Multilevel Interventions to Improve Colorectal Cancer Screening in an Urban Native American Community: A Pilot...

Native Americans have the highest burden of colorectal cancer (CRC) and the lowest rates of CRC screening across the United States.¹ The disparities in CRC screening were made worse during the pandemic, creating an unmet need to implement evidence-based, multilevel interventions to improve CRC screening uptake. This can be achieved through an organized outreach program with identification of screen-eligible individuals using health records from the clinic; and a screening program with the following: (1) a mailed invitation, (2) a package of materials so patients can complete a fecal immunochemical test (FIT) kit from their homes, (3) reminder calls and a letter, and (4) navigation to a diagnostic colonoscopy.^2-5 We conducted a pilot randomized controlled trial of a program of outreach vs usual care for completion of CRC screening at an urban clinic serving the Native American community. Applying the Consolidated Framework for Implementation Research (CFIR),⁶ we also conducted patient and provider interviews to understand barriers and facilitators to the organized program and CRC screening in general.