Interventions to Increase Colorectal Cancer Screening Uptake in Rural Settings: A Scoping Review

An estimated 6,000 preventable cancer deaths - including from colorectal cancer (CRC) - occurred in rural America in 2022. Screening can prevent CRC or identify disease at earlier stages when it is more treatable. However, national estimates for CRC screening lag behind Healthy People 2030 objectives. In rural settings, barriers to screening are unique and persistent.

We performed a scoping review to describe the types and effectiveness of interventions to increase CRC screening in primarily rural settings. We included US-based studies published during January 2010 through May 2024. Interventions were categorized according to US Community Preventive Services Task Force-recommended strategies for multicomponent interventions.

Of 508 unique publications identified, 36 met inclusion criteria. Most studies were multicomponent interventions (n = 34). Most studies were associated with an increase in CRC screening uptake. The most common intervention approaches were client reminders (eg, telephone reminders about screening) (n = 25), small media (eg, pamphlets) (n = 25), and reducing structural barriers to screening (eg, patient navigation) (n = 24). Over half (n = 21) of studies reported using a theory, framework, or research approach to inform intervention development, implementation, or evaluation. Six studies (17%) included cost evaluations. The studies included in this review represented less than half of all US states.

This scoping review provides insight into CRC screening intervention implementation in rural settings. The limited geographic representation of the interventions included in our review may highlight an opportunity to improve implementation and dissemination of effective CRC screening interventions in rural settings to reduce CRC incidence and death.