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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
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