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Transl Behav Med. 2015 Mar;5(1):60-7. doi: 10.1007/s13142-014-0276-x.

Reasons for non-response to a direct-mailed FIT kit program: lessons learned from a pragmatic colorectal-cancer screening study in a federally sponsored health center.

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Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227 USA.
Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101 USA.


Colorectal cancer screening rates are below optimal. As part of a pilot clinic-based pragmatic study aiming to raise rates of colorectal-cancer screening, we explored patients' reasons for not responding to a direct-mailed screening invitation. We conducted telephone interviews with patients who were mailed a fecal immunochemical test (FIT) but who did not return it to the lab. Interviews were audio-recorded, transcribed, and coded for thematic analysis. We met our goal of 20 interviews (10 in English and 10 Spanish; 75 % female). Reasons for not completing tests were fear of results or cost of follow-up colonoscopy (n = 9); not having received the test in the mail (n = 7); concerns about mailing fecal matter or that test results could be mixed up (n = 6); and being busy or forgetful (n = 4). Efforts to improve uptake of colorectal cancer screening in a direct-mailed program ought to address concerns identified in our study.


Colorectal cancer screening; Direct-mailed fecal testing; Federally qualified health centers; Implementation; Pragmatic research; Qualitative interviews

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