Enhancing Adherence Among Older African American Men Enrolled in a Longitudinal Cancer Screening Trial

Abstract

The purpose of this study was to enhance adherence among older (aged 55 years and older) African American men enrolled in a cancer screening trial for prostate, lung, and colorectal cancer. For this study, we defined adherence as completing the trial screenings. We used a randomized trial design. Case managers contacted intervention group participants (n=352) at least monthly by telephone and provided information and referral services. The control group included 351 participants. Among participants with low income, those in the intervention group had higher screening adherence rates than did participants in the control group for (a) prostate-specific antigen test for prostate cancer (74.3% vs 53.0%, p=.001), (b) digital rectal exam for prostate cancer (66.2% vs 46.1%, p=.011), and (c) chest x-ray for lung cancer (70.9% vs 51.3%, p=.012). We found no statistically significant differences in adherence rates for flexible sigmoidoscopy screening for colorectal cancer. In contrast, among participants with moderate-to-high income, we found no statistically significant differences in adherence rates between intervention and control group participants for any of the screening tests. The case management intervention was effective in enhancing adherence among participants with the lowest income, who in many studies are the most difficult to retain.