, California (Hudnut, Prieto).
Purpose:
Interventions tailored to sociopsychological factors associated with health behaviors have promise for reducing colorectal cancer screening disparities, but limited research has assessed their impact in multiethnic populations. We examined whether an interactive multimedia computer program (IMCP) tailored to expanded health belief model sociopsychological factors could promote colorectal cancer screening in a multiethnic sample.
Methods:
We undertook a randomized controlled trial, comparing an IMCP tailored to colorectal cancer screening self-efficacy, knowledge, barriers, readiness, test preference, and experiences with a nontailored informational program, both delivered before office visits. The primary outcome was record-documented colorectal cancer screening during a 12-month follow-up period. Secondary outcomes included postvisit sociopsychological factor status and discussion, as well as clinician recommendation of screening during office visits. We enrolled 1,164 patients stratified by ethnicity and language (49.3% non-Hispanic, 27.2% Hispanic/English, 23.4% Hispanic/Spanish) from 26 offices around 5 centers (Sacramento, California; Rochester and the Bronx, New York; Denver, Colorado; and San Antonio, Texas).
Results:
Adjusting for ethnicity/language, study center, and the previsit value of the dependent variable, compared with control patients, the IMCP led to significantly greater colorectal cancer screening knowledge, self-efficacy, readiness, test preference specificity, discussion, and recommendation. During the followup period, 132 (23%) IMCP and 123 (22%) control patients received screening (adjusted difference = 0.5 percentage points, 95% CI -4.3 to 5.3). IMCP effects did not differ significantly by ethnicity/language.
Conclusions:
Sociopsychological factor tailoring was no more effective than nontailored information in encouraging colorectal cancer screening in a multiethnic sample, despite enhancing sociopsychological factors and visit behaviors associated with screening. The utility of sociopsychological tailoring in addressing screening disparities remains uncertain.
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