The overarching goal of this proposal is to create a scalable community-academic partnership model for colorectal cancer (CRC) and cardiovascular disease (CVD) prevention for African American (AA) communities. Our dual intervention approach allows us to target two major killers of AAs, and aggressively pursue the mandate of this Program Announcement. We aim to (1) increase guideline concordant10 CRC screening uptake using a community health worker (CHW)-Led SBIRT intervention (Primary Outcome); and (2) reduce dietary and CVD risk factors linked to CRC (Secondary Outcomes). The latter will be addressed by culturally adapting an existing, evidence-based, web-based lifestyle program called Alive!, which has been shown in several RCTs to improve CVD outcomes. Using a Hybrid Type 1 Implementation-Effectiveness design, we will randomize 440 subjects from 22 AA churches into a cluster RCT to accomplish the following:
Specific Aim 1: To compare the effect of SBIRT (Intervention) to Referral As Usual (RAU) (Usual Care) on guideline-concordant CRC screening uptake. Hypothesis: Intervention will lead to increased CRC screening uptake (colonoscopy, fecal DNA) (Primary Outcome) compared to RAU at 6-months.
Aim 2: To evaluate the effect of a Culturally-adapted Alive! Program (CAP) incorporated into the intervention arm on dietary inflammatory score (DIS). Hypothesis: participants in the CAP arm will have lower DIS scores compared to RAU at 6-months.
Aim 3: To evaluate the effect of CAP on changes in Life Simple-7 (LS7) scores. Hypothesis: participants in the CAP arm will have improvement in LS7 scores compared to RAU at 6-months and 1 year.
Aim 4: To examine the multi-level contextual mechanisms and factors influencing CHW effectiveness, reach, and implementation of CRC screening uptake and CAP activities. Guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR) we will conduct a mixed methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors. This information will inform future dissemination and scale-up of this intervention.
Condition or disease | Intervention/treatment | Phase |
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Colorectal Cancer | Behavioral: SBIRT Behavioral: Referral as Usual (RAU) | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 880 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Single (Outcomes Assessor) |
Primary Purpose: | Health Services Research |
Official Title: | Community Health Workers United to Reduce Colorectal Cancer and Cardiovascular Disease Among People at Higher Risk |
Estimated Study Start Date : | June 15, 2022 |
Estimated Primary Completion Date : | September 15, 2025 |
Estimated Study Completion Date : | September 15, 2025 |
Arm | Intervention/treatment |
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Experimental: Screening, Brief Intervention, and Referral to Treatment (SBIRT)
1a) SBIRT is an evidence-based approach originally designed for people at risk of developing mental disorders. SBIRT is composed of three components: Screening with a validated instrument, Brief Intervention, Referral to Treatment. Motivational Interviewing (MI) is an empirically tested, person-centered, behavior change intervention designed to guide, elicit, and strengthen motivation for change. It decreases ambivalence and increases motivation for treatment. 1b) We will utilize the Culturally-adapted Alive! Program - a cost-effective, lifestyle coaching web-based automated platform that includes step-by-step individualized tailoring, feedback, and weekly guidance through interactive emails focused on increasing physical activity, improving eating habits, and weight control. |
Behavioral: SBIRT
1a) SBIRT is an evidence-based approach originally designed for people at risk of developing mental disorders. SBIRT is composed of three components: Screening with a validated instrument, Brief Intervention, Referral to Treatment. Motivational Interviewing (MI) is an empirically tested, person-centered, behavior change intervention designed to guide, elicit, and strengthen motivation for change. It decreases ambivalence and increases motivation for treatment. 1b) We will utilize the Culturally-adapted Alive! Program - a cost-effective, lifestyle coaching web-based automated platform that includes step-by-step individualized tailoring, feedback, and weekly guidance through interactive emails focused on increasing physical activity, improving eating habits, and weight control Other Name: Culturally-adapted ALIVE! Program (CAP)
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Active Comparator: Referral as Usual (RAU)
Referral as Usual will involve distributing CRC health educational materials (e.g. NCI or CDC brochures that include new guidelines) and contact information for screening service providers in our target community.
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Behavioral: Referral as Usual (RAU)
Referral as Usual will involve distributing CRC health educational materials (e.g. NCI or CDC brochures that include new guidelines) and contact information for screening service providers in our target community.
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CRC screening uptake (colonoscopy, stool-based test) (Primary Outcome).
This cluster RCT will evaluate the impact of a CHW enhanced CRC screening intervention on screening uptake (clinic-based colonoscopy or home-based stool test) (Primary Outcome). The definition of screening uptake is the subject's self-report of completing a CRC screening test plus the research team's verification of this completion from medical records.
Screening uptake (clinic-based colonoscopy or home-based stool test) (Primary Outcome) is the subject's self-report of completing a CRC screening test plus the research team's verification of this completion from medical records.
Ages Eligible for Study: | 45 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
Exclusion Criteria:
United States, New York | |
Columbia University Medical Center | |
New York, New York, United States, 10032 |
Tracking Information | |||||||||||
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First Submitted Date ICMJE | November 5, 2021 | ||||||||||
First Posted Date ICMJE | December 30, 2021 | ||||||||||
Last Update Posted Date | December 30, 2021 | ||||||||||
Estimated Study Start Date ICMJE | June 15, 2022 | ||||||||||
Estimated Primary Completion Date | September 15, 2025 (Final data collection date for primary outcome measure) | ||||||||||
Current Primary Outcome Measures ICMJE |
CRC Screening Uptake [ Time Frame: Measured at 6 months post-screening ] CRC screening uptake (colonoscopy, stool-based test) (Primary Outcome).
This cluster RCT will evaluate the impact of a CHW enhanced CRC screening intervention on screening uptake (clinic-based colonoscopy or home-based stool test) (Primary Outcome). The definition of screening uptake is the subject's self-report of completing a CRC screening test plus the research team's verification of this completion from medical records.
Screening uptake (clinic-based colonoscopy or home-based stool test) (Primary Outcome) is the subject's self-report of completing a CRC screening test plus the research team's verification of this completion from medical records.
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Original Primary Outcome Measures ICMJE | Same as current | ||||||||||
Change History | No Changes Posted | ||||||||||
Current Secondary Outcome Measures ICMJE |
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Original Secondary Outcome Measures ICMJE | Same as current | ||||||||||
Current Other Pre-specified Outcome Measures | Not Provided | ||||||||||
Original Other Pre-specified Outcome Measures | Not Provided | ||||||||||
Descriptive Information | |||||||||||
Brief Title ICMJE | Community Health Workers United to Reduce Colorectal Cancer and Cardiovascular Disease Among People at Higher Risk | ||||||||||
Official Title ICMJE | Community Health Workers United to Reduce Colorectal Cancer and Cardiovascular Disease Among People at Higher Risk | ||||||||||
Brief Summary |
The overarching goal of this proposal is to create a scalable community-academic partnership model for colorectal cancer (CRC) and cardiovascular disease (CVD) prevention for African American (AA) communities. Our dual intervention approach allows us to target two major killers of AAs, and aggressively pursue the mandate of this Program Announcement. We aim to (1) increase guideline concordant10 CRC screening uptake using a community health worker (CHW)-Led SBIRT intervention (Primary Outcome); and (2) reduce dietary and CVD risk factors linked to CRC (Secondary Outcomes). The latter will be addressed by culturally adapting an existing, evidence-based, web-based lifestyle program called Alive!, which has been shown in several RCTs to improve CVD outcomes. Using a Hybrid Type 1 Implementation-Effectiveness design, we will randomize 440 subjects from 22 AA churches into a cluster RCT to accomplish the following: Specific Aim 1: To compare the effect of SBIRT (Intervention) to Referral As Usual (RAU) (Usual Care) on guideline-concordant CRC screening uptake. Hypothesis: Intervention will lead to increased CRC screening uptake (colonoscopy, fecal DNA) (Primary Outcome) compared to RAU at 6-months. Aim 2: To evaluate the effect of a Culturally-adapted Alive! Program (CAP) incorporated into the intervention arm on dietary inflammatory score (DIS). Hypothesis: participants in the CAP arm will have lower DIS scores compared to RAU at 6-months. Aim 3: To evaluate the effect of CAP on changes in Life Simple-7 (LS7) scores. Hypothesis: participants in the CAP arm will have improvement in LS7 scores compared to RAU at 6-months and 1 year. Aim 4: To examine the multi-level contextual mechanisms and factors influencing CHW effectiveness, reach, and implementation of CRC screening uptake and CAP activities. Guided by a racism-conscious adaptation of the Consolidated Framework for Implementation Research (CFIR) we will conduct a mixed methods process evaluation with key stakeholders to understand multi-level influences on CRC screening and CVD risk behaviors. This information will inform future dissemination and scale-up of this intervention. |
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Detailed Description | Colorectal cancer (CRC) is the second most lethal cancer in the U.S with the highest incidence and mortality rates among African Americans (AAs) compared to other racial groups. Despite these disparities, which includes premature mortality, AAs are the least likely to undergo CRC screening, have precancerous colorectal polys removed, and have CRC detected at stages early enough for curative excision. Lower screening rates are linked to the downstream effects of structural inequities such as access to care, knowledge of screening options and benefits, health system mistrust, fear and anxiety. Although reducing the burden of CRC is best accomplished by screening, compelling evidence links inflammatory diets and cardiovascular disease (CVD) risk factors to increased CRC risk. In response to RFA-MD-21-007 to address two or more chronic diseases that commonly co-occur, share social contexts or risk factors, this proposal aims to develop a community-based prevention model to reduce CRC and CVD risk among AAs. | ||||||||||
Study Type ICMJE | Interventional | ||||||||||
Study Phase ICMJE | Not Applicable | ||||||||||
Study Design ICMJE | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Single (Outcomes Assessor) Primary Purpose: Health Services Research |
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Condition ICMJE | Colorectal Cancer | ||||||||||
Intervention ICMJE |
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Study Arms ICMJE |
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Publications * |
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* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline. |
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Recruitment Information | |||||||||||
Recruitment Status ICMJE | Not yet recruiting | ||||||||||
Estimated Enrollment ICMJE |
880 | ||||||||||
Original Estimated Enrollment ICMJE | Same as current | ||||||||||
Estimated Study Completion Date ICMJE | September 15, 2025 | ||||||||||
Estimated Primary Completion Date | September 15, 2025 (Final data collection date for primary outcome measure) | ||||||||||
Eligibility Criteria ICMJE |
Inclusion Criteria:
Exclusion Criteria:
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Sex/Gender ICMJE |
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Ages ICMJE | 45 Years and older (Adult, Older Adult) | ||||||||||
Accepts Healthy Volunteers ICMJE | Yes | ||||||||||
Contacts ICMJE | |||||||||||
Listed Location Countries ICMJE | United States | ||||||||||
Removed Location Countries | |||||||||||
Administrative Information | |||||||||||
NCT Number ICMJE | NCT05174286 | ||||||||||
Other Study ID Numbers ICMJE | AAAT9307 | ||||||||||
Has Data Monitoring Committee | Yes | ||||||||||
U.S. FDA-regulated Product |
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IPD Sharing Statement ICMJE |
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Responsible Party | Olajide Williams, Columbia University | ||||||||||
Study Sponsor ICMJE | Columbia University | ||||||||||
Collaborators ICMJE | Not Provided | ||||||||||
Investigators ICMJE | Not Provided | ||||||||||
PRS Account | Columbia University | ||||||||||
Verification Date | December 2021 | ||||||||||
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP |