A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial

Abstract

Background: Minority racial/ethnic groups have low colorectal cancer (CRC) screening rates.

Objective: To evaluate a culturally tailored intervention to increase CRC screening, primarily using colonoscopy, among low income and non-English speaking patients.

Design: Randomized controlled trial conducted from January to October of 2007.

Setting: Single, urban community health center serving a low-income, ethnically diverse population.

Patients: A total of 1,223 patients 52-79 years of age overdue for CRC screening, randomized to intervention (n = 409) vs. usual care control (n = 814) groups.

Intervention: Intervention patients received an introductory letter with educational material followed by phone or in-person contact by a language-concordant "navigator." Navigators (n = 5) were community health workers trained to identify and address patient-reported barriers to CRC screening. Individually tailored interventions included patient education, procedure scheduling, translation and explanation of bowel preparation, and help with transportation and insurance coverage. Rates of colorectal cancer screening were assessed for intervention and usual care control patients.

Results: Over a 9-month period, intervention patients were more likely to undergo CRC screening than control patients (27% vs. 12% for any CRC screening, p < 0.001; 21% vs. 10% for colonoscopy completion, p < 0.001). The higher screening rate resulted in the identification of 10.5 polyps per 100 patients in the intervention group vs. 6.8 in the control group (p = 0.04).

Limitations: Patients were from one health center. Some patients may have obtained CRC screening outside our system.

Conclusions: A culturally tailored, language-concordant navigator program designed to identify and overcome barriers to colorectal cancer screening can significantly improve colonoscopy rates for low income, ethnically and linguistically diverse patients. ClinicalTrials.gov registration number: NCT00476970.

Figures

Figure 1

Flow diagram of study participants through recruitment, eligibility assessment, randomization, intervention, and outcome analysis. CRC = Colorectal cancer.

Figure 2

Colorectal cancer screening rates, intervention vs. usual care groups. Percentage of patients completing: (1) any colorectal cancer screening and (2) colonoscopy.

Figure 3

Odds ratios for colorectal cancer screening, intervention vs. usual care by demographic subgroups.

Figure 4

Percentage of patients with colorectal cancer screening, intervention vs. usual care by ethnicity and language status.