**6. Intervention related to CRC screening**

**Table 1** showed some evidence from previous studies on CRC screening and intervention modalities. Mixed of intervention through telephone counseling, a mail invitation, email/text-message reminder, health talk, video and brochure are some intervention has been done and showed a positive finding on CRC screening uptake. The government needs to take action for CRC screening programme and


**11**

 **Design**

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result** counseling group

(p < 0.01 for

differences

*Public Health: Prevention*

*DOI: http://dx.doi.org/10.5772/intechopen.94396*

between each

intervention

usual care and for

the difference between the basic and the enhanced

intervention).

2 2014 Florida, United

States

Ecological study.

SaTScan ver 9.1.1,

NA

36,094 cases with

Clusters of CRC

 Much of analysis

The high risk area

[29]

was and that no single method detected all

clusters of statistical or public health significance.

underpowered

is potentially a

priority area for a

screening

intervention.

Cluster detection

can be incorporated

routine public health operations,

but the challenge is to identify areas

in which the burden of disease

can be alleviated

through public

health

intervention.

3 2013

Washington,

RCT. 4-group,

EHR-linked

Usual care;

4675 patients

The proportion of

Compared with

Compared with

[30]

usual care, a

centralized,

 EHR-

those in the usual

care group, participants

 in the

linked, mailed

participants

current for screening in both

attended to 21

primary care

medical centres in

involved services

parallel-design,

mailings

("automated"),

to promote CRC

screening,

automated plus

randomized,

controlled

United States

 into

CRC diagnosed at

late stages from

1996 through 2010

in Florida, aged

more than 50.

From cases

a free clusterdetection software

> reported to the

Florida Cancer

application

used to describe spatial clusters of

CRC

 was

Registry.

 and

**Conclusion**

 **Reference**


### *Public Health: Prevention DOI: http://dx.doi.org/10.5772/intechopen.94396*

**No Year Country**

**10**

1 2010 San Francisco,

RCT. Participants

Culturally tailored

Usual care (no

1789 Latino and

Self-reported

1358 individuals

An that included

intervention

[28]

*Colorectal Cancer*

(718 Latinos and

640 completed the

follow-up survey.

Self-reported

screening rates

increased by 7.8%

in the control

group, by 15.1% in

the brochure group, and by 25.1% in the

brochure/telephone

counseling group

(p < 0.01 for

differences

between each

intervention

usual care and for

the difference between brochure/

telephone

counseling and

brochure alone).

For any CRC

screening, rates

increased by 4.1%

in the usual care

group, by 11.9% in

the

group, and by

21.4% in the brochure/telephone

FOBT/brochure

 and

 FOBT

counseling

increased CRC

screening in

Latinos and the

Vietnamese.

Brochure and

telephone

counseling

together had the

greatest impact.

Vietnamese)

culturally tailored

brochures and tailored telephone

receipt of FOBT or

any CRC screening

at 1-year follow-

up.

Vietnamese

primary care

patients at a large

public hospital,

aged 50-79.

further

description).

telephone

counseling by

community

advisors employed

 health

were randomized

to (1) basic

intervention:

culturally tailored

brochure plus

by a community-

based

organization,

culturally tailored

brochures, and

customized

kits.

 FOBT

FOBT kit (*<sup>n</sup>* = 765); (2)

enhanced

intervention:

brochure, FOBT

plus telephone

counseling

(*<sup>n</sup>* = 768); or (3)

usual care (*<sup>n</sup>* = 256).

United States

 **Design**

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result**

**Conclusion**

 **Reference**


**13**

4 2011

Massachusetts,

RCT. We

Intervention

Usual care (no

465 patients from

The primary

During a 1-year

Patient navigation

[31]

*Public Health: Prevention*

increased

completion

CRC screening

among ethnically

diverse patients.

*DOI: http://dx.doi.org/10.5772/intechopen.94396*

Targeting patient

navigation to

black and non–Englishspeaking patients

 of

period,

intervention

patients were more

likely to undergo CRC screening than

control patients

outcome was

completion

CRC screening

within 1 year.

Secondary

outcomes included

the proportions

patients screened

by colonoscopy

who had adenomas or

cancer detected.

 of

P < .001), to be

screened by colonoscopy

(26.4% vs. 13.0%;

may be a useful

approach to

reducing

disparities in CRC

screening.

P < .001), and to

have adenomas detected (8.1% vs.

3.9%; P = .06). In

prespecified

subgroup analyses,

the navigator

intervention

particularly

beneficial for patients whose

primary language

was other than English (39.8% vs.

18.6%; P < .001) and black patients

(39.7% vs. 16.7%;

P = .004).

 was

(33.6% vs. 20.0%;

 of any

4 community health centers and

2 public hospital– based clinics who

were not up-to-

date with CRC

screening, aged 52

to 74.

further

patients received

an letter from their

introductory

description).

randomly

allocated patients

to receive a patient

navigation–based

primary care

intervention

usual care.

 or

provider with

educational

material, followed

by telephone calls

from a language-

concordant

navigator. The

navigators offered

patients the option

of being screened

by fecal occult

blood testing or

colonoscopy.

United States

 **Design**

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result**

**Conclusion**

 **Reference**


**12**

 **Design** comparative

telephone

including

Washington,

current for CRC screening, aged 50

to 73.

 not

years, defined as

intervention

 groups

CRC screening

*Colorectal Cancer*

program led to

twice as many

persons being

current for screening over

2 years. Assisted

and navigated

interventions

 led

colonoscopy

sigmoidoscopy

(year 1) or fecal

occult blood testing (FOBT) in

year 1 and FOBT,

colonoscopy,

sigmoidoscopy

(year 2).

 or

care, 26.3% [95%

CI, 23.4% to

29.2%]; automated,

to smaller but significant stepped

increases

compared with the

automated

intervention

The rapid growth of EHRs provides

opportunities

spreading this

model broadly.

 for

 only.

50.8% [CI, 47.3% to

54.4%]; assisted, 57.5% [CI, 54.5% to

60.6%]; and

navigated, 64.7%

[CI, 62.5% to

67.0%]; P < 0.001

for all pair-wise

comparisons).

Increases in screening were

primarily due to

increased uptake of

FOBT being completed in both

years (usual care,

3.9% [CI, 2.8% to

5.1%]; automated, 27.5% [CI, 24.9% to

30.0%]; assisted, 30.5% [CI, 27.9% to

33.2%]; and

navigated, 35.8%

[CI, 33.1% to

38.6%]).

 or

were more likely to

be current for CRC

screening for both

years with

significant increases

by intensity (usual

guidelines, patient

handouts, and an

annual systems delivered involved

services patient-

tailored letter" with

"birthday

assistance

("assisted"),

automated and assisted plus nurse

navigation to

testing completion

or refusal ("navigated").

previous

completion

subsequent

dates for immunizations,

screening tests,

and long-term

care tests (such as

influenza shots, CRC screening, or

hemoglobin

tests).

 A1c

 due

 and

Interventions

were repeated in

year 2.

 or

effectiveness

with concealed

allocation and blinded outcome

assessments.

 trial

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result**

**Conclusion**

 **Reference**


**15**

 **Design**

**Intervention**

group education,

session but received no intervention

than accepting the

contents of the gift

 other

and 3) reducing

out-of-pocket

costs (financial

support). Two of

the

were educational,

and the third

intervention

responded to

financial barriers

(participants

offered financial

reimbursement

to \$500 for out-of-

pocket expenses

to that of the

participants

other cohorts.

 in the

incurred for CRC

screening,

including

transportation

other nonmedical

expenses).

 and

 up

follow-up on a

schedule identical

 were

session), post-

testing, and

interventions

bag with the

educational

pamphlets.

received

pretesting (at the

introductory

 They

**Comparison**

 **Population**

 **Main Outcome**

**Result**

**Conclusion**

 **Reference**

**Measured**

screening test

follow-up 3 months

CRC cancer screening rates

*Public Health: Prevention*

among African

Americans.

screening rate of

<35% in a group

of individuals

 who

*DOI: http://dx.doi.org/10.5772/intechopen.94396*

participated

educational

program through multiple sessions

over a period of

several weeks indicated that

there still are

barriers to overcome.

 in an

 The

to 6 months later. Among completers,

there were significant increases

in knowledge in

both educational

cohorts but in neither of the other

2 cohorts. By the 6-

month follow-up,

17.7% (11 of 62

participants)

Control cohort reported having

undergone

screening compared

with 33.9% (22 of

65 the Group Education cohort

(P = .039). Screening rate

increases in the other 2 cohorts

were not statistically

significant.

7 2011 Georgia and

RCT. Health plan

Intervention

Usual care; at

Members of a

Primary: Self-

Among 443 active

Interventions

[34]

participants,

 75.8%

combining a

patient-directed

decision aid and

reported

completion

 of any

were ages 52 to

59 years, 80.9%

large health plan

(Aetna's health

maintenance

CRC screening test

patient level -

participants

received neither

practices received

members

intervention

 trial.

1) academic

detailing (2

Florida, United

States

participants)

 of

 of the

within 6 months.


**14**

5 2014 Chicago,

RCT. randomized

controlled trial conducted in a

network of community

centers.

 health

instructions,

postage-paid

return envelope; (2) an automated

telephone and text

message

tests (FIT), and

clinician feedback

on CRC screening

rates.

reminding them

that they were due

for screening and

that a FIT was being mailed to

them; (3) an

automated

telephone and text

reminder 2 weeks later for those who

did not return the

FIT; and (4) personal telephone outreach by a CRC

screening

navigator after

3 months.

> 6 2010 Atlanta, United

RCT. Community

The three

Control group;

African-American

Post increase in CRC

knowledge and

obtaining a

were available for

intervention

257 participants

The current results

[33]

indicated that

completed the

intervention

 and

group education

could increase

intervention

 trial. 1) one-on-one

education 2)

interventions

 are

Participants

men and women,

aged ≥50 years.

attended the introductory

States

 and a

for medical assistants to give

patients home

fecal

immunochemical

Patient-level

The

group received (1)

a mailed reminder

letter, a free FIT

with low-literacy

intervention

Usual care;

450 patients who

were previously negative for FOBT

from March 2011 through February 2012. aged 51 to 75.

included

computerized

reminders,

standing orders

United States

 **Design**

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result**

**Conclusion**

 **Reference**

**Measured**

Completion

FOBT within 6 months of the date the patient

was due for annual

screening.

 of

Intervention

This greatly increased

adherence to

annual CRC screening; most

screenings were

achieved without personal calls. It is

possible to

improve annual

CRC screening for

vulnerable

intervention

[32]

*Colorectal Cancer*

patients were much

more likely than

those in usual care

to complete FOBT

(82.2% vs. 37.3%; *P*

< .001). Of the 185

intervention

patients completing

screening, 10.2%

completed prior to

their due date (intervention

not given), 39.6%

within 2 weeks

(after initial

intervention),

24.0% within 2 to

13 weeks (after automated call/text

reminder),

8.4% between 13 and 26 weeks (after

personal call).

 and

 was

populations

relatively low-cost

strategies that are

facilitated by

health information

technologies.

 with


**17**

 **Design**

**Intervention**

information,

screening options

chart, and the

decision aid

survey).

 CRC

**Comparison**

 **Population**

 **Main Outcome**

**Result** participants.

intervention

more effective in

those who had

incomes (OR, 2.16; 95% CI,

1.07-4.35) than in

those who had lower incomes (OR,

1.25; 95% CI, 0.53-2.94; P = .03

for interaction).

> 8 2016 Texas, United

States

Quasi experiment.

Eligible subjects

Controls were

Population from

6 month self-

784 subjects (467 in

A

multicomponent

[35]

community-wide,

bilingual, CRC

screening

intervention

significantly

increased CRC screening in an

uninsured

predominantly

Hispanic

population.

intervention

 group,

community

clinic sites in

Texas, aged 50-75.

 and

reported CRC

screening.

317 controls) were

recruited; mean age

was 56.8 years;

78.4% were female,

98.7% were Hispanic and 90.0%

were born in Mexico. In the

worst case scenario

analysis (n = 784)

screening uptake

was 80.5% in the

intervention

and 17.0% in the

control group [relative risk 4.73, 95% CI: 3.69–6.05,

P <

0.001]. No

 group

recruited from a

similar county,

received no intervention.

were randomized

Two arm parallel

non-equivalent

to either 1)

promotora (P), 2)

video (V), or 3)

combined

promotora and

video (PV) education, and

control group design in which

participants

randomly

allocated to three

education

intervention

also received no-

cost screening

with fecal immunochemical

testing or

colonoscopy

navigation.

 and

delivery groups in

a 1:1:1 ratio.

 were

>\$50,000

 was

*Public Health: Prevention*

*DOI: http://dx.doi.org/10.5772/intechopen.94396*

 The

**Conclusion**

 **Reference**


### *Public Health: Prevention DOI: http://dx.doi.org/10.5772/intechopen.94396*

**No Year Country**

**16**

 **Design**

**Intervention**

physician detailers

academic detailing

organization

at 12 months.

were white, 62.1%

practice-directed

*Colorectal Cancer*

academic detailing

had a modest but

statistically

nonsignificant

effect on CRC

were women, and

46.4% had college degrees or greater education. Among

Secondary: The

effect of the

[HMO] product)

from selected

metropolitan

 areas

decision aid in the

subtrial of nonrespondents.

380 active participants

known screening

status at 12 months

based on survey results, 39% in the

intervention

reported receiving

CRC screening compared with

32.2% in the usual

care group (unadjusted

ratio [OR], 1.34;

95% confidence

interval; [CI],

0.88-2.05; P = .17). After adjusting for

baseline differences

and accounting for

clustering, the

effect was somewhat larger (OR, 1.64; 95% CI, 0.98-2.73; P = .06).

Claims analysis produced similar

effects for active

 odds

 group

 with

screening rates

among active

participants

conducted 2

nor decision aid.

All Aetna members

(including those in

in Georgia and

Florida, aged 52 to

sessions for each

practice that

included

information

colon cancer and

screening tests,

practice-specific

annually received

brief mailed reminders from Aetna encouraging

screening rates,

clips of the

decision aid, and

the of practicespecific plans to

address requests for screening) to

facilitate CRC

testing once

patients were

activated by the 2)

decision aid (a

personalized

letter, the decision

aid in DVD and

VHS formats with

instructions

viewing, stage-

targeted

brochures, Aetna-

specific

copayment

referral

 and

 for

development

them to obtain CRC screening.

 about

our study's intervention

usual care groups)

 and

75.

**Comparison**

 **Population**

 **Main Outcome**

**Result**

**Conclusion**

 **Reference**


**19**

10 2010 United States

 RCT. from nation-wide

database.

Randomized

A narrative

Control

Participants

recruited from Survey Sampling

International

(SSI), aged 49-60.

 were

Perceptions

impact of the

barriers on screening, risk

perception,

knowledge,

interest in screening.

 and

 of the

Compared to

The narrative also

[37]

*DOI: http://dx.doi.org/10.5772/intechopen.94396*

increased risk perception for

colorectal cancer

and interest in

participants

received only the

educational

message,

participants

received the

message along with

a narrative reported

that the barriers to

screening would

have less of an

impact on a future

screening

experience.

 who

screening in the

next year.

 who

participants

not receive a

narrative.

 did

intervention

within educational

message was used

to promote colorectal cancer

screening i.e. first-

person narrative

from a similar

other (i.e., an

individual who

matched

participants

gender, age, and

race), who

described a

personal

experience with

the colon cancer

screening

decision.

11 2011 Germany

 RCT. from German

statutory health

insurance scheme.

Randomized

Intervention

Controls received

Insured people

The primary end

The response rate

Evidence based

[38]

risk information

for return of both

questionnaires

92.4% (n = 1457).

345/785 (44.0%)

participants

 in the

 was

on colorectal

cancer screening

increased

informed choices

point was

"informed

choice,"

comprising

"knowledge,"

who were

official

information

 leaflet

members of the

target group for

colorectal cancer

group received 38

pages brochure

with evidence

of the German colorectal cancer

based risk information

 on

 in

 **Design**

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result** screening uptake

between

intervention

and control (P

<

0.001).

 groups

*Public Health: Prevention*

**Conclusion**

 **Reference**


### *Public Health: Prevention DOI: http://dx.doi.org/10.5772/intechopen.94396*

**No Year Country**

**18**

9 2017 Hamadan, Iran 1) FGD and IDI.

Focused group

A multicomponent

Controls received

Patients in 8

4 month CRC

The preliminary

Intervention

[36]

Mapping (IM) is a

useful process in

the design of a

theory-based

intervention

addressing CRC

screening among

Iranian

population.

evaluation findings

revealed that during the 4-month

follow up period, CRC screening rates

were 87.1%, 61.3%,

54.8 and 1.6% for

participants

assigned to

education with free

FOBT, only education, only free

FOBT and control

group,

Adults in either of

the 3 groups were

significantly

likely to undergo

screening compared

to adults in the

control group.

There were

significant

differences

 in CRC

 more

intervention

respectively.

screening.

only

questionnaire

health centres in

Hamadan, aged

discussion and in-

intervention

developed and

piloted. In final

the CRC screening

intervention

stage, participants

received either 1) education and free

FOBT, or 2) education only, or

3) free FOBT.

Education

materials were reminder pack

that contains postcards and

pamphlet, and an

educational

with title "Being a

winner in life: how

to prevent CRC

cancer".

 video

 trial

behaviors).

 was

(regarding the

determinants

 of

40-70.

depth interview

were held among

physicians and

adult population.

2) RCT. Cluster

intervention

 trial.

 **Design**

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result** educational

differences

observed. Covariate

adjustment

significantly

the effect.

 alter

 did not

 were

 group

**Conclusion**

 **Reference**

*Colorectal Cancer*


**21**

12 2013 California,

RCT. Patients

One group was

Usual care;

Uninsured

Screening

Mean patient age

Among

[39]

*DOI: http://dx.doi.org/10.5772/intechopen.94396*

underserved

patients whose

CRC screening

was not up to date,

mailed outreach

invitations

resulted in markedly higher

participation

any CRC test

within 1 year of

recruitment.

 in

was 59 years; 64%

of patients were

women. The sample

was 41% white, 24% black, 29%

Hispanic, and 7%

other race/ ethnicity. Screening

participation

significantly

for both FIT (40.7%) and

colonoscopy

more effective with FIT than with

colonoscopy

invitation.

outreach (24.6%) than for usual care (12.1%) (P < .001

for both comparisons

usual care). Screening was

significantly

for FIT than for

colonoscopy

outreach (P

< .001). In

stratified analyses,

screening was

 higher

 with

 higher

compared with

usual care. Outreach was

 was

CRC screening

patients, not up to

date with CRC screening, served

by the John Peter

Smith Health

Network, a safety

net health system,

aged 54 to 64.

consisting of

opportunistic

primary care visit–

based screening

(n = 3898).

assigned to fecal

immunochemical

were assigned randomly to 1 of 3

groups.

test (FIT) outreach,

consisting of

mailed invitation

to use and return

an enclosed no-

cost FIT (n = 1593). A

second was assigned to

colonoscopy

outreach,

consisting of

mailed invitation

to schedule a no-

cost colonoscopy

(n = 479). These

groups also

received telephone

follow-up to

promote test

completion.

United States

 **Design**

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result** actual and planned

uptake (72.4%

*Public Health: Prevention*

(568) v 72.9%

(577); P = 0.87).

**Conclusion**

 **Reference**


### *Public Health: Prevention DOI: http://dx.doi.org/10.5772/intechopen.94396*

**No Year Country**

**20**

 **Design**

**Intervention**

colorectal cancer

screening

screening, age

"attitude," and

intervention

 group

and improved

*Colorectal Cancer*

knowledge,

little change in

attitudes. The

intervention

not affect the

combination

actual and planned

uptake of

 of

 did

 with

"combination

actual and planned

uptake."

Secondary

outcomes were "knowledge" and

"combination

actual and planned

uptake."

Knowledge

attitude were assessed after

6 weeks and combination

actual and planned

uptake of

screening after

6 months.

 of

(n = 468) v 16.2%

(128); difference

43.5%, 37.8% to

49.1%; P <

A

"positive

attitude" towards colorectal screening

prevailed in both

groups but was

significantly

in the

group (93.4% (733)

v 96.5% (764);

difference

5.9% to

< 0.01). The

intervention

effect on the combination

 of

 had no

0.3%; P

 3.1%,

 lower intervention

0.001).

 and

 of

99% confidence interval 25.7% to

36.7%; P <

More

group participants

had "good knowledge" (59.6%

intervention

0.001).

screening.

 of

made an informed

choice, compared

with 101/792 (12.8%) in the

control group

(difference

 31.2%,

50-75.

programme

screening and two

optional

interactive

internet modules

on risk and diagnostic tests.

**Comparison**

 **Population**

 **Main Outcome**

**Result**

**Conclusion**

 **Reference**


**23**

13 2012

Massachusetts,

RCT. Participants

Intervention

Controls reviewed

Population in an

Completion

CRC screening test

within 12 months of the study visit.

 of a

Patients in the

Decision aid–

[40]

*Public Health: Prevention*

assisted SDM has a

modest impact on

CRC screening

*DOI: http://dx.doi.org/10.5772/intechopen.94396*

uptake. A decision

aid plus personalized

assessment

no more effective than a decision aid

alone.

 tool is

 risk

decision-aid

were more likely to

complete a

screening test than

control patients (43.1% vs. 34.8%,

p = 0.046) within

12 months of the

study visit;

conversely,

uptake for the

decision aid and decision aid plus

personalized

assessment

was similar (43.1%

vs. 37.1%, p = 0.15).

Assignment

decision-aid

(AOR = 1.48, 95%

CI = 1.04, 2.10),

black race (AOR = 1.52, 95%

CI = 1.12, 2.06) and

a preference for a

patient-dominant

decision-making

approach

(AOR = 1.55, 95%

 arm

 to the

 arms

 risk

 test

 group

urban, academic

safety-net hospital

and community health center, aged

50-75.

groups received

a modified online

version of "9 Ways to Stay

either 1) decision

were randomized

to one of two

intervention

and one control

group.

 arms

aid plus personalized

assessment,

decision aid alone.

Interventions

place just prior to

a routine office visit with their

primary care

providers.

 took

generic lifestyle changes other than

screening for

minimizing

preventable

diseases.

 risk of

 or 2)

 risk

Healthy and

Prevent Disease,"

which discussed

United States

 **Design**

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result** complete

colonoscopy.

**Conclusion**

 **Reference**


*Public Health: Prevention DOI: http://dx.doi.org/10.5772/intechopen.94396*

**No Year Country**

**22**

 **Design**

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result** higher for FIT and

colonoscopy

outreach than for

usual care, and

higher for FIT than

for colonoscopy outreach among whites, blacks, and

Hispanics (P < .005

for all comparisons).

Rates of CRC identification

advanced adenoma

detection were 0.4% and 0.8% for FIT outreach, 0.4%

and 1.3% for colonoscopy

outreach, and 0.2%

and 0.4% for usual

care, respectively

(P < .05 for

colonoscopy

usual care advanced

adenoma

comparison;

for all other comparisons).

Eleven of 60 patients with

abnormal FIT results did not

 P > .05

 vs.

 and

**Conclusion**

 **Reference**

*Colorectal Cancer*


**25**

15 2011 Texas, United

RCT. from a baseline

survey into one of

three groups.

Randomized

Intervention

Control group;

Patients from

Completion

recommended

 of any

There was no

A tailored

[42]

*Public Health: Prevention*

intervention

 was

statistically

significant

not more effective

at increasing

*DOI: http://dx.doi.org/10.5772/intechopen.94396*

screening than a

public web site or

only being

difference in screening by 6 months: 30%, 31%, and 28% of

the web site, and

tailored groups

were screened.

Exposure to the

tailored

intervention

associated with

increased

knowledge and

CRC screening self-

efficacy at 2 weeks

and 6 months. Family history, prior screening,

stage of change,

and physician recommendation

moderated the

intervention

effects.

 was

survey-only,

surveyed.

Kelsey-Seybold

Clinic, overdue for

CRC screening by

6 months.

CRC screening,

aged 50-70.

survey-only

group.

groups received

either 1) a tailored

intervention

CRC screening (tailored group),

or 2) a public web

site about CRC screening (web

site group).

 about

States

 **Design**

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result**

were participants the control group.

 in

**Conclusion**

 **Reference**


*Public Health: Prevention DOI: http://dx.doi.org/10.5772/intechopen.94396*

**No Year Country**

**24**

 **Design**

**Intervention**

**Comparison**

 **Population**

 **Main Outcome**

**Result**

**Conclusion**

 **Reference**

*Colorectal Cancer*

**Measured**

CI = 1.02, 2.35)

were determinants

completion.

Activation of the

screening

discussion and enhanced screening intentions mediated

the effect.

14 2010 California,

RCT. Community

Intervention

Control group

Filipino American

Self-reported

 CRC

Self-reported

screening rates

during the 6-month

follow-up period

were 30%, 25%,

and 9% for

participants

can significantly

increase CRC

assigned to

intervention

FOBT kit, intervention

without the kit, and

control group,

respectively.

Participants

either of the 2

intervention

were significantly

more likely to

report screening at

follow-up than

 groups

 in

 with

screening among

Filipino

Americans,

when no free FOBT kits are

distributed.

 even

 CRC

A

multicomponent

[41]

intervention

includes an educational

session in a community

 setting

 group

 that

population,

50-75.

 aged

screening rates

during the 6month follow-up

period.

received an education session

groups received

either 1) an

education session

on the health

benefits of

physical activity.

on CRC screening

and free fecal

occult blood test

(FOBT) kits, or 2)

an education session but no free

FOBT kits

based trial.

United States

intervention

 of test

independent


**Table 1.** *Evidence from previous studies*

 *on CRC screening and intervention*

 *modalities.* promote it. The example from **Table 1** can be part of promoting the CRC screening

Findings from a systematic review suggest that small media interventions (eg, interventions using mailed materials, text messages, and telephone calls) may be effective in improving screening uptake for breast, cervical, colorectal, and gastric cancer in Asian countries. Therefore, there is a priority need for programs that raise awareness about the warning signs and symptoms of cancer and the benefits of early detection. This form of secondary prevention should be implemented in countries in which resources for population-based screening are lacking, particularly for cancers. Overall, the findings of the evaluation indicate that a culturally adapted, evidence-based mass media intervention appears to impact positively in terms of improving CRC symptom awareness among population; and that impact is more likely when a campaign operates a differentiated approach that matches modes of communication to the ethnic and religious diversity in a population. Research shown that there was a significant improvement in the recognition of all CRC symptoms (prompted) at follow up and a significant improvement in the

'blood in stool

' and

A recommendation from a physician is the most influential factor in determining whether a patient is screened for colorectal cancer. While the vast majority of primary care physicians report that they screen for colorectal cancer, many patients do not receive the recommendation they need. People with a high risk for CRC should not be included in a routine screening used for the general population. Their screening must be started early in a shorter period, and using various tests. The United States Preventive Task Force recommends CRC screening for the average atrisk population, using an annual fecal occult blood test (FOBT), a periodic flexible sigmoidoscopy (FS), or a colonoscopy [22]. One of the solutions is to engage the primary care doctors and family physician in identifying and recommending high risk patients for colorectal cancer screening. The effectiveness of the family doctor

role has been proven in previous studies and should be the way forward to increase

Simultaneously, concerted effort is needed to increase numbers of skill operators and availability of the procedure throughout the country. In certain Europe countries, nurses have been trained to perform endoscopy to reduce patient's waiting time. On the other hand, fecal occult blood test can be utilized for mass screening

All these barriers could be overcome with the implementation of governmentsubsidized nationwide population screening, with the provision of more accessible screening times such as having them available during non-working hours or nonworking days. However, even if the above-mentioned barriers have been overcome, it would not solve the problem if the people inherently do not wish to participate due to certain psychological barriers that are more difficult to tackle. Among these is the fatalistic belief that their lives are in the hands of fate or God. They believe that if it is destined that they are to have cancer, there is nothing they can do about

the health status of family members is also needed and should be encouraged. Awareness of discrepancies in screening rates for people in racial and ethnic groups

's personal awareness of his or her risk level is important. Awareness of

' ,

'unexplained weight loss

'feeling that the

' .

's

using FOBT for early detection of cancer.

*DOI: http://dx.doi.org/10.5772/intechopen.94396*

knowledge of three unprompted symptoms, i.e.

bowel does not empty after using the lavatory

awareness and cancer screening uptake.

among low risk or asymptomatic patients.

can help to reduce these disparities.

A patient

**27**

it and early detection of cancer would not benefit them [23].

**7. Others prevention strategies**

*Public Health: Prevention*

promote it. The example from **Table 1** can be part of promoting the CRC screening using FOBT for early detection of cancer.
