African Americans experience higher incidence and greater mortality from colorectal cancer in comparison to non-Hispanic whites. To reduce this disparity, interventions are needed that will increase rates of colorectal cancer screening by this population. Regular screening can reduce both morbidity and mortality from colorectal cancer and offers the possibility of early detection and prevention. The primary propose of this study is to develop and test the feasibility of a peer-based navigator intervention for increasing colorectal cancer screening rates for African Americans referred to a no-cost screening program. Initial data collected from the screening program show that 82% of African Americans who were referred to the program failed to complete colorectal cancer screening. The first aim of this study is to identify determinants of colorectal cancer screening for participants referred to this no-cost screening program. Semi-structured interviews and focus groups will be conducted to identify determinants that influence the decision to, or failure to, participate in colorectal cancer screening. Qualitative research will be guided by the PEN-3 framework and will explore cultural context and its relationship to colorectal cancer screening. The second aim of this study is to develop and pilot test a peer-based navigator intervention to increase screening rates. Findings from the qualitative studies will help inform the development of a peer-based navigator intervention. To test the efficacy of the intervention, two hundred African American men and women meeting the eligibility requirements of the no- cost program will be randomly assigned to the control (standard care) and peer-based navigator conditions. Those in the intervention condition will receive a peer-based navigator who will provide social support and assist participants in overcoming potential barriers. Outcome evaluation will be based on a follow-up telephone survey conducted 3-months after the initial baseline survey as well as payment record verification of self-reported colonoscopy screening. By the completion of this project, we will have tested the feasibility of a peer-based navigator intervention and collected data to plan a larger intervention trial to increase colorectal cancer screening among African Americans.
