Community-clinic partnership to address social needs and improve colorectal cancer screening outcomes: The PRIME stepped-wedge study

Background: US colorectal cancer screening rates are suboptimal, particularly among Latino populations and patients served by federally qualified health centers (FQHCs). PRIME is a two-phased study to test effectiveness of a multi-component program to address patient social needs and improve colorectal cancer screening and follow-up in neighborhoods served by our partnering FQHC. 

Methods: PRIME is a modified stepped-wedge study involving health-center patients in 12 neighborhoods in Southern California, followed by a scale-up study involving four additional health centers/neighborhoods. Eligible adults are ages 45–64, due for colorectal cancer screening, with a health center clinic visit in the previous 6 months. The intervention combines: (1) phone-based advance notification, a mailed FIT, and text messages with links to a short animated instructional video on FIT completion, (2) patient navigation for addressing patients' social needs, and (3) neighborhood-level events to raise awareness about the need for colorectal cancer screening. 

Results: Recruitment for Phase I began in July 2024. Primary effectiveness outcome is receipt of any colorectal cancer screening within 6 months; primary implementation outcome is clinic-level and organizational-level rates of program delivery, by component (e.g., mailed FIT, social needs navigation, community events). Phase II scale-up activities will: use webinars, train-the-trainer workshops, and collaborative learning activities; and will assess adoption of and adaptations to the multi-component program. 

Conclusion: This study will test the effectiveness, implementation, and scale-up of a multi-component video text message and social needs navigation program to improve colorectal cancer screening uptake in neighborhoods served by our partnering FQHC and community-based organizations.