Background/Objectives: Colorectal cancer (CRC) is the leading cancer-related death in Puerto Rico (PR). Yet CRC screening (CRCS) rates remain low. We developed¡Salud!, por la Vida, an educational intervention aiming to increase CRCS among age-eligible adults living in PR.Methods: We conducted a cluster randomized controlled trial among adults 50–75 years old at Federally Qualified Health Clinics in PR. Participants could not have a history of CRC nor be currently adherent to CRCS guidelines for a fecal occult blood test (FOBT) or fecal immunochemical test (FIT) (within last year) or colonoscopy (within last 5–10 years). Out of 445 randomized participants, 355 completed the study procedures (Control: 277; Intervention: 78) and were included in the main analysis. Participants in the intervention arm completed baseline and follow-up questionnaires alongside the educational intervention (at baseline) and two reminder calls (before follow-up) within a four-month period. Control arm participants only completed baseline and follow-up questionnaires within the same period. All participants were followed up to assess CRCS completion.Results: Post-trial screening rates were significantly higher in the intervention group: FOBT/FIT (55% vs. 39%,p= 0.02), colonoscopy (10% vs. 3%,p= 0.02), and any CRCS (60% vs. 41%,p< 0.01). Compared to controls, those in the intervention group showed a 48% higher probability of undergoing any CRCS (RR = 1.48, 95%CI: 1.17, 1.86), were 1.4 times more likely to complete a FOBT/FIT (RR = 1.40, 95%CI: 1.09, 1.80), and were over 3 times more likely to undergo a colonoscopy (RR = 3.16, 95%CI: 1.26, 7.91).Conclusions: The findings underscore the efficacy of the intervention in increasing CRCS uptake, potentially preventing late-stage detection and reducing CRC mortality in PR.
背景/目的：结直肠癌（CRC）是波多黎各（PR）癌症相关死亡的主要原因，然而其筛查率仍处于较低水平。为此，我们开发了名为“¡Salud!, por la Vida”的教育干预项目，旨在提高波多黎各符合年龄条件的成年人群的结直肠癌筛查参与率。 方法：我们在波多黎各联邦认证社区卫生诊所中，针对50-75岁成年人开展了一项整群随机对照试验。参与者需无结直肠癌病史，且当前未遵循结直肠癌筛查指南要求完成粪便潜血试验（FOBT）或粪便免疫化学检测（FIT）（近一年内）或结肠镜检查（近5-10年内）。在445名随机分组的参与者中，355人完成研究流程（对照组：277人；干预组：78人）并被纳入主要分析。干预组参与者在四个月内完成基线问卷与随访问卷，同时接受教育干预（基线阶段）及两次提醒电话（随访前）。对照组参与者在同期仅完成基线问卷与随访问卷。所有参与者均接受随访以评估结直肠癌筛查完成情况。 结果：试验后干预组的筛查率显著更高：FOBT/FIT（55% vs. 39%，p=0.02）、结肠镜检查（10% vs. 3%，p=0.02）及任何形式的结直肠癌筛查（60% vs. 41%，p<0.01）。与对照组相比，干预组参与者接受任何形式结直肠癌筛查的概率高出48%（RR=1.48，95%CI：1.17-1.86），完成FOBT/FIT的可能性是对照组的1.4倍（RR=1.40，95%CI：1.09-1.80），接受结肠镜检查的可能性更是对照组的3倍以上（RR=3.16，95%CI：1.26-7.91）。 结论：研究结果证实了该干预措施在提升结直肠癌筛查参与率方面的有效性，有望预防波多黎各地区结直肠癌的晚期检出并降低其死亡率。
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