Evaluation of a Telephone Navigation Program to Increase Cancer Control Behaviors

Background: Health behaviors such as cancer screening and HPV vaccination can reduce colorectal, breast, and cervical cancer incidence and mortality yet they are underutilized, particularly among low income and minority populations. Interventions targeting medically underserved individuals are needed to increase use of cancer control and prevention services to eliminate inequities in cancer-related morbidity and mortality. The University of Texas School of Public Health (UTHealth) and the 2-1-1 Texas telephone Helpline partnered to develop, implement and evaluate a telephone-based cancer prevention program to reach large numbers of underserved Texans. The 2-1-1 U.S. designated Helpline connects low-income and underserved callers with health and social services. In 2017, the 2-1-1 Texas/United Way Helpline answered over 1,056,000 calls. The goal of the intervention, which used telephone navigation, was to screen, educate, motivate and link 2-1-1 Texas callers to local cancer control and prevention services Aim: The study aim was to evaluate the effectiveness of the intervention. Methods: We used a randomized comparison group design to evaluate the effectiveness of the 2-1-1 -delivered Cancer Control Navigation (CCN) intervention on increasing use of cancer control services among 2-1-1 callers. We assessed the impact of the program on increasing mammography, Pap test, colorectal cancer screening, HPV vaccination, and smoking cessation among a sample of 2-1-1 callers. Trained 2-1-1 information specialists invited callers to complete a risk assessment after receiving usual 2-1-1 service (addressing the need that they called about). They then offered eligible callers referrals and invited them to participate in the program. Consented participants were randomized to either the CCN condition or referral only condition. We conducted follow-up at three and six months to assess whether participants obtained any of the needed cancer control services. Results: When considering any needed cancer control outcome, CCN significantly increased completion of the cancer control behavior by 18% ( P < .05). CNN also increased Pap test completion by 33% ( P < .05). For other behaviors, while not statistically significant, results indicated that CNN increased colorectal cancer screening by 43%, mammography by 18%, and HPV vaccination of daughters by 29%. Conclusion: Outcome evaluation results demonstrate effectiveness of the 2-1-1 CCN program in increasing cancer control behaviors among callers. This study also demonstrates the feasibility of reaching minority, low income and underserved individuals through 2-1-1 to connect them to cancer control services. This 2-1-1-delivered program has great potential to connect large numbers of medically underserved individuals to cancer prevention services, decrease the burden of cancer and reduce inequities.