Strategies improve colorectal screening rates in low-income and minority populations

The colonoscopy has undoubtedly saved millions of lives since it was developed more than four decades ago. Although the screening procedure has been around for a long time, not everyone has access to it or the knowledge that other colon cancer screening tests exist.

Strategies to improve screening rates in low-income and minority populations are being developed by K. Allen Greiner, MD, MPH, member of The University of Kansas Cancer Center's Cancer Control and Population Health program and professor and director of the research division in the Department of Family Medicine in Kansas City.

"We wanted to try to better understand the barriers that keep people from following through on screening,” said Greiner. “In some of our earlier research, we found people were receptive to screening. Once they learned more about it, they wanted to have it done.”

Greiner and his team are using something called "implementation intentions" questions to determine what will help people get screened for colorectal cancer. The results were published in a recent issue of the American Journal of Preventive Medicine (2015; doi:10.1093/her/cyv006).

Implementation intention questions were used with the Precaution Adoption Process Model, a decision-based model of health behavior accounting for people who have no knowledge of a health issue and those who have decided against participating in the behavior altogether. These concepts have been used to help addicts going through withdrawal, increase cervical cancer screening, and increase physical activity in low-income kids and adults.

This knowledge helps researchers design plans that detail the how, where, and when a health behavior (in this case, colon cancer screening) will be performed.

For this study, participants were older than 50 years (the normal age for when colon cancer screening is recommended) and were a mix of African American, Hispanic, and white. They were placed in one of two groups: One group was given standard education about colon cancer screening along with questions about diet, exercise, and healthy living. The other group was given implementation intention questions such as

  • To remind myself to call and set up my colonoscopy appointment, I will …
  • The day before my colonoscopy, to remind myself to start taking the laxative medicines, I will …
  • I will get a ride to my colonoscopy from …

"Basically we walk them through a series of goal-setting exercises where they get really specific about how they were going to follow through on their screening and remember each step of the process,” said Greiner.

Both groups completed their informational sessions on touchscreens in the waiting room of their doctors' offices. They could choose to get either a colonoscopy or a less-invasive fecal blood test.

So did these more pointed, specific questions help increase the number of people who underwent screening?

Yes. Those who answered the implementation intention questions had 1.91 higher odds of getting screened than those who solely received educational information.

“Sometimes people don't realize how difficult it is to follow through on this kind of thing, and it seems like this is a virtual solution that helps both patients and doctors save time,” said Greiner. “We think it mentally prepares them a little more for the rigors of the process and helps them work through the potential problems of setting it up.”

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