Search

Simple Summary: Despite the benefits of stool-based tests for colorectal cancer screening, the return rate is low. In this study, we tested if adding a tailored, one-page educational flyer to the mailed stool kits targeted at rural Midwestern residents in the USA improved the kit return rates. Overall, there was no significant difference in return rate between the groups that did and did not receive the flyer. However, females and older participants were more likely to return the kits compared to males and younger participants. To improve the kit return rates of male and younger participants, future programs should consider how the content and design of the flyer can be more closely tailored to the audience's needs and preferences as well as how the flyer can be combined with other approaches (e.g., reminders). Background/Objectives: Stool-based tests, such as the fecal immunochemical test (FIT), have been widely used for increasing colorectal cancer (CRC) screening. Small media, such as printed materials or flyers, are known to be an effective intervention to increase CRC screening by fecal tests. However, more evidence is needed to determine whether such small media are effective in improving screening uptake of a mailed FIT intervention targeted at rural populations in the USA. Methods: In this randomized study, 1230 FIT kits were mailed from July to December 2022 to rural Nebraskans aged 45–74 who were not up to date on CRC screening. Half of the participants (n = 608) also received a tailored, one-page, gender-specific educational flyer created based on focus groups with rural residents. Logistic regression was used to determine predictors of returning the FIT. Results: Study participants were predominantly female (76%), non-Hispanic White (83%), and within the age group of 55–64 (43%). Overall, 192 (15.6%) kits were returned (16.1% from the flyer group; 15.1% from the no-flyer group). However, we found no significant differences between the flyer and no-flyer groups (Adjusted Odds Ratio [AOR]: 1.21; 95% CI: 0.88–1.66). Females (AOR: 1.78; 95% CI: 1.19–6.14) and the oldest (65–74) age group (AOR: 5.03; 95% CI: 2.78–8.47) were more likely to return FIT kits than males and the youngest (45–54) age group. Conclusions: A tailored educational flyer was not effective in improving the CRC-screening-rate-by-mailed-FIT approach for rural populations. Future research should explore the content, timing, and mode of delivery of educational interventions as well as other multi-component strategies to improve screening rates. Public health officials might also consider developing strategies targeted at males and younger (45–54) age groups. [ABSTRACT FROM AUTHOR]

Rural regions have higher incidence rates of colorectal cancer (CRC) than urban regions, while screening is lower in rural residents than in urban residents. Rural residents experience barriers to CRC screening due to a lack of access to healthcare, perceived lack of privacy, and other cultural factors. The fecal immunochemical tests (FITs) may provide an inexpensive and convenient alternative for those lacking access to a colonoscopy or sigmoidoscopy. In a clinical trial, we investigated factors that influenced the return of a FIT kit for CRC screening among 1,230 rural residents in a midwestern U.S. state. Participants were selected from two cancer screening databases maintained by the state health department. Participants returning and not returning the FIT kit were compared for differences by age category (45–54, 55–64, 65–74), gender (female vs. male), race (non-white vs. white), and ethnicity (Hispanic vs. not Hispanic) using chi-square tests and logistic regression. Cox proportional hazard models and Kaplan–Meier curves were used to assess differences in FIT kit return time by age and gender. The youngest age group was significantly less likely to return the FIT kit and were slower at returning it when they did. In models adjusted for age category, females were significantly more likely to return the FIT kit than males and returned the FIT kit sooner than males. The results suggest that efforts are needed to reach those 45 to 55, especially males, who are not likely to see the need for CRC screening. [ABSTRACT FROM AUTHOR]