The primary purpose of this study is to determine the effectiveness of a multi-media
presentation and survey to increase screening for colorectal cancer. Content of this
presentation is based on the concept of "implementation intentions," an advanced planning
model taken from the Theory of Planned Behavior. The multi-media presentation is delivered
in a touch-screen computer format and contains messages about colorectal cancer that are
tailored to each participant based on individual survey responses. It is hypothesized that
tailored messages and defining implementation intentions may have a relationship with
completion of colorectal cancer screening.
The majority of the intervention will be delivered in primary care settings on low-cost
touch-screen computers through multi-media audio-narrative and video messages. Studies have
not tested the effectiveness of tailored communications specified to stated "implementation
intentions" for improving CRC screening. A randomized design will test a comparison of
generic information versus a multi-media tailored intervention that specifically addresses
each participant's screening test preference, current CRC screening decisional state
(Precaution Adoption Process Model), and specified to stated "implementation intentions"
(the "when," "Where," and "how" details of screening.) Behavioral intervention materials in
English and Spanish will be developed with the help of cultural experts, pilot tests, and
interviews that will test salience and cultural appropriateness of audio, video, and graphic
messages for low-income minorities and whites. The study will be conducted with 460
patients eligible for CRC screening and recruited while presenting for care in urban
clinics. All participants will receive baseline touch-screen administered assessment and,
depending on stated preference, be offered either immunochemical fecal occult blood test
(iFOBT-InSureTM) or a colonoscopy. Participants will be randomized to either "C"
(comparison group-computer delivered generic CRC information) or "TI2" (active
intervention-computer delivered tailored messaging based on individual PAPM stage,
behavioral constructs, and "implementation intentions"). A brief office exit survey will
assess patient-provider discussions of CRC screening and satisfaction with computerized
message materials. A 90-day post randomization follow-up telephone call assessment with all
participants will reassess PAPM stage and perceived CRC screening barriers.
The primary outcome will be CRC screening completion at 90 days. Secondary outcomes will
assess 90-day PAPM stage and perceived barriers among participants preferring various
screening methods (iFOBT, Colonoscopy). This intervention will provide information on the
utility of embedding a low-cost technologically advanced "implementation intentions" based
behavioral intervention in primary care practice.
- Participants must be at least 50 years of age
- Must not have had a colonoscopy in the last 10 years
- Must not have completed Fecal Occult Blood Test in the past year
- Must not have a family history of colorectal cancer.