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Table 2 Conceptual framework for the intervention components

From: Design of a randomized controlled trial to assess the comparative effectiveness of a multifaceted intervention to improve adherence to colorectal cancer screening among patients cared for in a community health center

Barrier

Intervention component(s) to address barrier

No clinical systems in place to identify patients who need repeat screening, unless they present for care

EHR query to identify patients due for repeat screening; outreach to patients (half randomized to intervention)

No personal systems in place for patients to track when preventive services are due

Automatic phone/text reminders to remind patients they are due for screening

Low adherence to repeat screening because of financial and/or logistical barriers

Mail FOBT kits to patients

Patients forget to return FOBT

Automatic phone/text reminders to patients who do not return FOBT within 2 weeks

Low priority and/or risk perception for CRC

Call from CRC Screening Coordinator at 3 months to patients who do not complete FOBT to explain need for screening

Change of phone number and/or address makes initial reminders unsuccessful

When CRC Screening Coordinator calls at 3 months, he can use updated information (i.e., from a recent visit)

Patients do not understand instructions

Mailed FOBT kits include plain language information, instructions, and direct phone number for CRC Screening Coordinator

Lack of understanding of polyps, CRC, and recommendation for FOBT screening

Call from CRC Screening Coordinator at 3 months to patients who do not complete FOBT to explain why they need repeat screening, answer questions, and mail another FOBT if requested; letter from CRC Screening Coordinator when FOBT results are negative to remind patients to repeat screening in 1–2 years and give due date