Original Article

Journal of General Internal Medicine

, Volume 24, Issue 2, pp 211-217

A Culturally Tailored Navigator Program for Colorectal Cancer Screening in a Community Health Center: A Randomized, Controlled Trial

  • Sanja Percac-LimaAffiliated withChelsea HealthCare Center, Massachusetts General HospitalGeneral Medicine Division, Massachusetts General HospitalDisparities Solutions Center, Massachusetts General HospitalHarvard Medical School Email author 
  • , Richard W. GrantAffiliated withGeneral Medicine Division, Massachusetts General HospitalHarvard Medical School
  • , Alexander R. GreenAffiliated withGeneral Medicine Division, Massachusetts General HospitalDisparities Solutions Center, Massachusetts General HospitalHarvard Medical School
  • , Jeffrey M. AshburnerAffiliated withGeneral Medicine Division, Massachusetts General Hospital
  • , Gloria GambaAffiliated withChelsea HealthCare Center, Massachusetts General Hospital
  • , Sarah OoAffiliated withChelsea HealthCare Center, Massachusetts General Hospital
  • , James M. RichterAffiliated withGeneral Medicine Division, Massachusetts General HospitalGastroenterology Unit, Massachusetts General HospitalHarvard Medical School
  • , Steven J. AtlasAffiliated withGeneral Medicine Division, Massachusetts General HospitalDisparities Solutions Center, Massachusetts General HospitalHarvard Medical School

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Abstract

Background

Minority racial/ethnic groups have low colorectal cancer (CRC) screening rates.

Objective

To evaluate a culturally tailored intervention to increase CRC screening, primarily using colonoscopy, among low income and non-English speaking patients.

Design

Randomized controlled trial conducted from January to October of 2007.

Setting

Single, urban community health center serving a low-income, ethnically diverse population.

Patients

A total of 1,223 patients 52-79 years of age overdue for CRC screening, randomized to intervention (n = 409) vs. usual care control (n = 814) groups.

Intervention

Intervention patients received an introductory letter with educational material followed by phone or in-person contact by a language-concordant “navigator.” Navigators (n = 5) were community health workers trained to identify and address patient-reported barriers to CRC screening. Individually tailored interventions included patient education, procedure scheduling, translation and explanation of bowel preparation, and help with transportation and insurance coverage. Rates of colorectal cancer screening were assessed for intervention and usual care control patients.

Results

Over a 9-month period, intervention patients were more likely to undergo CRC screening than control patients (27% vs. 12% for any CRC screening, p < 0.001; 21% vs. 10% for colonoscopy completion, p < 0.001). The higher screening rate resulted in the identification of 10.5 polyps per 100 patients in the intervention group vs. 6.8 in the control group (p = 0.04).

Limitations

Patients were from one health center. Some patients may have obtained CRC screening outside our system.

Conclusions

A culturally tailored, language-concordant navigator program designed to identify and overcome barriers to colorectal cancer screening can significantly improve colonoscopy rates for low income, ethnically and linguistically diverse patients.

ClinicalTrials.gov registration number: NCT00476970

KEY WORDS

colon cancer screening colonoscopy patient navigation randomized control trial