Background/Objectives: Stool-based tests, such as the fecal immunochemical test (FIT), have been widely used for increasing colorectal cancer (CRC) screening. Small media, such as printed materials or flyers, are known to be an effective intervention to increase CRC screening by fecal tests. However, more evidence is needed to determine whether such small media are effective in improving screening uptake of a mailed FIT intervention targeted at rural populations in the USA.Methods: In this randomized study, 1230 FIT kits were mailed from July to December 2022 to rural Nebraskans aged 45–74 who were not up to date on CRC screening. Half of the participants (n = 608) also received a tailored, one-page, gender-specific educational flyer created based on focus groups with rural residents. Logistic regression was used to determine predictors of returning the FIT.Results: Study participants were predominantly female (76%), non-Hispanic White (83%), and within the age group of 55–64 (43%). Overall, 192 (15.6%) kits were returned (16.1% from the flyer group; 15.1% from the no-flyer group). However, we found no significant differences between the flyer and no-flyer groups (Adjusted Odds Ratio [AOR]: 1.21; 95% CI: 0.88–1.66). Females (AOR: 1.78; 95% CI: 1.19–6.14) and the oldest (65–74) age group (AOR: 5.03; 95% CI: 2.78–8.47) were more likely to return FIT kits than males and the youngest (45–54) age group.Conclusions: A tailored educational flyer was not effective in improving the CRC-screening-rate-by-mailed-FIT approach for rural populations. Future research should explore the content, timing, and mode of delivery of educational interventions as well as other multi-component strategies to improve screening rates. Public health officials might also consider developing strategies targeted at males and younger (45–54) age groups.
背景/目的：粪便免疫化学检测（FIT）等基于粪便的检测方法已被广泛用于提高结直肠癌（CRC）筛查率。印刷材料或宣传单等小型媒介被认为是提高粪便检测筛查率的有效干预手段。然而，此类小型媒介是否能有效提升美国农村人群通过邮寄FIT进行筛查的参与率，仍需更多证据支持。 方法：本随机研究于2022年7月至12月期间，向1230名未按时接受CRC筛查的45-74岁内布拉斯加州农村居民邮寄FIT检测包。其中半数参与者（n=608）额外收到一份基于农村居民焦点小组讨论制定的个性化单页性别教育宣传单。采用逻辑回归分析确定FIT寄回率的预测因素。 结果：研究对象以女性（76%）、非西班牙裔白人（83%）和55-64岁年龄组（43%）为主。总体寄回率为15.6%（宣传单组16.1%；无宣传单组15.1%）。但两组间无显著差异（校正比值比[AOR]：1.21；95%置信区间[CI]：0.88-1.66）。女性（AOR：1.78；95% CI：1.19-6.14）和最年长（65-74岁）年龄组（AOR：5.03；95% CI：2.78-8.47）比男性和最年轻（45-54岁）年龄组更可能寄回检测包。 结论：个性化教育宣传单未能有效提升农村人群通过邮寄FIT进行CRC筛查的参与率。未来研究应探索教育干预的内容、时机、实施方式及其他多组分策略以提高筛查率。公共卫生官员或需针对男性和较年轻（45-54岁）人群制定专项策略。
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