Greiner K Allen, Daley Christine M, Epp Aaron, James Aimee, Yeh Hung-Wen, Geana Mugur, Born Wendi, Engelman Kimberly K, Shellhorn Jeremy, Hester Christina M, LeMaster Joseph, Buckles Daniel C, Ellerbeck Edward F
Department of Family Medicine; University of Kansas Cancer Center.
Department of Family Medicine; Center for American Indian Community Health; Department of Preventive Medicine; University of Kansas Cancer Center.
Am J Prev Med. 2014 Dec;47(6):703-14. doi: 10.1016/j.amepre.2014.08.005. Epub 2014 Nov 18.
Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups.
The study aimed to test a theoretically based "implementation intentions" intervention for improving CRC screening among unscreened adults in urban safety-net clinics.
Randomized controlled trial.
SETTING/PARTICIPANTS: Adults (N=470) aged ≥50 years, due for CRC screening, from urban safety-net clinics were recruited.
The intervention (conducted in 2009-2011) was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (Comparison group) or "implementation intentions" questions and planning (Experimental group) specific to the CRC screening test chosen (fecal immunochemical test or colonoscopy).
The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted in 2012-2013).
The study population had a mean age of 57 years and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions-based intervention had higher odds (AOR=1.83, 95% CI=1.23, 2.73) of completing CRC screening than the Comparison group. Those with higher self-efficacy for screening (AOR=1.57, 95% CI=1.03, 2.39), history of asthma (AOR=2.20, 95% CI=1.26, 3.84), no history of diabetes (AOR=1.86, 95% CI=1.21, 2.86), and reporting they had never heard that "cutting on cancer" makes it spread (AOR=1.78, 95% CI=1.16, 2.72) were more likely to complete CRC screening.
The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low-income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors.
低收入和种族/族裔少数群体承受着不成比例的结直肠癌（CRC）负担，且生存率较低。需要新的行为策略来提高这些群体的筛查率。
本研究旨在测试一种基于理论的“实施意图”干预措施，以提高城市安全网诊所中未接受筛查的成年人的CRC筛查率。
随机对照试验。
设置/参与者：招募了年龄≥50岁、应进行CRC筛查的城市安全网诊所的成年人（N = 470）。
干预（于2009 - 2011年进行）通过触摸屏电脑进行，该电脑根据决策阶段和筛查障碍定制信息。然后，电脑将参与者随机分为提供饮食和运动方面的一般健康信息的组（对照组）或针对所选CRC筛查测试（粪便免疫化学测试或结肠镜检查）的“实施意图”问题及计划的组（实验组）。
主要研究结局是根据测试报告在26周时完成CRC筛查（于2012 - 2013年进行分析）。
研究人群的平均年龄为57岁，其中42%为非西班牙裔非裔美国人，28%为非西班牙裔白人，27%为西班牙裔。接受基于实施意图干预的人群完成CRC筛查的几率（调整后比值比[AOR]=1.83，95%置信区间[CI]=1.23，2.73）高于对照组。筛查自我效能较高（AOR = 1.57，95% CI = 1.03，2.39）、有哮喘病史（AOR = 2.20，95% CI = 1.26，3.84）、无糖尿病病史（AOR = 1.86，95% CI = 1.21，2.86）以及表示从未听说“切除癌症会使其扩散”（AOR = 1.78，95% CI = 1.16，2.72）的人更有可能完成CRC筛查。
本研究结果表明，纳入实施意图方法的项目即使在非常低收入和多样化的初级保健人群中也有助于成功完成CRC筛查。未来旨在减少CRC发病率和死亡率差异的举措或许能够在大规模努力中采用实施意图来鼓励筛查和预防行为。
