Community Dissemination of an Evidence-based Colorectal Cancer (CRC) Screening Intervention

Filipino Americans have lower rates of colorectal cancer (CRC) screening, later stage of
diagnosis and poorer survival relative to other racial/ethnic groups. To address this
disparity, the investigators developed a multi-component intervention to increase CRC
screening and have determined its efficacy in a randomized trial (Maxwell,et. al., 2010).
This study aims to determine how an intervention to increase CRC screening can best be
integrated within the cultural norms and existing structures of churches and community based
organizations (CBOs) with predominantly Filipino American membership to ensure broad
dissemination to those in need of screening.

The investigators will provide our partner CBOs with resources and technical assistance,
including training of community volunteers as health advisors, to enable them to promote CRC
screening to their constituents. Using a scientifically rigorous research design, the
investigators will compare two dissemination strategies: Basic dissemination which consists
of a single kick-off event during which community health advisors will receive print
materials and FOBT kits for distribution and training on how to conduct educational
small-group sessions; and Organizational dissemination aimed at integrating CRC screening
dissemination into organizational practices and processes that can be sustained after the
end of the study. The study will be implemented in 20 CBOs and will train 100 community
health advisors (CHAs). The impact of the two dissemination strategies will be
comprehensively assessed by collecting data at the CBO level, from the CHAs and from 1000
Filipino American participants. The investigators will compare the proportion of Filipino
American participants who obtain CRC screening by dissemination strategy, but the
investigators will also assess how many are reached, if the intervention is implemented as
planned, how CBOs support the screening efforts at their regular activities, and if CBOs and
CHAs maintain their efforts over the 4 years of the study.

The investigators hypothesize that CBOs can implement evidence-based strategies to promote
CRC screening and CHAs in the organizational dissemination arm will reach more participants
and more screened participants than CHAs in the basic dissemination arm; and organizations
in the organizational dissemination arm will adopt more CRC screening activities and
maintain these better than organizations in the basic dissemination arm.