Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review
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abstract
African-American men have the lowest 5-year survival rate for colorectal cancer (CRC) of any ethnic/racial group in the country, which may be due in part to poor screening rates. Evidenced-based interventions are needed to increase CRC screening (CRCS) uptake among this population, as screening is associated with increased survival. Using Rayyan QCRI, a systematic review was employed to synthesize the evidence from published studies evaluating interventions to increase CRCS uptake among African-American men. Potential studies were retrieved from MEDLINE, CINAHL, EMBASE, and Cochrane CENTRAL resulting in 960 initial results. Articles published before 1998 were excluded, as well as studies that were not explicitly about CRCS uptake, were not in English, did not take place in the U.S., and/or did not include African-American men. Only primary analyses and evaluations of CRCS uptake interventions, as opposed to interventions considering behaviors related to but not directly indicative of CRCS uptake, were considered. After an abstract screening and full-text review was conducted by two blinded team members, 41 publications ranging from 2000 2018 made up the final sample. These studies were then coded for study setting, geographic region, theory, intervention type, and limitations. The majority of studies were conducted in either a medical center or church in the southern U.S. Nearly half of the studies did not report a theoretical foundation, yet in those which did, the Health Belief Model, Preventative Health Model, and the Stages of Change Model were the most common. Reflecting recent screening guidelines endorsed by the American Cancer Society, studies had age ranges starting as early as age 45. The most common interventions of 122 types utilized were telephone education (18%), mailed/electronically-sent educational materials (14%), mailed or administered in person CRCS stool-based kits (12%), and patient navigation (11%), and printed materials given to individuals in person (11%). The most effective intervention types were patient navigation and free stool kits, but were limited due to sustainability cost. Such a finding indicates a need for more research to uncover effective interventions that are not cost-prohibitive. Print education materials that were culturally-tailored specifically for African-Americans often performed as well as control interventions (e.g., those utilizing the Centers for Disease Control and Preventions Screen for Life Campaign materials). Furthermore, given most of the interventions took place in the south, studies in other regions of the country may uncover different CRC screening uptake patterns, as there may be regional variation in intervention effectiveness among African-American men. A major weakness our review revealed was that only 2 of the 41 studies (5%) solely focused on African-American men, warranting the needed for intervention samples comprised exclusively of African-American men to eliminate CRC screening uptake inequities.
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Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved
