Author: John Travis Gossey, MD, BA

Primary Advisor: M Sriram Iyengar, PhD

Committee Members: John Riggs, MD, MS

Masters thesis, The University of Texas School of Health Information Sciences at Houston.

Literature Review:

Colorectal cancer (CRC) is the 3rd most common cause of cancer and the 2nd leading cause of cancer death in the United States [1].  The incidence rate of CRC differs among population groups in the United States.  Between 1998 and 2003, the incidence rates of CRC for white men and women were 63.7 and 45.9 per 100,000, African Americans men and women had 70.2 and 53.2 per 100,000, and Hispanics had 52.4 and 37.3 per 100,000 [2].  In addition to differing cancer incident rates, the prevalence of screening for CRC varies among races within the United States with African Americans and Hispanics less apt to be screened than their Caucasian counter-parts [3].   The reasons for the differing rates of screening include poor quality of communication between provider and patient, less health care coverage, lower overall education, and limited knowledge about CRC specifically [4-7].  In addition to these CRCS related barriers, a patient’s health literacy presents a more global barrier to a patient receiving optimal care.

The Institute of Medicine (IOM) defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions [8].  Hence, health literacy encompasses more than just being able to read and write. In order to fully use the healthcare system a patient must be able to understand everything from how to properly take a medication to an appointment slip.  Unfortunately, many patients have inadequate or marginal health literacy and therefore face significant challenges when using the healthcare system.  We have previously studied health literacy in the Harris County Hospital District (HCHD) and we have documented that in certain patient populations, up to 50% of the patients have marginal or low health literacy [9].  Thus, we need alternatives to brochures and other printed materials to reach these patients.

Previous studies examined the use of multimedia messages to increase colorectal cancer screening (CRCS) in patients.  In a study by Zapka et. al., researchers mailed out a video tape to patients before they were scheduled for a primary care visit.  These patients had increased rates of flexible sigmoidoscopy [10].  In a different study by Pignone et. al. researchers randomized patients due for CRCS to either an 11-minute video and tailored brochure or to a general prevention-oriented video.  The patients who received the decision aid had increased rates of having FOBT ordered (20.8% higher) and CRCS completed (14.2% higher) [11].  Neither of these interventions was targeted towards low-health literacy populations and they both required interventions that were outside the normal workflow in a clinic.