Arnold Connie L, Rademaker Alfred, Liu Dachao, Davis Terry C
Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA.
Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL.
J Community Med Health Educ. 2017 Feb;7(1). doi: 10.4172/2161-0711.1000497. Epub 2017 Jan 13.
The objective in this pre- and post-survey assessment was to compare the effectiveness of a health literacy-directed intervention designed to increase knowledge, beliefs, barriers, self-efficacy and behavior associated with CRC screening with FOBT among patients cared for in predominantly rural community clinics and the change in these characteristics over the first 15 months after enrolling in a study designed to assess screening strategies.
Between 2008 and 2011, a quasi-experimental intervention was conducted in 8 predominantly rural Federally Qualified Health Centers. Patients were orally administered a 15-minute survey at enrollment by a clinic research assistant (RA) and at 15 months by phone by a central RA. Participants included 428 community clinic patients aged 50-85 (mean 58.5); the majority (79%) were female, 69% were African American, and 54% had limited health literacy.
There was significant improvement across all groups with the number of patients reporting they had been given information /education on CRC testing (p<.0001), been given an FOBT kit (p<.0001), and completed an FOBT (p<.0001) with significant improvement in having a doctor recommendation in all groups except usual care. Confidence in an FOBT's potential to decrease chances of dying from CRC improved across all groups as well (p<0.002). In addition, patients 'belief that they would get CRC in their lifetime' decreased across all groups post-intervention (p<0.03) as did their worry that they may find out they have CRC (p<0.04).
Overall these low income FQHC patients who were not up-to-date with screening had heard of CRC screening, had positive attitudes toward screening and wanted to know if they had cancer. Results demonstrate the value of giving patients a recommendation and a kit; patients in all groups reported significant increases at 15 months in completing CRC screening (>83%) as confirmed by study records.
在本次调查前后评估中，目的是比较一种以健康素养为导向的干预措施的效果，该干预措施旨在增加在主要为农村社区诊所接受治疗的患者中与采用粪便潜血试验（FOBT）进行结直肠癌筛查相关的知识、信念、障碍、自我效能和行为，以及在参与一项旨在评估筛查策略的研究后的头15个月内这些特征的变化。
2008年至2011年期间，在8个主要为农村地区的联邦合格健康中心进行了一项准实验性干预。患者在入组时由诊所研究助理（RA）进行15分钟的口头调查，并在15个月时由中央RA通过电话进行调查。参与者包括428名年龄在50 - 85岁（平均58.5岁）的社区诊所患者；大多数（79%）为女性，69%为非裔美国人，54%的健康素养有限。
所有组均有显著改善，报告接受过结直肠癌检测信息/教育的患者数量（p<0.0001）、收到FOBT试剂盒的患者数量（p<0.0001）以及完成FOBT的患者数量（p<0.0001）均有显著增加，除常规护理组外，所有组在获得医生推荐方面也有显著改善。所有组对FOBT降低死于结直肠癌几率的潜力的信心也有所提高（p<0.002）。此外，干预后所有组患者“认为自己一生中会患结直肠癌”的信念降低（p<0.03），他们担心自己可能查出患有结直肠癌的程度也降低了（p<0.04）。
总体而言，这些未及时进行筛查的低收入联邦合格健康中心患者听说过结直肠癌筛查，对筛查持积极态度，并想知道自己是否患有癌症。结果表明向患者提供推荐和试剂盒的价值；研究记录证实，所有组的患者在15个月时完成结直肠癌筛查的比例均显著增加（>83%）。
