A Novel Community-Based Study to Address Disparities in Hypertension and Colorectal Cancer: A Study Protocol for a Randomized Control Trial

Contact Name: 
Helen Cole
Publication Author(s): 
Ravenell J, Thompson H, Cole H, Plumhoff J, Cobb G, Afolabi L, Wells M, Scott M, Ogedegbe G.
Category: 
Patient Navigation
Subcategory: 
Barriers to Care Access
Target Population: 
Adult
Black or African American
Older Adult
Cancer Site: 
Colorectal
Setting Description: 

A community sample of participants (n=480) was recruited from and screened at Black-owned barber shops in all five boroughs of NYC, primarily in central Harlem and central Brooklyn. The interventions compared were conducted in person and over the phone.

Project Description: 

The Multibehavior Intervention to Increase Screening & Enhance Risk Reduction in Black Men (MISTER B) study is a randomized control trial to increase Colorectal Cancer (CRC) screening among older Black men who had hypertension and had not had timely CRC screening. [The study also compared approaches to increase blood pressure screening among the same sample.] Study participants were randomized into one of three intervention groups. The first session of each intervention included basic CRC education, including print materials which were reviewed with the participant by their interventionists. Following the introduction session, participants were randomized to receive either: (1) culturally tailored CRC screening-focused patient navigation (PN) delivered by trained community health workers for a minimum of three in-person sessions with weekly contact up to six months until all identified barriers to CRC screening identified by the participant were resolved (see the full text methods paper, linked below, for descriptions of each intervention) or (2) four sessions of motivational interviewing focused on blood pressure control delivered in-person or over the phone by trained research assistants (serving as the control group for assessing the effectiveness of the CRC PN intervention) or (3) both interventions, where the order was randomly assigned. Initial results show that men who received PN were about twice as likely as those who received motivational interviewing to receive screening colonoscopy or FIT card screening within six months of receiving the intervention. These results were consistent for the sample that received PN regardless of prior engagement in the healthcare system, insurance status, or health literacy level.

Significance of Findings: 

Pre-clinical PN, or PN that occurs in community settings with patients who may not have consistent access to a primary care doctor, who would normally make referrals for screenings, can increase adherence for recommended screenings. Pre-clinical PN can increase access to both clinical and PN services among community members who might otherwise be excluded from them.

Key Takeaways or Implications for Patients or Caregivers: 
Community-based PN can help facilitate access to recommended screenings for colorectal cancer.
Key Takeaways for Practice: 
Pre-clinical PN can improve access to recommended screenings among populations who do not have consistent access to primary care providers (who would customarily make referrals).
Opportunities for Future Research or Takeaways for Other Researchers: 
This is among the first studies of the effects of community-based pre-clinical PN on patient adherence to recommended screening for colorectal cancer. Future studies should continue to document the impacts of pre-clinical community-based PN on screenings among diverse or medically underserved populations. In addition, we noted differences in barriers and facilitators to screening by ethnicity and nativity among black men (i.e., Black Caribbean vs African immigrant vs African American men), thus researchers designing and testing interventions among the black community (as well as any other community) should consider within-race diversity, particularly when designing culturally tailored or targeted interventions.
Patient, Caregiver and/or Communities Research Engagement: 
Barbershop owners and staff familiar with the neighborhoods in which they were working were key in engaging and recruiting participants.
Funder: 

The study is a part of the Comprehensive Center of Excellence in Disparities Research and Community Engagement and is supported by NCMHD grant number 5P60MD003421.

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