The Colorectal Cancer Screening Intervention Trial was a randomized community study that aimed to assess the efficacy of (1) small group education, (2) one-on-one education, or (3) financial support only, in contrast to (4) a control condition. The Metropolitan Atlanta Coalition on Cancer Awareness (MACCA), the Community Coalition Board of the Morehouse School of Medicine Prevention Research Center, churches, clinics, and other community organizations in Atlanta, Georgia, participated in the recruitment of study participants. To be eligible, participants had to be African American, over age 49, have no history of CRC, and no CRC screening test within the recommended time interval. Two full-time and one part-time community health workers made contacts in person at senior centers, churches, community centers, and public health clinics. They also worked with MACCA and members of the Community Coalition Board.
Participants in this study were primarily African American women over age 65 with a high school diploma or some technical college. Participants were randomized by the site (i.e., church, community/senior center, or clinic) where they were assigned to one of four different conditions. That is, all participants at a given site were assigned to the same arm of the study. This prevented the "contamination" that could result from participants in different arms of the study sharing information with one another. All participants were given a gift bag with small household items and printed literature on CRC.
For the one-on-one education cohort, a health educator met individually with participants for three 45-minute sessions over 3 weeks to review educational materials on CRC risk and screening. All meetings took place at the recruitment site. The educational material included descriptions of CRC symptoms, diagnosis and treatment, screening tests, and screening recommendations. Ninety-eight participants (76.5% women) were assigned to the one-on-one education cohort.
For the small group education cohort, a health educator met with participants in groups of 4-14 (average of 5) to review the educational material. Although the material was identical to that covered in the one-on-one cohort, there were more people at each meeting, and four sessions over 4 weeks were required to cover the material. Again, all meetings took place at the recruitment site. Ninety-nine participants (66.7% women) were assigned to the group education cohort.
For the reduced out-of-pocket expense (financial support) cohort, participants were offered financial reimbursement up to $500 for out-of-pocket expenses incurred for CRC screening, including transportation and other nonmedical expenses. A health educator was available to assist with negotiating direct payment and arranging transportation to the doctor's office or medical clinic for the screening test. The health educator also provided letters of introduction and guarantee of payment for the patient to assist in scheduling the test visit. The amount offered was more than sufficient to pay all costs involved in obtaining a fecal occult blood test, but less than half the cost of a colonoscopy. For patients seeking an endoscopic screening, the amount could cover the copayment and/or deductible for those with private insurance or Medicare or the full cost of screening at a reduced-cost public facility. A total of 84 participants (72.6% women) were assigned to the financial support group.
Control group participants attended the introductory session but received only the contents of the gift bag with the educational pamphlets. They received pretesting (at the introductory session), posttesting, and followup on a schedule identical to that of the participants in the other cohorts. Eighty-eight participants (76.1% women) were assigned to the control group.
Medical records were requested from the participants' physicians or health care facilities to determine whether they had been screened for CRC before enrollment in the study. All participants completed a questionnaire at pretest and posttest that included an assessment of their knowledge, attitudes, beliefs, and practices regarding general health issues and knowledge about CRC risk and screening. Posttest questionnaires were administered to the two educational cohorts at their final intervention session. The control and financial support cohorts completed the posttest questionnaire 2 weeks after the second introductory session. Screening status for CRC was assessed by telephone and/or mail during the followup assessment periods at 3 months and if necessary at 6 months after the intervention.