Larkey Linda K, McClain Darya, Roe Denise J, Hector Richard D, Lopez Ana Maria, Sillanpaa Brian, Gonzalez Julie
Am J Health Promot. 2015 Nov-Dec;30(2):e59-70. doi: 10.4278/ajhp.131111-QUAN-572. Epub 2015 Jan 23.
Screening rates for colorectal cancer (CRC) lag for low-income, minority populations, contributing to poorer survival rates. A model of storytelling as culture-centric health promotion was tested for promoting CRC screening.
A two-group parallel randomized controlled trial.
Primary care, safety-net clinics.
Low-income patients due for CRC screening, ages 50 to 75 years, speaking English or Spanish.
Patients were exposed to either a video created from personal stories composited into a drama about "Papa" receiving CRC screening, or an instrument estimating level of personal cancer risk. Patients received a health care provider referral for CRC screening and were followed up for 3 months to document adherence.
Behavioral factors related to the narrative model (identification and engagement) and theory of planned behavior.
Main effects of the interventions on screening were tested, controlling for attrition factors, and demographic factor associations were assessed. Path analysis with model variables was used to test the direct effects and multiple mediator models.
Main effects on CRC screening (roughly half stool-based tests, half colonoscopy) did not indicate significant differences (37% and 42% screened for storytelling and risk-based messages, respectively; n = 539; 33.6% male; 62% Hispanic). Factors positively associated with CRC screening included being female, Hispanic, married or living with a partner, speaking Spanish, having a primary care provider, lower income, and no health insurance. Engagement, working through positive attitudes toward the behavior, predicted CRC screening.
A storytelling and a personalized risk-tool intervention achieved similar levels of screening among unscreened/underscreened, low-income patients. Factors usually associated with lower rates of screening (e.g., no insurance, being Hispanic) were related to more adherence. Both interventions' engagement factor facilitated positive attitudes about CRC screening associated with behavior change.
低收入少数族裔人群的结直肠癌（CRC）筛查率较低，这导致了较差的生存率。为促进CRC筛查，对一种以文化为中心的健康促进故事讲述模式进行了测试。
两组平行随机对照试验。
初级保健安全网诊所。
年龄在50至75岁之间、讲英语或西班牙语、应进行CRC筛查的低收入患者。
患者观看一段视频，该视频由个人故事编辑而成，内容是关于“爸爸”接受CRC筛查的短剧，或者使用一种评估个人癌症风险水平的工具。患者收到医疗服务提供者关于CRC筛查的转诊，并随访3个月以记录其依从性。
与叙事模型（认同和参与）以及计划行为理论相关的行为因素。
测试干预措施对筛查的主要影响，控制损耗因素，并评估人口统计学因素的关联。使用模型变量进行路径分析，以测试直接效应和多重中介模型。
对CRC筛查的主要影响（大约一半是基于粪便的检测，一半是结肠镜检查）没有显示出显著差异（分别有37%和42%的患者因故事讲述和基于风险的信息而进行了筛查；n = 539；33.6%为男性；62%为西班牙裔）。与CRC筛查呈正相关的因素包括女性、西班牙裔、已婚或与伴侣同住、讲西班牙语、有初级保健提供者、低收入以及没有医疗保险。通过对行为持积极态度来参与，可预测CRC筛查。
在未接受筛查/筛查不足的低收入患者中，故事讲述干预和个性化风险工具干预达到了相似的筛查水平。通常与较低筛查率相关的因素（如没有保险、西班牙裔）与更高的依从性有关。两种干预措施的参与因素都促进了对与行为改变相关的CRC筛查的积极态度。
