Neoplasms

Digestive System Diseases

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Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

Behavioral: small media, group education (multicomponent)

small media, group education (multicomponent)

John M. Westfall, MD, MPH

This community based participatory research study involves multicomponent educational interventions. Telephone interviews and focus groups of persons who are residents of the High Plains region of Colorado will be conducted. A card study will also be carried out to collect limited data about colorectal cancer screening in primary care practices. The multicomponent intervention approaches (e.g., small media and group education) consist of educational materials about routine colorectal cancer screening.

Specific Aims:

* Using community-based participatory research (CBPR), incorporate an existing Community Advisory Council into a project-specific Joint Planning Committee to provide community voices and be experts for a project to design strategies to improve CRC screening of all adults over the age of 50 in the High Plains community.
* Work with the Joint Planning Committee to develop an acceptable and respectful message and dissemination plan to change the community perception concerning colorectal cancer screening.
* Conduct a random digit dialing survey of rural eastern Colorado to determine rates of individuals up to date on CRC screening and to determine current knowledge level of individuals over 50 concerning the need for CRC screening.
* Deliver the screening message(s) through the methods suggested by the Joint Planning Committee in two High Plains communities and solicit community members' reactions to the message(s) and dissemination approaches.

Setting

The Intervention Communities:

The nine rural counties within northeast Colorado that make up the High Plains communities encompass 15,000-square-miles. The economy is largely agricultural, with a population of approximately 90,000. Based on the 2000 census 22% (range 20-29%) of the population is over 50, which is higher than the state as a whole (20%) or the Denver Metropolitan Statistical Area - MSA (18%). There is not a single MSA in the High Plains region and most of the region is a frontier area and therefore considered an underserved community.

The Control Communities:

We will also utilize the 8 county region in southeastern Colorado as our control communities for the intervention evaluation.

Primary Care Offices:

This study will be conducted within the community detailed above. The intervention will be at the population level. Evaluation of the intervention will include surveys of providers and patients within the primary care offices in the High Plains Region (these offices are part of the High Plains Research Network \[HPRN\]) and piloting the intervention will occur in the primary care practices that are part of the Colorado Research Network (CaReNet). Both CaReNet and HPRN are practice based research networks (PBRNs) affiliated with the Department of Family Medicine at the University of Colorado.

Project Aims (Overview):

We will combine three different proven research approaches to develop and study a community-based intervention to improve CRC screening rates.

- Component 1: Intervention Planning:

* Using a community-based participatory research model, the Joint Planning Committee (JPC) composed of members of an established Community Advisory Council for a practice-based research network and other community members, we will explore and define the messages and the delivery approaches the community members feel are most likely to result in actual behavioral change.

  * Component 2: Assessment of Intervention Effectiveness:
* Using a random digit dialing telephone survey, pre and post provider/patient card study and a provider survey, we will assess the impact of the intervention.

  * Component 3: Evaluation of Intervention Process and Implementation:
* Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework12, we will guide our evaluation of both the community-based participatory research process and the effects of the intervention developed.

Promoting Colorectal Cancer Screening in Rural Colorado

University of Colorado, Denver

Centers for Disease Control and Prevention

one-on-one education, group education, small media

Irene Tessaro, DrPH

The purpose of this project is to conduct a community-based intervention and evaluate the independent and combined effects of two intervention strategies on primary and secondary prevention of colorectal cancer (CRC) among members of rural Appalachian churches. The sampling frame consists of all of the churches in a 7 county area of western West Virginia. Eligible churches will have at least 180 active members, will not share a common pastor, and will have no CRC control activities. Using a 2x2 experimental design, churches will be divided into two separate clusters, those with and without an existing parish nurse program. Then churches from each cluster will be randomized to one of two conditions, a natural helper or a control condition.

The purpose of this project is to conduct a community-based intervention and evaluate the independent and combined effects of two intervention strategies on primary and secondary prevention of colorectal cancer (CRC) among members of rural Appalachian churches. Many regions of Appalachia have high poverty, low education, and high unemployment. Health disparities are great in this region and social and behavioral factors put many individuals at high risk for increased mortality from CRC.

The sampling frame consists of all churches in a 7 county area of western West Virginia. Eligible churches will have at least 180 active members, will not share a common pastor, and have no CRC control activities. Using a 2x2 experimental design, churches will be divided into two separate clusters, those with and without an existing parish nurse program. Then churches from each cluster will be randomized to one of two conditions, a natural helper or control condition.

Eligible church members will be adult males and females who are identified through member lists provided by the recruited churches. Because the primary outcome variable is CRC screening, at least half of the recruited church members must be age 50 and older, report no history of CRC, and have not recently completed CRC screening. Interested members will be asked to complete an informed consent form detailing participation in either the intervention or control arm of the study. The control group will be offered other health promotion interventions through the church and the CRC educational materials after data collection is completed.

Data will be collected before and after the intervention activities. Study participants will complete a paper and pencil survey at the church at each measurement point (baseline, follow-up). The baseline survey will assess sociodemographics, psychosocial information, stage of change, self-efficacy, health beliefs, barriers to change, health behavior knowledge and practices involving diet, physical activity, and CRC screening. The follow-up survey will assess body mass index, dietary intake, physical activity level, and CRC screening by FOBT, flexible sigmoidoscopy, and colonoscopy.

The primary hypothesis to be tested is that the combination of these two community-based intervention strategies will be most effective overall. To evaluate the effectiveness of the intervention strategies, the proportions in outcome measures between each intervention, the combined intervention, and control groups will be compared.

Colorectal Cancer Control in Appalachian Churches

West Virginia University

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Promoting Colorectal Cancer Screening in Rural Colorado	NCT00137592	Colorectal Canc...	small media, gr...	50 Years -	Centers for Disease Control and Prevention
Promoting Colorectal Cancer Screening in Rural Colorado	NCT00137592	Colorectal Canc...	small media, gr...	50 Years -	Centers for Disease Control and Prevention
Colorectal Cancer Control in Appalachian Churches	NCT00137683	Colorectal Canc...	one-on-one educ...	50 Years -	Centers for Disease Control and Prevention

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