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Overcoming Literacy Barriers in Colorectal Cancer Screening: a Randomized Trial of a Web-based Decision Aid

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abstract
Background: Patients with low health literacy have difficulty understanding health information and receive fewer preventive services. We sought to determine whether a literacy-sensitive, web-based decision aid (DA) could increase colorectal cancer (CRC) screening rates in both low and high literacy patients. Methods: Patients at a community-based health center who were overdue for CRC screening were randomized to view either the web-based CRC screening DA or a control program about medication safety. All patients completed a baseline and post-program survey. Blinded chart review determined screening test ordering and completion rates. Results: Of the 248 patients who completed the study, 54% had limited health literacy. Compared to the control patients, DA patients were more likely to report a testing preference (84% vs. 53%, p<0.0001) and an increase in readiness to receive screening (29% vs. 10%, p<0.001). More DA patients had CRC screening tests ordered (31% vs. 23%) and completed (19% vs. 14%), but the differences were not statistically significant (multivariate p=0.08 and 0.07 respectively). Similar results were found when stratifying by literacy level. Conclusions: The DA increased patients’ test preferences and intent to receive screening. Future studies should investigate how to link the DA with other supportive strategies to increase screening rates.
subject
computer assisted instruction
health literacy
decision aid
colorectal cancer
screening
randomized controlled trial
primary care
contributor
Miller, David Jr (author)
Spangler, John (committee chair)
Avis, Nancy (committee member)
Case, L Doug (committee member)
Goff, David Jr (committee member)
date
2009-12-29T13:56:13Z (accessioned)
2010-06-18T18:58:27Z (accessioned)
2009-12-29T13:56:13Z (available)
2010-06-18T18:58:27Z (available)
2009-12-29T13:56:13Z (issued)
degree
Clinical Epidemiology & Health Services (discipline)
identifier
http://hdl.handle.net/10339/14765 (uri)
language
en_US (iso)
publisher
Wake Forest University
rights
Release the entire work for access only to the Wake Forest University system for one year from the date below. After one year, release the entire work for access worldwide. (accessRights)
title
Overcoming Literacy Barriers in Colorectal Cancer Screening: a Randomized Trial of a Web-based Decision Aid
type
Thesis

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