This community based participatory research study involves multicomponent educational
interventions. Telephone interviews and focus groups of persons who are residents of the
High Plains region of Colorado will be conducted. A card study will also be carried out to
collect limited data about colorectal cancer screening in primary care practices. The
multicomponent intervention approaches (e.g., small media and group education) consist of
educational materials about routine colorectal cancer screening.
- Using community-based participatory research (CBPR), incorporate an existing Community
Advisory Council into a project-specific Joint Planning Committee to provide community
voices and be experts for a project to design strategies to improve CRC screening of
all adults over the age of 50 in the High Plains community.
- Work with the Joint Planning Committee to develop an acceptable and respectful message
and dissemination plan to change the community perception concerning colorectal cancer
- Conduct a random digit dialing survey of rural eastern Colorado to determine rates of
individuals up to date on CRC screening and to determine current knowledge level of
individuals over 50 concerning the need for CRC screening.
- Deliver the screening message(s) through the methods suggested by the Joint Planning
Committee in two High Plains communities and solicit community members' reactions to
the message(s) and dissemination approaches.
The Intervention Communities:
The nine rural counties within northeast Colorado that make up the High Plains communities
encompass 15,000-square-miles. The economy is largely agricultural, with a population of
approximately 90,000. Based on the 2000 census 22% (range 20-29%) of the population is over
50, which is higher than the state as a whole (20%) or the Denver Metropolitan Statistical
Area - MSA (18%). There is not a single MSA in the High Plains region and most of the region
is a frontier area and therefore considered an underserved community.
The Control Communities:
We will also utilize the 8 county region in southeastern Colorado as our control communities
for the intervention evaluation.
Primary Care Offices:
This study will be conducted within the community detailed above. The intervention will be
at the population level. Evaluation of the intervention will include surveys of providers
and patients within the primary care offices in the High Plains Region (these offices are
part of the High Plains Research Network [HPRN]) and piloting the intervention will occur in
the primary care practices that are part of the Colorado Research Network (CaReNet). Both
CaReNet and HPRN are practice based research networks (PBRNs) affiliated with the Department
of Family Medicine at the University of Colorado.
Project Aims (Overview):
We will combine three different proven research approaches to develop and study a
community-based intervention to improve CRC screening rates.
- Component 1: Intervention Planning:
- Using a community-based participatory research model, the Joint Planning Committee
(JPC) composed of members of an established Community Advisory Council for a
practice-based research network and other community members, we will explore and define
the messages and the delivery approaches the community members feel are most likely to
result in actual behavioral change.
- Component 2: Assessment of Intervention Effectiveness:
- Using a random digit dialing telephone survey, pre and post provider/patient card study
and a provider survey, we will assess the impact of the intervention.
- Component 3: Evaluation of Intervention Process and Implementation:
- Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance)
framework12, we will guide our evaluation of both the community-based participatory
research process and the effects of the intervention developed.
- Colorectal cancer
John M. Westfall, MD, MPH
University of Colorado, Denver