Journal of General Internal Medicine

, Volume 24, Issue 2, pp 211–217 | Cite as

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

  • Sanja Percac-LimaEmail author
  • Richard W. Grant
  • Alexander R. Green
  • Jeffrey M. Ashburner
  • Gloria Gamba
  • Sarah Oo
  • James M. Richter
  • Steven J. Atlas
Original Article



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


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


Randomized controlled trial conducted from January to October of 2007.


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


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 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.


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).


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


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. registration number: NCT00476970


colon cancer screening colonoscopy patient navigation randomized control trial 



The authors thank the staff from Clinical Research Program and Community Benefits Program at Massachusetts General Hospital. The paper was presented at the Annual Meeting of the Society of General Medicine in Pittsburg, PA, on April 10, 2008. The study was funded by: Clinical Innovation Award through the Massachusetts General Hospital, Community Benefits Program at Massachusetts General Hospital, Jane’s Trust, Massachusetts Cancer Prevention Community Research Network, and a grant for the Massachusetts General Primary Care Practice-Based Research Network (NCI 1CA121908).

Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Sanja Percac-Lima
    • 1
    • 2
    • 3
    • 5
    Email author
  • Richard W. Grant
    • 2
    • 5
  • Alexander R. Green
    • 2
    • 3
    • 5
  • Jeffrey M. Ashburner
    • 2
  • Gloria Gamba
    • 1
  • Sarah Oo
    • 1
  • James M. Richter
    • 2
    • 4
    • 5
  • Steven J. Atlas
    • 2
    • 3
    • 5
  1. 1.Chelsea HealthCare CenterMassachusetts General HospitalChelseaUSA
  2. 2.General Medicine DivisionMassachusetts General HospitalBostonUSA
  3. 3.Disparities Solutions CenterMassachusetts General HospitalBostonUSA
  4. 4.Gastroenterology UnitMassachusetts General HospitalBostonUSA
  5. 5.Harvard Medical SchoolBostonUSA

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