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Mi-CARE: Comparing Three Evidence-Based Interventions to Promote Colorectal Cancer Screening among Ethnic Minorities
Karriem S Watson1, Katherine Y Tossas2, Yazmin San Miguel3
1National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA.
International Journal of Environmental Research and Public Health
|November 24, 2023
Summary
Choosing the right colorectal cancer screening intervention matters. Mailed reminders, lay navigation, and provider education showed varied effectiveness in diverse clinics serving marginalized communities.
Area of Science:
- Public Health
- Health Services Research
- Cancer Prevention
Background:
- Colorectal cancer (CRC) screening completion remains low in marginalized communities served by Federally Qualified Health Centers (FQHCs).
- Evidence-based interventions (EBIs) exist, but their comparative effectiveness across diverse clinical settings and populations is understudied.
- Targeting interventions to specific patient demographics and clinic contexts is crucial for improving CRC screening rates.
Purpose of the Study:
- To compare the relative effectiveness of three EBIs (mailed birthday cards, lay navigation, provider-delivered education) for increasing CRC screening completion.
- To evaluate EBI effectiveness among African American (AA) and Latino American (LA) patients aged 50-75 within FQHCs.
- To determine if EBI effectiveness varies based on clinic demographics and patient ethnicity.
Main Methods:
- A convenience sample of 1252 eligible patients due for CRC screening were recruited from three FQHC clinics in the United States.
- Patients identified as African American or Latino American.
- Logistic regression analysis was used to compare CRC screening completion rates across three EBIs, considering clinic-specific factors.
Main Results:
- Overall CRC screening completion increased from a baseline of 13% to 20% in the study population.
- Mailed birthday reminders were most effective in a multi-ethnic clinic (p = 0.03).
- Provider-delivered education was most effective in a predominantly LA clinic (p = 0.02), and lay navigation in a predominantly AA clinic (p = 0.03).
Conclusions:
- The effectiveness of EBIs for CRC screening varies significantly depending on the clinical context and patient population.
- Tailoring interventions to specific clinic characteristics (e.g., ethnic majority) and patient demographics can optimize CRC screening completion rates.
- Understanding contextual factors is essential for selecting and implementing the most impactful EBIs in safety-net settings.
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