Trial Information

Colorectal Cancer Control in Appalachian Churches

The purpose of this project is to conduct a community-based intervention and evaluate the
independent and combined effects of two intervention strategies on primary and secondary
prevention of colorectal cancer (CRC) among members of rural Appalachian churches. Many
regions of Appalachia have high poverty, low education, and high unemployment. Health
disparities are great in this region and social and behavioral factors put many individuals
at high risk for increased mortality from CRC.

The sampling frame consists of all churches in a 7 county area of western West Virginia.
Eligible churches will have at least 180 active members, will not share a common pastor, and
have no CRC control activities. Using a 2x2 experimental design, churches will be divided
into two separate clusters, those with and without an existing parish nurse program. Then
churches from each cluster will be randomized to one of two conditions, a natural helper or
control condition.

Eligible church members will be adult males and females who are identified through member
lists provided by the recruited churches. Because the primary outcome variable is CRC
screening, at least half of the recruited church members must be age 50 and older, report no
history of CRC, and have not recently completed CRC screening. Interested members will be
asked to complete an informed consent form detailing participation in either the
intervention or control arm of the study. The control group will be offered other health
promotion interventions through the church and the CRC educational materials after data
collection is completed.

Data will be collected before and after the intervention activities. Study participants
will complete a paper and pencil survey at the church at each measurement point (baseline,
follow-up). The baseline survey will assess sociodemographics, psychosocial information,
stage of change, self-efficacy, health beliefs, barriers to change, health behavior
knowledge and practices involving diet, physical activity, and CRC screening. The follow-up
survey will assess body mass index, dietary intake, physical activity level, and CRC
screening by FOBT, flexible sigmoidoscopy, and colonoscopy.

The primary hypothesis to be tested is that the combination of these two community-based
intervention strategies will be most effective overall. To evaluate the effectiveness of
the intervention strategies, the proportions in outcome measures between each intervention,
the combined intervention, and control groups will be compared.