# Using audio and video brochures in a mail-based FIT outreach intervention

> **NIH NIH R21** · OHIO STATE UNIVERSITY · 2020 · $195,000

## Abstract

PROJECT SUMMARY
Our overall goal is to improve the completion of CRC (CRC) screening tests among mid-life adults (50-64
years of age) who reside in Appalachia. CRC screening tests are widely available, however many mid-life
adults do not adhere to screening guidelines. Ohio ranks 31st and Kentucky ranks 24th among the United
States (U.S.) for CRC screening adherence and CRC screening among Appalachian residents is lower than
national standards. This factor likely contributes to the higher CRC incidence and mortality rates in
Appalachian Ohio and Appalachian Kentucky compared to rates in the U.S. Because of these CRC disparities,
the Appalachian region is included in one of three “hotspots” (spatial clusters of counties with unnecessarily
high CRC mortality rates) identified in the U.S. that could benefit from CRC screening interventions. Factors
contributing to CRC disparities among Appalachian residents include: lower socioeconomic status and
educational attainment; limited health literacy; lifestyle factors; significant co-morbidities; health insurance
issues; living in a rural area with inadequate public transportation; less access to healthcare; and lower CRC
screening rates. Based on these screening data, lack of public transportation and the distance needed to travel
for a colonoscopy in a rural region, and that annual CRC screening with fecal immunochemical test (FIT) is a
recommended test option by the United States Preventive Service Task Force and the American Cancer
Society, a mailed FIT intervention is a more viable strategy for Appalachian residents.
While FIT outreach programs have been shown to increase CRC screening, many adults still do not complete
a FIT mailed to their home (up to 70% non-completion in past studies). Common patient barriers to FIT
completion include: lack of provider recommendation, perception of low CRC risk; concern about doing the test
correctly; messiness with sample collection; concern about test results; forgetfulness; and embarrassment with
specimen mailing. Importantly, many of these barriers may be addressed by materials (e.g. FIT instructions)
sent with a FIT. However, a limitation of prior FIT outreach interventions has been including materials that are
heavy in text and only supplemented with pictures, which may not be appropriate for individuals with limited
health literacy. We will develop and pilot test two FIT outreach interventions that address this limitation and
overcome other common CRC screening barriers. The interventions will use newer technology, audio or video
brochures that include FIT instructions. Audio and video brochures incorporate audio or a video screen (with
audio capabilities) surrounded by illustrations, pictures, and text. These brochures offer novel approaches for
increasing FIT return by addressing common FIT barriers via targeted CRC screening information and FIT
instructions appropriate for all health literacy skills. In addition, we will include disposable gloves in the...

## Key facts

- **NIH application ID:** 9870860
- **Project number:** 5R21AG061496-02
- **Recipient organization:** OHIO STATE UNIVERSITY
- **Principal Investigator:** MIRA L KATZ
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $195,000
- **Award type:** 5
- **Project period:** 2019-02-15 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9870860

## Citation

> US National Institutes of Health, RePORTER application 9870860, Using audio and video brochures in a mail-based FIT outreach intervention (5R21AG061496-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9870860. Licensed CC0.

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