Colorectal cancer (CRC) incidence and mortality are disproportionately high among rural residents and Medicaid enrollees. Mailed fecal immunochemical testing (FIT) can raise screening rates, but rural patients have lower response rates than their urban counterparts. To help address these persistent disparities, we tailored mailed FIT screening messages for rural, Medicaid enrollees using a patient engagement approach called Boot Camp Translation (BCT).
A modified BCT was conducted with eligible patients (English-speaking and ages 50 to 74) and clinic staff involved in patient outreach, and located in rural areas. To accommodate COVID-related restrictions, BCT was conducted virtually. In four sessions held over two months, participants learned about CRC and considered messaging and outreach. We used rapid turn-around qualitative methods to analyze recordings of the sessions and the detailed field notes.
Thirteen adults agreed to participate in BCT; however, six could not engage due to COVID-related difficulties (4) or other reasons (2). Several key areas emerged that reflected messaging tailored for rural populations, such as being direct about cancer, close clinic-patient connections, and not including family pictures. Other themes were CRC seriousness, test safety and ease, and the low cost of FIT. The recommended outreach approach included a live phone call prior to the mailing, sharing a CRC information sheet, and text or phone reminders a week after the FIT mailing.
We were able to successfully use remote methods to gather rural patient feedback about a mailed FIT outreach program and CRC screening messages. We used this information to adapt mailed FIT materials including introduction (or prompt) letter, a letter to accompany the mailed FIT, phone scripts, and best practices recommendations. By finding themes and modalities that are preferred by a rural population, we hope to inform others working across the country with this hard-to-engage, yet underserved, population.