Community Health workers United to Reduce Colorectal cancer and CVD among people at Higher risk
Public Health Relevance
The CHURCH Trial aims to reduce disparities in Colorectal Cancer (CRC) screening and cardiovascular disease (CVD) risk factors linked to increased risk of CRC. This cluster randomized controlled trial (RCT) will employ Community Health Workers (CHWs) in a cohort of 22 African American churches in New York City. We will assess CRC screening uptake (Primary Outcome) and dietary inflammation score (DIS) and Life Simple-7 scores (Secondary Outcomes) at 6- and 12-months post-intervention and conduct a mixed-methods process evaluation to assess multi-level facilitators and barriers of screening uptake.
African American (AA) adults are more likely to contract and die from Colorectal Cancer (CRC) than any other racial group in the U.S. AAs are the least likely to undergo CRC screening, have precancerous colorectal polys removed, and have CRC detected at stages early enough for curative excision. Lower screening rates are linked to the downstream effects of structural racism and other socio-ecological factors. Although reducing the mortality from CRC is best accomplished by screening, compelling evidence links inflammatory diets and other cardiovascular disease (CVD) risk factors to increased risk of CRC. Black churches are central institutions in AA communities that can help increase access to CRC screening and address CVD risk factors. Community Health Workers (CHWs), who are trusted paraprofessionals from the target community, may be able to bridge the connection between CRC screening and CVD risk factors through church-based intervention delivery. Thus, the overall goal of this study is to develop a comprehensive, culturally tailored community- based CRC prevention model with a dual emphasis on reducing CRC risk along with its CVD risk factors. The study intervention has two components: Screening, Brief Intervention, and Referral to Treatment (SBIRT) to address CRC screening and a web-based lifestyle program called “Alive!” to address CVD risk factors linked to CRC.
The C.H.U.R.C.H. Trial (Community Health workers United to Reduce Colorectal cancer and cardiovascular disease among people at Higher risk) has four specific aims:
- (1) to compare the effect of a CHW-Led SBIRT (Intervention) to Referral As Usual (RAU) (Usual Care) on guideline-concordant CRC screening uptake;
- (2) to evaluate the effect of a Culturally Adapted CHW-linked Alive! (CACA) program incorporated into the intervention arm on dietary inflammatory score (DIS);
- (3) to evaluate the effect of CACA on changes in Life Simple-7 (LS7) scores; and
- (4) to examine the multi-level contextual mechanisms and factors influencing CHW effectiveness, reach, and implementation of CRC screening uptake and CACA activities through a mixed-methods process evaluation.
Given the broad reach and influence of Black churches, results from this study can be used to inform future scale up of this multi-pronged intervention.