Behavioral interventions to increase adherence in colorectal cancer screening

This investigation was a randomized controlled trial to determine the impact of health education interventions on the return of mailed fecal occult blood (FOB) tests (FOBT adherence) in a colorectal cancer Screening program. The study sample included 2,201 men and women aged 50 to 74 years who were members of an Independent practice Association (IPA)-type health maintenance Organization (HMO). Subjects were randomly assigned to a “usual care” Control Group (advance letter, screening kit, reminder letter), and Treatment Groups 1 (usual care + reminder call), 2 (usual care + self-held screening booklet 4-reminder call), or 3 (usual care + self-held screening booklet 4-instruction call + reminder call). Bivariate analysis revealed significant differences in adherence (P < .001) across study groups: Control Group (27%), Group 1 (37%), Group 2 (37%), Group 3 (48%). In addition, a significant positive association between age and adherence (P<.00l) was found. Logistic regression analysis revealed an interaction between sex and treatment. Adherence among men in all treatment groups increased significantly (P < .0001) in relation to Control Group males. Men in Group 3 also were more likely to adhere than those in Group 2 (P < .01) or Group 1 (P < .01). Among women, adherence was significantly higher in Group 3 than in Group 2 (P <.03), Group 1 (P < .025), or the Control Group (P = .0008). The primary reason cited for nonadherence was perceived inconvenience of the FOB testing procedure.