Public Awareness of Colorectal Cancer Screening: Knowledge, Attitudes, and Interventions for Increasing Screening Uptake

Table 2

Randomized controlled trials using small media as interventional strategy.

Author	Aim	Intervention	Participants,; 𝑛	Participation,; 𝑛 (%)	Follow-up (months)
Hart et al. (1997) [29]	FOBT completion after intervention	Group 1: invitation letter with mailed FOBT, brochure with educational information about CRC and screening, and prepaid envelope to return FOBT	786	36 (men aged 61–65)	NR
				39 (men aged 66–70)
				38 (women aged 61–65)
				31 (women aged 66–70)
		Group 2: invitation letter with mailed FOBT and prepaid envelope to return FOBT	785	27 (men aged 61–65)
				23 (men aged 66–70)
				36 (women aged 61–65)
				31 (women aged 66–70)
Pignone et al. (2000) [30]	CRC screening after intervention	Group 1: 11-minute video about colon cancer screening and color-coded educational brochure	125	37*	7
		Group 2: generic brochure on automobile safety	124	23
Friedman et al. (2001) [31]	FOBT completion after intervention	Group 1: educational video about main topics about CRC, screening benefits and FOBT completion, educational brochure, and note card to order FOBT	110	44	2
		Group 2: same information given to Group 1 plus questionnaires before and after the video	50	36
		Group 3: brochure plus note card to order screening
Dolan and Frisina (2002) [32]	Any screening test after intervention	Group 1: decision aid about the different CRC screening tests available (Analytic Hierarchy Process)	45	40	6
		Group 2: one-to-one simple educational intervention, consisting of the explanation of the screening options	43	33
Wardle et al. (2003) [33]	Flexible sigmoidoscopy screening after intervention	Group 1: mailed intervention brochure addressing barriers and benefits of flexible sigmoidoscopy screening	1453	54* (<0.05)	24
		Group 2: standard invitation group	1513	50
Ruffin and Gorenflo (2004) [34]	Any screening test after intervention	Group 1: usual care	4212	FOBT 40.9; other 11	36
		Group 2: office intervention. To provide, at every patient encounter, past screening history and current screening recommendations for access by all the staff	4160	FOBT 24; other 13
		Group 3: patient intervention. To provide patients the current screening guidelines and a record of their past screening and cues to the future	4286	FOBT 33.9; other 16
		Group 4: Groups 2 and 3 combined	4557	FOBT 34 other 8
Church et al. (2004) [17]	Any screening test after intervention	Group 1: mailed FOBT and educational brochure	1255	13.2*	12
		Group 2: same as Group 1 and phone call reminder		14.1
		Group 3: just mailed FOBT		7.8
Campbell et al. (2004) [35]	FOBT screening test after intervention	Group 1: tailored print and video intervention (educational newsletters, and targeted videotapes about beliefs, barriers, knowledge and motivation)	587	37*	12
		Group 2: Lay Health Advisor intervention (enhanced support for healthy eating, physical activity, and CRC screening)		33
		Group 3: combined Group 1 and Group 2		31
		Group 4: usual care		22
Zapka et al. (2004) [36]	Any CRC screening test after intervention	Group 1: mailed CRC educational videotape	938	55^†	6
		Group 2: usual care		55
Lipkus et al. (2005) [37]	FOBT screening after intervention	Group 1: nontailored information including a brochure about CRC risk factors	216	60 (year 1); 52 (year 2); 41 (year 3)	36
		Group 2: nontailored information: same information given to Group 1 plus lifestyle information and occupational risk factors	212	60 (year 1); 54 (year 2); 59 (year 3)*
		Group 3: Tailored information: same information given to Group 1 plus tailored information highlighting the risk factor which increases their personal CRC risk	218	68 (year 1); 57 (year 2); 49 (year 3)
		Group 4: Tailored information: same information given to Group 3 plus counselling about lifestyles and occupational factors on CRC risk	214	74 (year 1)*; 59 (year 2); 51 (year 3)
Segnan et al. (2005) [18]	Screening FS or FOBT after intervention	Group 1: mailed invitation to biennial FOBT, FOBT, instructions, educational leaflet, and 2 reminder letters	26682	30	24
		Group 2: biennial FOBT delivered by the PCP or screening facility		28
		Group 3: same as Group 1 and invitation to choose between FOBT and once only FS		27
		Group 4: same as Group 1 and mailed invitation to FS		28
		Group 5: same as Group 1 and invitation to FS followed by biennial FOBT		28
Marcus et al. (2005) [38]	Any CRC screening test	Group 1: educational message encouraging screening and single untailored mailed booklet	380	42	14
		Group 2: educational message encouraging screening and single tailored mailed booklet	377	44
		Group 3: educational message encouraging screening and multiple tailored print materials using information at baseline mailed at different intervals	424	51**
		Group 4: educational message encouraging screening and multiple tailored print materials using information at baseline and at 6 months. They were mailed at different intervals	419	48
Miller et al. (2005) [39]	FOBT screening after intervention	Group 1: computer educational program about FOBT	93	62	1
		Group 2: participants received instructions by a nurse on how to complete FOBT	101	63
Denberg et al. (2006) [19]	Screening colonoscopy after intervention	Group 1: mailed educational brochure with reminder after primary care visit	781	70.7*	4
		Group 2: usual care		59
Myers et al. (2007) [20]	FOBT screening after intervention	Group 1: mailed letter, information booklet, FOBT, and reminder letter	1546	46*	24
		Group 2: same as Group 1 and tailored message pages		44
		Group 3: same as Group 2 and reminder phone call		48
		Group 4: usual care		33
Costanza et al. (2007) [40]	Any CRC screening after intervention	Group 1: educational brochure and tailored computer assisted telephone counselling by trained interviewers	2448	25	22
		Group 2: usual care		24
Ruffin et al. (2007) [41]	CRC screening after intervention	Group 1: interactive educational website about CRC tests	174	56*	6
		Group 2: same information given to group 1 but noninteractive		33
Chan and Vernon (2008) [21]	FOBT screening after intervention	Group 1 (home e-mail access): e-mailed reminders, FOBT, last screening results, and link for additional information	97	26	18
		Group 2 (home e-mail access): usual care		23
		Group 3 (public library access): same as Group 1		0
		Group 4 (public library access): same as Group 2		33
Sequist et al. (2009) [22]	Any screening test after intervention	Group 1: educational pamphlet, mailed FOBT with an stamped return envelope, telephone number to schedule colonoscopy or flexible sigmoidoscopy, and mailed reminder	21860	44*	15
		Group 2: usual care		38.1
Lee et al. (2009) [23]	FOBT screening after intervention	Group 1: mailed educational reminder, mailed FOBT, and postage paid return envelope	775	64.4*	6
		Group 2: mailed FOBT and postage paid return envelope		48.4
Percac-Lima et al. (2009) [42]	Colonoscopy screening after intervention	Group 1: introductory letter and language-concordant phone call	1223	27	9
		Group 2: usual care		12
Gimeno-Garcia et al. (2009) [43]	FOBT after intervention	Group 1: CRC educational video	158	69.6*	2 weeks
		Group 2: nonmedical video		54.4
Aragones et al. (2010) [44]	CRC screening after intervention	Group 1: CRC educational video and brochure	65	55	3
		Group 2: usual care		11
Simon et al. (2010) [45]	CRC screening after intervention	Group 1: automated telephone with information for CRC screening	20938	30.6	12
		Group 2: usual care		30.4
Lasser et al. (2011) [46]	Colonoscopy or FOBT screening after intervention	Group 1: introductory letter with educational material and telephone calls (language concordant)	465	33.6^*‡	12
		Group 2: usual care		20
Sequist et al. (2011) [24]	Any screening test after intervention	Group 1: electronic reminders, educational information, and link for additional information	1103	15.8	4
		Group 2: usual care		13.1
Vernon et al. (2011) [47]	CRC screening after intervention	Group 1: tailored group (narrative videos, list of common concerns about CRC screening, and patient-physician discussion)	413	28	6
		Group 2: website program (educational program developed by the Centers for Disease Control and Prevention)	398	31
		Group 3: usual care	413	30
Cameron et al. (2011) [25]	Any screening test after intervention	Group 1: reminder letter, educational brochure, educational digital video disc, and phone call reminder	628	18.2*	6
		Group 2: usual care		12.1
Doorenbos et al. (2011) [27]	Any screening test after intervention	Group 1: reminders and e-mailed calendar with messages of CRC screening	5633	4.1	15
		Group 2: calendar without any message		4.4
Misra et al. (2011) [48]	Any screening test after intervention	Group 1: usual care	1224	33.4^#	12
		Group 2: web-based program (educational program developed by the Centers for Disease Control and Prevention)		35.4
		Group 3: tailored interactive computer based intervention (based on the transtheoretical model)		32

∗Intervention groups increased CRC screening rates compared with the usual care.
**Intervention 3 versus Intervention 1, 𝑃=0.03.
^†Significantly higher participation in the group of participants who viewed the video.
^‡More beneficial for patients whose primary language was not English.
^#Despite the fact that there were no significant differences in participation, the usual care strategy was the most cost-effective strategy.
NR: nonreported.