Randomized Controlled Trial of Tailored Interactive Multimedia to Reduce Colorectal Cancer Screening Disparities

- Background: Interactive multimedia computer programs (IMCPs) show promise as a way of
delivering personally tailored (PT) information to enhance cognitive mediators of
health behavior and improve patient outcomes. However, it is unclear whether PT IMCPs
can be deployed in primary care offices to increase cancer screening uptake and
eliminate ethnic disparities in uptake by providing PT information in each user's
preferred language.

- Aims/Hypotheses: We will compare changes in colorectal cancer (CRC) screening cognitive
mediators (self-efficacy, perceived barriers, and readiness) and uptake resulting from
an IMCP - PT to enhance the key cognitive mediators and targeted to patients'
self-identified ethnicity - with changes resulting from a non-tailored "electronic
leaflet" control IMCP. The experimental and control IMCPs will each be offered in
English and Spanish versions. We hypothesize that, compared with the appropriate
control condition (English, Spanish, or both combined): (1) the English version of the
PT IMCP will enhance the cognitive mediators of CRC screening behavior for
English-speaking Hispanics and non-Hispanics; (2) there will be similarly favorable
changes in these mediators for Hispanics using the Spanish version of the PT IMCP; (3)
deployment of the PT IMCP will provide evidence of elimination of disparities in CRC
screening between Hispanic and non-Hispanic subjects via its relative impact on the
cognitive mediators in these groups; and (4) the PT IMCP (English and Spanish combined)
will increase CRC screening uptake in Hispanics and non-Hispanics (considered
separately) via changes in the cognitive mediators.

- Methods: Randomized controlled trial of 2 groups, comparing a PT (to the cognitive
mediators) CRC screening IMCP offered in both English and Spanish versions and deployed
before a primary care office visit with a non-tailored "electronic leaflet" CRC
screening IMCP (control) also offered in both English and Spanish. Screening methods
targeted will be fecal occult blood testing, flexible sigmoidoscopy, and colonoscopy.
Primary outcomes will be CRC screening uptake, self-efficacy, perceived barriers, and
readiness.

- Implications: Our findings will determine whether an IMCP that is PT to cognitive
mediators of screening behavior and deployed in primary care offices prior to
previously scheduled visits can activate patients of various ethnicities to undergo CRC
screening. They may also suggest a promising, portable method of reducing disparities
in CRC (and other) screening uptake between Hispanic and non-Hispanic individuals.

Inclusion Criteria:

- Receive primary care at one of the participating outpatient study offices

- Age at or above 50 years

- Able to read and speak English and/or Spanish

- Adequate vision, hearing, and hand function to use an IMCP running on a laptop
computer via a touch screen interface

- Have an active telephone

- Not up to date for CRC screening. Up to date status will be defined as having
completed CRC screening via: fecal occult blood test within 2 years; flexible
sigmoidoscopy within 5 years; or colonoscopy within 10 years, consistent with
national practice guidelines and standards.

Exclusion Criteria:

- Unable to understand the consent form or the telephone screening questionnaire due to
cognitive impairment

- Unable to provide informed consent due to serious acute illness