Encouraging low-literacy African Americans to be screened for colorectal cancer: An experimental comparison of "usual care" materials with a customized touch-screen tutorial

Colorectal cancer (CRC) is the third leading cause of cancer death in the United States, disproportionately affecting low-literacy African Americans. Survival rates for CRC are high if caught early through screening techniques such as colonoscopy, but African Americans have low rates of use. This presentation summarizes a Random Controlled Experimental Trial of “usual care” print materials with a computer-based touch screen tutorial designed to educate and encourage low-literacy African Americans to have colonoscopy. The tutorial was developed specifically for low literacy African American patients, emphasizing psycho-social barriers to screening and utilizing “testimonials” from real patients who had undergone colonoscopy. Testing was done in the General Internal Medicine clinic of a major university medical center. Patients over the age of 50 who had low literacy (assessed using the REALM-R) were randomly assigned to either the Usual Care group (n=27) or the Tutorial group (n=33). In comparison to the Usual Care print document, the Touch Screen Tutorial was judged to be superior on its length (p=.009), the amount of information it provided (p=.001), the usefulness of the information (p=.005), its balance (p=.001) and ease of use (p=.000). Users of the tutorial also felt it provided enough information to make a decision about colonoscopy (p=.006) and means on overall attitude about having a colonoscopy (p=.001) and likelihood of having a colonoscopy (p=.002) were significantly higher compared to the usual care group. Results indicate a tailored decision aid developed specifically for low literacy minority patients can be extremely effective in encouraging colonoscopy screening.