Increasing Colorectal Cancer Screening among African Americans

Background: Mortality from colorectal cancer is higher among African Americans than among whites, and African Americans are less likely than whites to have been screened. The Guide to Community Preventive Services lists a number of strategies for which there is “insufficient evidence” regarding effectiveness. Among these are one-on-one education, small group education, and reducing out-of-pocket costs. We tested the effect of these interventions on knowledge, attitudes and beliefs (KABs) about colorectal cancer among African Americans and on screening.

Methods: 369 African-American men and women aged 50 and above were randomized to one of the three interventions or a control arm. A health educator conducted educational sessions. “Reducing out-of-pocket costs” consisted of reimbursement of expenses up to $500. We assessed baseline and post intervention data on KABs through questionnaires and assessed screening outcomes 6 months after the intervention.

Results: The small group educational intervention resulted in the greatest improvement in KAB and was associated with the highest screening rates post-intervention (p= 0.039 compared to the control cohort). However, even in this group, only about 40% of participants were screened 6 months after the intervention. Persons in the “Reduced out-of-pocket costs” group were no more likely to be screened than the controls (about 20%).

Conclusions: The small group milieu is conducive to both learning and behavior change. Rates of completed screening were surprisingly low post-intervention. Financial barriers may not be the greatest obstacle to screening for colorectal cancer. Additional research into approaches to increasing colorectal cancer screening among African Americans is warranted.