Likelihood of pursuing colorectal cancer (CRC) screening was found to increase when African American individuals participated in in-person interventions compared with web access interventions, according to a study published in AJPM Focus. The findings suggest that in-person interventions could play a key role in increasing screening rates for CRC.
CRC is estimated to have been the cause of 53,000 deaths in 2022 in the United States alone, with African American patients high susceptibility to both incidence of CRC and CRC-related mortality compared with other racial groups. An educational intervention that promoted screening for CRC was created by the authors, with an aim of determining the most effective approach for improving screening rates among African American individuals.
This study reported on the findings of the dissemination and intervention implementation in 16 cities throughout the United States. The aim of the study was to determine which educational approach was most effective in increasing CRC screening and identifying other factors that affect the likelihood of CRC screening.
Healthy large intestine anatomy on doctor hands | Image credit: Orawan – stock.adobe.com
The Educational Program to Increase Colorectal Cancer Screening (EPICS) was the intervention used, and it has been successful in past research and practice. African American men and women who had not been screened for CRC were recruited for 3 small group educational sessions. African American individuals who were aged 50 years and older, had no history of CRC, and had no previous screening for CRC were eligible for the study.
All participants were randomly assigned to 1 of 4 conditions in the 16 community coalitions: website access to training materials without technical assistance (WA-TA); website access to training materials with technical assistance (WA+TA); in person training and access to training materials without technical assistance (IP-TA); and in-person training and access to training materials with technical assistance (IP+TA). In-person training focused on educational content and the approach to its delivery. The intervention was delivered over 36 months from 2014 to 2017.
There were 2877 participants included in the study who had a mean age of 65.4 years, were mostly female (65.2%), mostly African American (93.7%), and were covered by some form of health insurance (92.4%). A total of 20.8% made up the WA-TA arm, 19.5% in the WA+TA arm, 25.8% in the IP-TA arm, and 33.9% in the IP+TA arm.
A total of 37.6% of participants had a screening for CRC, with the highest proportions of people getting screened being from the IP-TA group (40.0%) and IP+TA group (39.8%) compared with 35.5% and 33.0% in the WA-TA and WA+TA cohorts respectively. Participants in the IP groups were found to have higher odds of getting a screening for CRC compared with the participants in the WA+TA, with IP+TA having an adjusted odds ratio (aOR) of 1.31 (95% CI, 1.04-1.64) and IP-TA having an aOR of 1.35 (1.07-1.71).
When excluding non-Black ethnic subgroups, similar results were found. The OR for screening for CRC was found to be 1.11 (95% CI, 0.8-1.42) for the WA-TA cohort, 1.37 (95% CI, 1.08-1.73) in the IP-TA cohort, and 1.39 (95% CI, 1.11-1.74) in the IP+TA cohort when compared with the WA+TA cohort.
There were some limitations to this study. These findings may not be able to be generalizable to people of other ethnic groups, and larger urban centers made up the majority of the coalitions, which could have left out rural community coalitions. Challenges in quality health care such as increased use of telehealth and transportation barriers could have influenced the effectiveness of IP vs WA interventions.
The EPICS intervention determined that in-person interactions in target populations could increase the screening rates for CRC in African Americans. Participants in the in-person interventions had higher odds of going for a screening for CRC after the EPICS intervention.
Reference
Ansa BE, Alema-Mensah E, Sheats JQ, Mubasher M, Akintobi TH. Colorectal cancer knowledge and screening change in African Americans: implementation phase results of the EPICS cluster RCT. AJPM Focus. 2023;2(4):100121. doi:10.1016/j.focus.2023.100121
