Patient Navigation Activities in a Large Community -Based Colorectal Cancer Screening Program

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Mitchell, Rebekah Salaiz, Cynthia Chacon, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8264168/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Jan, 2026 Read the published version in BMC Primary Care → Version 1 posted 9 You are reading this latest preprint version Abstract Introduction: Colorectal cancer (CRC) screening is recommended for average-risk individuals aged 45–75 years old; however, screening rates are suboptimal. An evidence-based strategy found to be effective at increasing screening uptake is patient navigation. The purpose of this paper is to describe patient navigation activities delivered in an effective culturally tailored community-based colorectal cancer screening program in an unscreened, underserved and predominantly Hispanic population. Methods: A total of 690 participants recruited between March 2012 and January 2015 were eligible to receive a colonoscopy. A random sample of 100 high-risk participants and 100 participants who had a positive FIT test were selected for inclusion. We characterized participant identified barriers, navigation contact types, frequency and duration. Linear and logistic regression models were used to examine associations between sociodemographic and health-related factors and two outcomes: ( 1 ) the number of navigation activities participants required, and ( 2 ) whether participants reported experiencing at least one barrier to screening. Results: The average age of participants in our sample was 56.3 years (SD = 5.72), with the majority being female (74.0%) and Hispanic (96.5%). On average, participants received 9.66 navigation contacts in the program, and navigators spent 54.89 minutes per participant delivering navigation services. The most common activities identified were scheduling appointments, reminder phone calls, and communicating results. Conclusion: These results provide detailed information about type and duration of navigation activities for CRC screening and colonoscopy completion within an effective community-based CRC screening program designed for and underserved and underscreened population. Colorectal cancer patient navigation Hispanic population health disparities Introduction Colorectal cancer (CRC) screening is recommended for average-risk individuals aged 45–75 years old because of evidence of its effectiveness in reducing CRC incidence and mortality.( 1 ) The Healthy People 2030 target for CRC screening is 72.8%; however, screening rates remain suboptimal. Current national data indicate that screening is especially low among certain subgroups including the uninsured (22%), those who have resided in the United States for less than 10 years (30%) and Hispanics (51% up to date).( 2 ) The Community Preventive Services Task Force has found strong evidence in support of patient navigation to increase CRC screening within underscreened populations.( 3 ) Navigation includes reminders to complete screening, reducing structural barriers (e.g., assisting with transportation, scheduling appointments), and reducing out-of-pocket costs by finding low or no-cost screening services.( 3 ) For low-income, uninsured, and underinsured individuals, patient navigation has increased CRC screening completion and reduced the number of days to diagnostic testing.( 4 – 7 ) However, detailed information about the specific type and duration of navigation activities and the types of barriers being addressed is lacking in the navigation literature. This information is essential for planning and designing effective navigation programs. In this paper, we describe detailed patient navigation activities delivered in an effective culturally tailored community-based colorectal cancer screening program, Against Colorectal Cancer in our Neighborhoods (ACCION) that was implemented in a previously largely unscreened, underserved and predominantly Hispanic population. Outcomes have been described previously and include a colonoscopy completion rate of 74.5%.( 8 ) Materials and Methods Design, Setting and Sampling This is a secondary data analysis of navigation data collected during the implementation of the ACCION program that was delivered from March 2012 - July 2015. All participants in the ACCION program were consented to participate at time of enrollment. The purpose of this analysis was to provide a detailed description of navigation activities delivered during the intervention, specifically ( 1 ) frequency, type, and duration of navigation activities; ( 2 ) frequency and type of barriers encountered; and ( 3 ) association between participant demographics, barriers, and navigation activities. Ethical approval for this study was obtained from Texas Tech University Health Sciences Center El Paso Institutional Review Board (IRB No. E18157). This approval was in accordance with the Declaration of Helsinki. A stratified sampling scheme was used to randomly select 100 participants who were eligible for a diagnostic colonoscopy following a positive FIT and 100 participants who were eligible for a screening colonoscopy, from a total of 690 ACCION participants. Program Description ACCION is a Cancer Prevention and Research Institute of Texas-funded community-based intervention continuing to be implemented in El Paso County among a predominantly Hispanic population to reduce the burden of CRC through outreach, education, no-cost testing, and navigation services. During the period from which data is drawn, individuals aged 50–75, with no health insurance, a self-reported Texas address who were due for CRC screening without a history of rectal bleeding in the previous three months were eligible. Participants were recruited from community sites, enrolled and consented, provided education by community health workers (CHWs), offered home fecal immunochemical testing (FIT) if they were average risk or were referred to the navigator for a screening colonoscopy if they had a family history of CRC or a personal history of adenomatous polyps. Participants with a positive FIT were eligible for a no-cost diagnostic colonoscopy and were contacted by the navigator. Navigation services were provided to all participants to facilitate screening, diagnostic testing, and treatment adherence. Detailed program information is available in previous publications.( 8 , 9 ) Navigation Description During every encounter, navigators elicited and addressed barriers to attending the pre-procedure appointment, completing bowel preparation or the colonoscopy. Navigators documented all contact with participants in a HIPAA-compliant, encrypted web-based program database. Navigation activities covered four areas: 1) FIT and colonoscopy testing process. Navigators tracked all participants given a FIT, replacing a test if needed. If a FIT was not returned, phone call reminders were performed 14 and 28 days after test distribution. If both phone call attempts were unsuccessful, the navigator sent a letter to the participant to inform them no further contact would be attempted. For participants needing a colonoscopy, navigators contacted participants and scheduled an in-person pre-procedure preparation (pre-op) appointment to verify eligibility, explain the procedure, and provide education, bowel preparation and instructions for bowel preparation. The navigator was responsible for scheduling colonoscopy appointments and making reminder calls for pre-op and procedure visits. If a participant did not complete bowel preparation or did not attend their procedure, the navigator attempted to re-schedule; 2) Case management. The navigator was responsible for providing colonoscopy results to participants either by phone or letter. For participants diagnosed with CRC at the time of colonoscopy, the Project Director (a family medicine physician) and navigator would meet with the participant in-person to provide the results. The navigator would then assist the participant to identify financial coverage needs for treatment (details described below) and resources for additional health-related needs indicated by the participant; 3) Identifying and addressing individual barriers . Barriers to attending the pre-op appointment, bowel preparation, and the colonoscopy procedure were assessed. The program had funding to provide taxi vouchers for participants to attend the pre-op appointment and procedure. Navigators used motivational interviewing techniques and prepared scripts to address common barriers to procedure completion; and 4) Facilitating treatment follow-up. Participants with abnormal colonoscopy results or diagnosed with cancer were assisted in completing applications for the county safety-net and discount programs. The navigator also assisted in making appointments with an oncologist, surgeon, other specialists, and primary care physician, as needed. Navigator Characteristics and Training The program had one full-time navigator, and two separate individuals served in this role during the project period. Both were Hispanic women from the community, bilingual, with a background in community health outreach, case management, and health system experience. They were trained in the health educational materials used by the CHWs, including information on the screening tests, barriers to screening, and process for documentation in the database. The navigator received training on a detailed manual that included contact phone scripts, templates for result letters, scripts for communicating with clinicians and the endoscopy suite, bowel preparation, and all required paperwork for colonoscopy scheduling. Navigators also received an intense two-day training on motivational interviewing including role-playing exercises. The training included responses for the navigators to use when the participant presented myths about CRC or screening based on information from previous focus groups as well as constructs from the Health Belief Model.( 10 , 11 ) Measures Participant sociodemographic data was self-reported during program enrollment and included: gender, age, country of origin, time in the US, preferred language, education, income, marital status, and employment status. Health-related information was also collected: self-reported health, having a regular physician, prior awareness of CRC, previous physician recommendation for CRC screening, and CRC screening history. Navigator Activity Coding All patient encounters (phone, in-person, and via postal mail) were entered into the program database by the navigator including time spent, type of activities, and barriers. A coding system was used to classify barrier types and activities for each encounter. Patient barriers were categorized as “structural” if pertaining to policies, practices, or norms of healthcare facilities or systems (e.g., lack of transportation, prohibitive cost of care) or “personal or cultural” if related to individual or community characteristics of the participant (e.g., fear of pain, language, lack of time to complete testing).( 12 ) Statistical Analysis Descriptive statistics were used to examine the distribution of sociodemographic characteristics. The mean number of contacts per participant and the average duration of each contact were calculated. The mean and range of reported barriers and navigation contacts were assessed separately for the diagnostic colonoscopy group (FIT Positive) and the screening colonoscopy group (High-Risk). Frequency and percentage were also used to describe barriers among the two groups and overall. A multiple linear regression was conducted to predict the number of navigation contacts based on sociodemographic variables and health-related factors. Categorical variables were treated as factors, with the most common category used as the reference level. Independent t-tests were conducted to examine differences in navigation activities and navigation duration between the FIT Positive and High-Risk groups. Additionally, chi-square tests and t-tests were used to assess barriers to screening and navigation activities among participants with longer navigation durations compared to those with shorter durations. All analyses were conducted in R (version 4.2.2). Results Demographic Profile A total of 200 colonoscopy-eligible ACCION program participants were included in the study (Table 1 ). The average age was 56.3 years (SD = 5.72), the majority were female (74.0%), Hispanic (96.5%), born in Mexico (81.0%), and Spanish speakers (80.5%). The average number of years living in the US was 28.75 (SD = 17.28); 60% of participants reported their health to be Very Good/Excellent; 54.9% reported not having a regular doctor; and 43.0% reported a family history of CRC. Most participants (81.6%) reported never being screened for CRC (Table 1 ). Overall, the colonoscopy completion rate was 84.5%. 89.0% of FIT Positive participants completed a diagnostic colonoscopy, and 80.0% of High-Risk participants completed a screening colonoscopy (Table 2 ). Table 1 Participant Demographics. Characteristic High-Risk N = 100 1 FIT Positive N = 100 1 Overall N = 200 1 Gender Male 24 (24.0%) 28 (28.0%) 52 (26.0%) Female 76 (76.0%) 72 (72.0%) 148 (74.0%) Age, Mean Yrs (SD) 55.5 (5.7) 57.2 (5.7) 56.3 (5.7) Country of Birth USA 20 (20.0%) 15 (15.0%) 35 (17.5%) Mexico 78 (78.0%) 84 (84.0%) 162 (81.0%) Other 2 (2.0%) 1 (1.0%) 3 (1.5%) Race/Ethnicity Mexican or Mexican American, Hispanic or Latino 96 (96.0%) 97 (97.0%) 193 (96.5%) Non-Hispanic White 3 (3.0%) 1 (1.0%) 4 (2.0%) Non-Hispanic Black or African American 0 (0.0%) 1 (1.0%) 1 (0.5%) Asian/Pacific Islander 0 (0.0%) 0 (0.0%) 0 (0.0%) American Indian/Alaskan Native 0 (0.0%) 0 (0.0%) 0 (0.0%) Other 1 (1.0%) 1 (1.0%) 2 (1.0%) Time in US, Mean Yrs (SD) 28.9 (17.0) 28.6 (17.7) 28.8 (17.3) Preferred Language English 9 (9.0%) 3 (3.0%) 12 (6.0%) Spanish 81 (81.0%) 80 (80.0%) 161 (80.5%) Both 10 (10.0%) 17 (17.0%) 27 (13.5%) High School Diploma No 51 (51.0%) 63 (63.0%) 114 (57.0%) Yes 49 (49.0%) 37 (37.0%) 86 (43.0%) Income Category <10,000 34 (50.8%) 46 (66.7%) 80 (58.8%) 10,000-25,000 7 (10.4%) 3 (4.3%) 10 (7.4%) Unknown 33 31 64 Marital Status No 47 (47.0%) 36 (36.0%) 83 (41.5%) Yes 53 (53.00%) 64 (64.00%) 117 (58.50%) Working Status No 57 (57.6%) 56 (56.6%) 113 (57.1%) Yes, part time 19 (19.2%) 21 (21.2%) 40 (20.2%) Yes, full time 23 (23.2%) 22 (22.2%) 45 (22.7%) Unknown 1 1 2 Self-Reported Health Poor/Fair 8 (8.0%) 9 (9.0%) 17 (8.5%) Good 33 (33.0%) 30 (30.0%) 63 (31.5%) Very Good/Excellent 59 (59.0%) 61 (61.0%) 120 (60.0%) Has a regular physician No 56 (57.7%) 51 (52.0%) 107 (54.9%) Yes 41 (42.3%) 47 (48.0%) 88 (45.1%) Unknown 3 2 5 Before today, heard of CRC No 29 (29.0%) 40 (40.0%) 69 (34.5%) Yes 71 (71.0%) 60 (60.0%) 131 (65.5%) Doctor previously recommended testing for CRC No 71 (71.0%) 88 (88.0%) 159 (79.5%) Yes 29 (29.0%) 12 (12.0%) 41 (20.5%) Ever screened for CRC in the past No 79 (92.9%) 72 (72.0%) 151 (81.6%) Yes 6 (7.1%) 28 (28.0%) 34 (18.4%) Unknown 15 0 15 Family History of CRC No 14 (14.0%) 100 (100.0%) 114 (57.0%) Yes 86 (86.0%) 0 (0.0%) 86 (43.0%) 1 n (%); Mean (SD) Table 2 Percentage of study participants completing a screening or diagnostic colonoscopy in the FIT positive and high-risk groups. Overall N = 200 1 FIT Positive N = 100 1 High-Risk N = 100 1 Completed Colonoscopy No 31 (15.5%) 11 (11.0%) 20 (20.0%) Yes 169 (84.5%) 89 (89.0%) 80 (80.0%) 1 n (%) Navigation Contacts A total of 1,931 navigation contacts were recorded across our sample for a total duration of 10,978.41 minutes (Table 3 ). The FIT Positive group had significantly more total contacts (M = 10.50, SD = 3.6) than the High-Risk group (M = 8.81, SD = 3.50); t (198) = 3.33, p = .0010), but not significantly longer average contacts (FIT Positive: M = 54.41, SD = 29.24; High-Risk: M = 55.37, SD = 31.06; (198) = .224, p = .82). Table 3 Navigation Contacts: Frequency and duration by colonoscopy indication FIT Positive N = 100 1 High-Risk N = 100 1 Overall N = 200 1 Phone Calls Total Phone Calls (sum) 850 642 1492 Total Phone Call Minutes (sum) 2316.08 2874 5190.08 Phone Calls Per Person (M, Range) 8.50 (2.0–23.0) 6.42 (1.00–17.0) 7.46 (1.00–23.0) Phone Call Duration Per Person (M, Range) 23.16 (1.0–163.0) 28.74 (1.00–188.0) 25.95 (1.0–188.0) In-Person In-Person Activities (sum) 76 64 140 In-Person Activities 0 25 (25.0%) 37 (37.0%) 62 (31.0%) 1 74 (74.0%) 62 (62.0%) 136 (68.0%) 2 1 (1.0%) 1 (1.0%) 2 (1.0%) Total In-Person Minutes (sum) 3111 2663 5774 In-Person Activities Duration (M, Range) 42.03 (25.0–90.0) 42.27 (20.0–90.0) 42.14 (20.0–90.0) Overall Contacts Overall Contact (sum) 1050 881 1931 Overall Contact Minutes (sum) 5441.41 5537 10978.41 Overall Number of Contacts Per Person (M, Range) 10.50 (2.0–26.0) 8.81 (1.0–18.0) 9.66 (1.0–26.0) Duration of Overall Contacts Per Person (M, Range) 54.41 (1.0–163.0) 55.37 (1.0–188.0) 54.89 (1.0–188.0) 1 Mean (Min – Max); n (%) Phone Call Encounters Navigators made 1,492 phone calls to this sample of participants for a total of 5,190 minutes (Table 3 ). The mean number of phone calls participants received was 7.46 (range: 1 to 23) and the mean duration of a phone call was 25.95 minutes. The shortest phone calls were reminder calls or voicemails (duration of one minute) and the longest call (188 minutes) consisted of an intake assessment, although this was typically conducted in-person. Participants in the FIT Positive group received significantly more phone calls on average (M = 8.50, SD = 3.29) compared to the High-Risk group (M = 6.42, SD = 2.71, t (198) = 4.88, p < .001). Although more time was spent on phone calls with the High-Risk group (2,874 minutes and 642 calls) compared with the FIT Positive group (2,316 minutes and 850 calls), this did not differ significantly ( t (-1.45), p = .15). In-person Navigation Encounters A total of 140 in-person contact encounters were registered with an average of 42.14 minutes spent per participant (Table 3 ; range: 20 to 90 minutes) and a total of 5,774 minutes. Most participants had one in-person contact (68%), and FIT Positive participants were marginally more likely to have an in-person visit compared to High-Risk participants ( t (198) = 1.84, p = .067). Only 25% of FIT Positive participants did not have an in-person contact, whereas 37% of High-Risk participants did not. There were no differences in the average time spent on in-person activities between screening groups ( t (198) = .11, p = .91). Reasons for Navigation Encounters Seventeen different navigation objectives were identified, coded, and used for classification for encounters (Table 4 ). The four most common reasons for navigation contact included: scheduling pre-op or colonoscopy appointments (n = 528), unsuccessful contact, or no answer (n = 378), appointment reminders (n = 310), and communicating colonoscopy results (n = 241). The least common navigation contact reasons were attending a medical appointment with the participant (n = 1), helping to explain or get resources for additional treatment (n = 2) or additional testing or scans (n = 3), and communicating with the participant’s PCP for colonoscopy results (n = 4). Table 4 Navigation Activity Objective by Colonoscopy Indication. Navigation Activity FIT Positive N = 100 High-Risk N = 100 Overall N = 200 Scheduling 290 (28.97%) 237 (23.68%) 528 (26.39%) Unsuccessful Contact 194 (19.38%) 184 (18.38%) 378 (18.89%) Reminder Calls 186 (18.58%) 124 (12.39%) 310 (15.49%) Communicating Results 175 (17.48%) 66 (6.59%) 241 (12.04%) Gathering Medical Information 66 (6.59%) 84 (8.39%) 150 (7.50%) Intake Visit 78 (7.79%) 72 (7.19%) 150 (7.50%) Arrange Transportation 18 (1.80%) 17 (1.70%) 35 (1.75%) Help finding PCP 9 (0.90%) 16 (1.60%) 25 (1.25%) Follow-up Tracking 9 (0.90%) 9 (0.90%) 18 (0.90%) Helping access Community Resources 8 (0.80%) 7 (0.70%) 15 (0.75%) Liaising with PCP 1 (0.10%) 7 (0.70%) 8 (0.40%) Communicating with PCP for results 0 (18.58%) 4 (12.39%) 4 (0.20%) Helping with Additional Testing 1 (0.10%) 2 (0.20%) 3 (0.15%) Help with Treatment 0 (0.00%) 2 (0.20%) 2 (0.10%) Attend Medical Appointment 0 (0.00%) 1 (0.10%) 1 (0.05%) Helping to set up other appointment 0 (0.00%) 21 (2.10%) 21 (1.05%) Other 2 (0.20%) 30 (3.00%) 32 (1.60%) Navigation activity type differed significantly by screening group (Table 5 ). Among the most common navigation activities, participants in the FIT Positive group had significantly more scheduling (M = 2.90, SD = 1.85; t (198) = 2.17, p = .031), reminder calls (M = 1.86, SD = 1.12; t (198) = 4.20, p < .001), and communicating result contacts (M = 1.75, SD = .83; t (198) = 11.12, p < .001) than the High-Risk group. Participants in the High-Risk group had significantly more gathering medical information contacts (M = .84, SD = .60) than the FIT Positive group. Table 5 Mean of most frequently performed navigation activities by screening group. Navigation Activity FIT Positive M (SD) High-Risk M (SD) t p Scheduling 2.90 (1.85) 2.37 (1.59) 2.17 .031 Unsuccessful contact 1.94 (2.01) 1.84 (1.92) 0.36 .72 Reminder Calls 1.86 (1.13) 1.24 (0.95) 4.20 < .001 Communicating results 1.75 (0.83) 0.66 (0.52) 11.12 < .001 Gathering medical information 0.66 (0.50) 0.84 (0.60) 2.31 .02 Intake visit 0.78 (0.42) 0.72 (0.45) .98 .33 Arrange transportation 0.18 (0.44) 0.17 (0.59) .14 .89 Sociodemographic and Health-related Predictors of Navigation Contacts A multiple linear regression was conducted to examine whether sociodemographic and health-related factors predicted the number of overall navigation contacts (Supplementary Table A). The overall model was not statistically significant ( F (18,160) = 1.068, p = .389) and explained a small proportion of the variance in navigation activities (R 2 = .11, Adjusted R 2 = .007). Among the predictors, only the type of colonoscopy group was significantly associated with the number of navigation contacts. Participants in the High-Risk group received significantly fewer navigation activities than those in the FIT Positive group ( B = -1.60, SE = 0.67, t = -2.67, p = .008). Barriers Seventy-three (36.5%) participants reported at least one barrier for testing completion (Table 6 ). In general, structural barriers were more frequently reported (78.8% of total barriers reported) than personal/cultural barriers (21.2% of total barriers reported). A total of nine distinct barriers were identified (Table 6 ), with the most frequently reported barriers being transportation (33.6% of all barriers reported), cost (19.5%), and lack of time (16.8%). Table 6 Barriers reported during from subsample of ACCION participants who were eligible for a diagnostic colonoscopy following a Positive FIT and High-Risk participants eligible for a screening colonoscopy. FIT Positive N (%) High-Risk N (%) Overall N (%) Type of Barrier Transportation 22 (39.3) 16 (28.1) 38 (33.60) Structural Cost Prohibitive 10 (17.9) 12 (21.1) 22 (19.5) Structural Lack of Time 9 (16.1) 10 (17.5) 19 (16.8) Structural Lack of Doctor Recommendation 1 (1.80) 9 (15.8) 10 (8.9) Structural Total Structural Barriers 42 57 99 Not Feeling Well 7 (12.5) 2 (3.5) 9 (8.0) Personal or Cultural Out of Town 2 (3.6) 5 (8.8) 7 (6.2) Personal or Cultural Unpleasantness of Tests 3 (5.4) 1 (1.8) 4 (3.5) Personal or Cultural Fear of Pain 2 (3.6) 1 (1.8) 3 (2.7) Personal or Cultural Fear of Bad Results 0 (0.00) 1 (1.8) 1 (0.9) Personal or Cultural Total Personal or Cultural Barriers 14 10 24 Sociodemographic predictors of experiencing a barrier to screening A binary logistic regression was conducted to examine the association between demographic and health-related factors and the likelihood of reporting CRC screening barriers. The model included screening groups (FIT Positive, High-Risk), gender, income, age, language, country of birth, education, employment status, having a regular doctor, physician recommendation for CRC testing, CRC awareness, general health, and prior CRC screening status (Supplementary Table B). The overall model was statistically significant, χ²(19, N = 179) = 30.53, p = .045, indicating that the predictors reliably distinguished between individuals who did and did not report barriers to CRC screening. The model accounted for approximately 12.9% of the variance in whether participants experienced a barrier (Nagelkerke R² = .13) and correctly classified 72.6% of cases. Using full-time employment as the reference category, both part-time employment and being unemployed were significantly associated with increased odds of reporting barriers. Individuals employed part-time had significantly higher odds of reporting barriers compared to those employed full-time ( β = 1.43, SE = 0.62, p = .020; OR = 4.17, 95% CI [1.25, 13.91]). Likewise, individuals not currently working had higher odds of reporting barriers ( β = 1.30, SE = 0.55, p = .019; OR = 3.67, 95% CI [1.25, 10.80]) compared to those working full-time. No other predictors were associated with reporting at least one barrier to CRC screening. Navigation duration, participant barriers, and navigation activities To examine the relationship between total navigation duration, barriers, and navigation activities, navigation time was standardized using z-scores. Participants with a z-score of 1 or greater ( n = 21) were classified as the high-duration group and compared to those with z-scores below 1 ( n = 179). Participants in the high navigation time group were more likely than participants in the lower navigation time group to experience a barrier (chi-square = 14.092, df = 1, p < .001) and reported more total barriers ( M = 1.57, SD = 1.4) than participants in the lower time group (M = .46, SD = .77; t (21.47) = 3.58, p = .002). An independent samples t-test was used to examine if participants in the higher duration group had significantly more overall navigation contacts than those in the lower duration group. Participants in the high navigation duration group had significantly higher mean navigation contacts (M = 12.10, SD = 3.62) than lower duration participants (M = 9.31, SD = 3.43; t (198) = 3.50, p < .001; Supplementary Table C). Discussion Our findings reveal that most navigation contacts were completed by phone and included tracking, scheduling appointments, informing the participant about the colonoscopy procedure and prep, and procedure reminder calls. Participants requiring a screening colonoscopy had less navigation encounters compared to those needing a diagnostic colonoscopy. In general, navigation activities reported by ACCION navigators are similar to those seen by navigators of other CRC screening programs. These activities included addressing barriers to screening, scheduling appointments, making reminder calls, arranging transportation, providing social support, and conveying bowel prep instructions.( 6 , 12 – 17 ) The average duration of navigation telephone calls in this program was 25.95 minutes, and in-person encounters were 42.14 minutes. This corroborates findings from two other studies that report an average of 28 and 44 minutes of navigation encounters per patient, including both telephone and in-person contacts.( 18 , 19 ) One of the studies found that approximately 30 minutes of navigation was spent reviewing bowel preparation instructions and colonoscopy appointment scheduling and the most common barriers addressed through navigation included providing information about the colonoscopy, scheduling appointments, cost, and transportation. These are categorized as structural barriers, which were also commonly found in our program. The only other studies that specifically measured duration of navigation contacts were for individuals already diagnosed with cancer. With regards to the demographic characteristics of participants reporting a barrier, we found that participants reporting full-time employment were less likely to experience barriers than those who either worked part-time or were not employed. This is in contrast to what has been found from other cancer screening studies in which those who work full-time typically are less likely to be screened and that time barriers to screening particularly relate to missed work.( 20 – 22 ) One study found that those in areas with paid sick leave mandates were more likely to complete CRC screening compared to those in areas without these mandates.( 21 , 23 ) Therefore, it is possible that taking sick leave from work is an option for our participants who work full-time or that our navigators were able to better arrange appointments at convenient times for the participant. It is also possible that those working full-time may have access to regular transportation, removing the most common structural barrier reported by part-time or unemployed participants. One strength of our study is that the colonoscopy completion rate (84.5%) was higher than most other CRC screening patient navigation programs that ranged from 35% to 70%, suggesting that our culturally tailored program was particularly effective.( 24 – 26 ) We attribute this in part to the fact that our tailored program database was specifically developed to track all participant encounters and incorporated alerts designed to facilitate reminders and protocol-based navigation contacts. Additionally, navigators were bilingual and from similar ethnic backgrounds as participants which may have contributed to higher rates of screening success. Our finding that neither preferred language nor country of birth were associated with the number of navigation contacts or whether a barrier to screening was reported might suggest that navigator characteristics were closely aligned with unique participant needs in this area. A challenge to consider is that many times, the two phone call attempts to participants were unsuccessful due to participants not answering, changing numbers, or moving. One pilot study among community health center patients documented between 8 and 11 call attempts to successfully reach patients from multi-cultural, low-income backgrounds, which would require more resources.( 27 ) In addition, due to the study location being a Texas-Mexico border county, one limitation is that the findings may not be generalizable to Hispanics throughout the U S; however, they can be useful for building a framework for Spanish-speaking populations in similar regions. Future studies should provide detailed information on time intensity and details of navigation encounters. Further, navigator training should be standardized across the state, and potentially across the nation, to provide a certificate for those who have completed a specific number of training courses and hours with patients, similar to the CHW Core Consensus Project.( 28 ) This standardized training should focus on structural barriers as our study, along with others, have noted that participants who required the most navigation time reported experiencing more structural barriers than those who required less navigation time. Furthermore, a standardized framework should be developed and implemented throughout patient navigation programs to ensure that efficacy of screening programs can be replicated in various settings and among different populations. Considering program scalability, navigator caseloads may not be determined solely by number of participants but could account for the expected intensity of navigation required. Without considering the variability in navigation requirements per participant, programs could overburden navigators, particularly during periods with high proportions of participants facing more complex barriers. Conclusion There are many consistent findings with two other studies that provide this level of detail about navigation for supporting CRC screening in similar populations in other settings.( 18 , 19 ) The primary barrier of cost was mitigated in all three studies. In these settings, navigation helped individuals overcome similar logistical barriers, although their order of importance and pattern varied according to context. In our study, navigators effectively address primarily structural, and to a lesser extent, personal and cultural barriers to screening through various types of encounters. In all three studies, each participant had multiple navigation encounters, and it remains unclear how important the relationship component of navigation is to positive outcomes. It is also difficult to estimate the exact case load or number or type of encounters that guarantee a significant increase in CRC screening completion. What is certain is that patient navigation consistently proves to be a key component in lessening the burden of CRC and other cancers, especially for under screened and underserved communities. Declarations Author Affiliations: Aff1: The University of Texas at Austin Dell Medical School, Austin, Texas, USA Aff2: UTHealth Houston School of Public Health, San Antonio Regional Campus San Antonio, Texas, USA Author Responsibilities: All authors participated in the design, analysis, writing, and revisions of the manuscript. Dr. Calderón-Mora and Dr. Shokar hold accountability for this manuscript and provided final approval. Data Availability Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. Funding statement: This work was supported by a grant from the Cancer Prevention and Research Institute of Texas [PP130068]. Human Ethics Approval and Consent to Participate Declaration: Ethical approval was obtained from the Institutional Review Board (IRB) of Texas Tech University Health Sciences Center El Paso (IRB No. E18157). All participants were consented to participate prior to enrollment. Conflict of Interest Statement: The authors declare that there are no conflict of interest and no financial interest related to the work submitted for publication. Author Contribution All authors participated in the design, analysis, writing, and revisions of the manuscript.Dr. Calderón-Mora and Dr. Shokar hold accountability for this manuscript and provided final approval. < References US Preventive Services Task Force, Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(19):1965. Colorectal Cancer Facts &. Figures | Facts About Colon Cancer | American Cancer Society [Internet]. [cited 2025 May 30]. Available from: https://www.cancer.org/research/cancer-facts-statistics/colorectal-cancer-facts-figures.html Jandorf L, Ellison J, Villagra C, Winkel G, Varela A, Quintero-Canetti Z, et al. Understanding the barriers and facilitators of colorectal cancer screening among low income immigrant hispanics. J Immigr Minor Health. 2010;12(4):462–9. Rodday AM, Parsons SK, Snyder F, Simon MA, Llanos AAM, Warren-Mears V, et al. Impact of patient navigation in eliminating economic disparities in cancer care. Cancer. 2015;121(22):4025–34. Rice K, Sharma K, Li C, Butterly L, Gersten J, DeGroff A. Cost-Effectiveness of a Patient Navigation Intervention to Increase Colonoscopy Screening Among Low-Income Adults in New Hampshire. Cancer. 2019;125(4):601–9. Nelson HD, Cantor A, Wagner J, Jungbauer R, Fu R, Kondo K, et al. Effectiveness of Patient Navigation to Increase Cancer Screening in Populations Adversely Affected by Health Disparities: a Meta-analysis. J Gen Intern Med. 2020;35(10):3026–35. Myers RE, Stello B, Daskalakis C, Sifri R, González ET, DiCarlo M, et al. Decision Support and Navigation to Increase Colorectal Cancer Screening Among Hispanic Patients. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2019;28(2):384–91. Shokar NK, Calderón-Mora J, Salaiz R, Casner N, Zuckerman MJ, Byrd TL et al. Implementation and Evaluation of a Large Community-Based Colorectal Cancer Screening Program. J Public Health Manag Pract JPHMP. 2024 June 1;30(3):E143–53. Shokar NK, Byrd T, Salaiz R, Flores S, Chaparro M, Calderon-Mora J, et al. Against colorectal cancer in our neighborhoods (ACCION): A comprehensive community-wide colorectal cancer screening intervention for the uninsured in a predominantly Hispanic community. Prev Med. 2016;91:273–80. Byrd TL, Calderón-Mora J, Salaiz R, Shokar NK. Barriers and Facilitators to Colorectal Cancer Screening Within a Hispanic Population. Hisp Health Care Int Off J Natl Assoc Hisp Nurses. 2019;17(1):23–9. Health behavior: Theory, research, and practice, 5th ed. Hoboken, NJ, Jossey-Bass/Wiley US. 2015. xxv, 485 p. (Glanz K, Rimer BK, Viswanath K Vish, editors. Health behavior: Theory, research, and practice, 5th ed). Barrington WE, DeGroff A, Melillo S, Vu T, Cole A, Escoffery C, et al. Patient navigator reported patient barriers and delivered activities in two large federally-funded cancer screening programs. Prev Med. 2019;129:105858. Freund KM. Implementation of evidence-based patient navigation programs. Acta Oncol. 2017;56(2):123–7. Coronado GD, Ferrari RM, Barnes A, Castañeda SF, Cromo M, Davis MM et al. Characteristics of patient navigation programs in the Cancer Moonshot ACCSIS colorectal cancer screening initiative. J Natl Cancer Inst 2023 June 8;115(6):680–94. Mosquera I, Todd A, Balaj M, Zhang L, Benitez Majano S, Mensah K, et al. Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: A systematic review. Cancer Med. 2023 July;12(13):14584–611. Escoffery C, Fernandez ME, Vernon SW, Liang S, Maxwell AE, Allen JD, et al. Patient Navigation in a Colorectal Cancer Screening Program. J Public Health Manag Pract JPHMP. 2015;21(5):433–40. DeGroff A, Coa K, Morrissey KG, Rohan E, Slotman B. Key Considerations in Designing a Patient Navigation Program for Colorectal Cancer Screening. Health Promot Pract. 2014 July;15(4):483–95. Rohan EA, Slotman B, DeGroff A, Morrissey KG, Murillo J, Schroy P. Refining the Patient Navigation Role in a Colorectal Cancer Screening Program: Results From an Intervention Study. J Natl Compr Cancer Netw JNCCN. 2016;14(11):1371–8. Robinson CM, Beach ML, Greene MA, Cassells A, Tobin JN, Dietrich AJ. Staffing time required to increase cancer-screening rates through telephone support. J Ambul Care Manage. 2010;33(2):143–54. Yao X, Dembe AE, Wickizer T, Lu B. Does time pressure create barriers for people to receive preventive health services? Prev Med. 2015;74:55–8. Callison K, Pesko MF, Phillips S, Sosa JA. Cancer Screening after the Adoption of Paid-Sick-Leave Mandates. N Engl J Med. 2023;388(9):824–32. Jones RM, Devers KJ, Kuzel AJ, Woolf SH. Patient-reported barriers to colorectal cancer screening: a mixed-methods analysis. Am J Prev Med. 2010;38(5):508–16. Stimpson JP, Park S, Morenz AM, Gurley T, Wilson FA. Examining Employment Status, Paid Sick Leave, and Access to Care in Relation to Colorectal Cancer Screening Among U.S. Workers: A Structural Equation Modeling Approach. Cancer Control J Moffitt Cancer Cent. 2025;32:10732748251347731. Honeycutt S, Green R, Ballard D, Hermstad A, Brueder A, Haardörfer R, et al. Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA. Cancer. 2013;119(16):3059–66. Bensink ME, Ramsey SD, Battaglia T, Fiscella K, Hurd TC, McKoy JM, et al. Costs and outcomes evaluation of patient navigation after abnormal cancer screening: Evidence from the Patient Navigation Research Program. Cancer. 2014;120(4):570–8. Bernardo BM, Zhang X, Beverly Hery CM, Meadows RJ, Paskett ED. The efficacy and cost-effectiveness of patient navigation programs across the cancer continuum: A systematic review. Cancer. 2019;125(16):2747–61. Lasser KE, Murillo J, Medlin E, Lisboa S, Valley-Shah L, Fletcher RH, et al. A multilevel intervention to promote colorectal cancer screening among community health center patients: results of a pilot study. BMC Fam Pract. 2009;10:37. CHW Core Consensus P [Internet]. [cited 2025 June 9]. Home | CHW Core Consensus Project. Available from: https://www.c3council.org Additional Declarations No competing interests reported. Supplementary Files ACCIONNavigationPaperSupplementaryTables11.24.25.docx Cite Share Download PDF Status: Published Journal Publication published 30 Jan, 2026 Read the published version in BMC Primary Care → Version 1 posted Editorial decision: Revision requested 05 Jan, 2026 Reviews received at journal 03 Jan, 2026 Reviews received at journal 30 Dec, 2025 Reviewers agreed at journal 16 Dec, 2025 Reviewers agreed at journal 16 Dec, 2025 Reviewers invited by journal 16 Dec, 2025 Editor assigned by journal 08 Dec, 2025 Submission checks completed at journal 08 Dec, 2025 First submitted to journal 02 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Current national data indicate that screening is especially low among certain subgroups including the uninsured (22%), those who have resided in the United States for less than 10 years (30%) and Hispanics (51% up to date).(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe Community Preventive Services Task Force has found strong evidence in support of patient navigation to increase CRC screening within underscreened populations.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Navigation includes reminders to complete screening, reducing structural barriers (e.g., assisting with transportation, scheduling appointments), and reducing out-of-pocket costs by finding low or no-cost screening services.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) For low-income, uninsured, and underinsured individuals, patient navigation has increased CRC screening completion and reduced the number of days to diagnostic testing.(\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) However, detailed information about the specific type and duration of navigation activities and the types of barriers being addressed is lacking in the navigation literature. This information is essential for planning and designing effective navigation programs.\u003c/p\u003e \u003cp\u003eIn this paper, we describe detailed patient navigation activities delivered in an effective culturally tailored community-based colorectal cancer screening program, Against Colorectal Cancer in our Neighborhoods (ACCION) that was implemented in a previously largely unscreened, underserved and predominantly Hispanic population. Outcomes have been described previously and include a colonoscopy completion rate of 74.5%.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign, Setting and Sampling\u003c/h2\u003e \u003cp\u003eThis is a secondary data analysis of navigation data collected during the implementation of the ACCION program that was delivered from March 2012 - July 2015. All participants in the ACCION program were consented to participate at time of enrollment. The purpose of this analysis was to provide a detailed description of navigation activities delivered during the intervention, specifically (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) frequency, type, and duration of navigation activities; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) frequency and type of barriers encountered; and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) association between participant demographics, barriers, and navigation activities. Ethical approval for this study was obtained from Texas Tech University Health Sciences Center El Paso Institutional Review Board (IRB No. E18157). This approval was in accordance with the Declaration of Helsinki. A stratified sampling scheme was used to randomly select 100 participants who were eligible for a diagnostic colonoscopy following a positive FIT and 100 participants who were eligible for a screening colonoscopy, from a total of 690 ACCION participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProgram Description\u003c/h3\u003e\n\u003cp\u003eACCION is a Cancer Prevention and Research Institute of Texas-funded community-based intervention continuing to be implemented in El Paso County among a predominantly Hispanic population to reduce the burden of CRC through outreach, education, no-cost testing, and navigation services. During the period from which data is drawn, individuals aged 50\u0026ndash;75, with no health insurance, a self-reported Texas address who were due for CRC screening without a history of rectal bleeding in the previous three months were eligible. Participants were recruited from community sites, enrolled and consented, provided education by community health workers (CHWs), offered home fecal immunochemical testing (FIT) if they were average risk or were referred to the navigator for a screening colonoscopy if they had a family history of CRC or a personal history of adenomatous polyps. Participants with a positive FIT were eligible for a no-cost diagnostic colonoscopy and were contacted by the navigator.\u003c/p\u003e \u003cp\u003eNavigation services were provided to all participants to facilitate screening, diagnostic testing, and treatment adherence. Detailed program information is available in previous publications.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\n\u003ch3\u003eNavigation Description\u003c/h3\u003e\n\u003cp\u003eDuring every encounter, navigators elicited and addressed barriers to attending the pre-procedure appointment, completing bowel preparation or the colonoscopy. Navigators documented all contact with participants in a HIPAA-compliant, encrypted web-based program database.\u003c/p\u003e \u003cp\u003eNavigation activities covered four areas: 1) \u003cb\u003eFIT and colonoscopy testing process.\u003c/b\u003e Navigators tracked all participants given a FIT, replacing a test if needed. If a FIT was not returned, phone call reminders were performed 14 and 28 days after test distribution. If both phone call attempts were unsuccessful, the navigator sent a letter to the participant to inform them no further contact would be attempted. For participants needing a colonoscopy, navigators contacted participants and scheduled an in-person pre-procedure preparation (pre-op) appointment to verify eligibility, explain the procedure, and provide education, bowel preparation and instructions for bowel preparation. The navigator was responsible for scheduling colonoscopy appointments and making reminder calls for pre-op and procedure visits. If a participant did not complete bowel preparation or did not attend their procedure, the navigator attempted to re-schedule; 2) \u003cb\u003eCase management.\u003c/b\u003e The navigator was responsible for providing colonoscopy results to participants either by phone or letter. For participants diagnosed with CRC at the time of colonoscopy, the Project Director (a family medicine physician) and navigator would meet with the participant in-person to provide the results. The navigator would then assist the participant to identify financial coverage needs for treatment (details described below) and resources for additional health-related needs indicated by the participant; 3) \u003cb\u003eIdentifying and addressing individual barriers\u003c/b\u003e. Barriers to attending the pre-op appointment, bowel preparation, and the colonoscopy procedure were assessed. The program had funding to provide taxi vouchers for participants to attend the pre-op appointment and procedure. Navigators used motivational interviewing techniques and prepared scripts to address common barriers to procedure completion; and 4) \u003cb\u003eFacilitating treatment follow-up.\u003c/b\u003e Participants with abnormal colonoscopy results or diagnosed with cancer were assisted in completing applications for the county safety-net and discount programs. The navigator also assisted in making appointments with an oncologist, surgeon, other specialists, and primary care physician, as needed.\u003c/p\u003e\n\u003ch3\u003eNavigator Characteristics and Training\u003c/h3\u003e\n\u003cp\u003eThe program had one full-time navigator, and two separate individuals served in this role during the project period. Both were Hispanic women from the community, bilingual, with a background in community health outreach, case management, and health system experience. They were trained in the health educational materials used by the CHWs, including information on the screening tests, barriers to screening, and process for documentation in the database. The navigator received training on a detailed manual that included contact phone scripts, templates for result letters, scripts for communicating with clinicians and the endoscopy suite, bowel preparation, and all required paperwork for colonoscopy scheduling. Navigators also received an intense two-day training on motivational interviewing including role-playing exercises. The training included responses for the navigators to use when the participant presented myths about CRC or screening based on information from previous focus groups as well as constructs from the Health Belief Model.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eParticipant sociodemographic data was self-reported during program enrollment and included: gender, age, country of origin, time in the US, preferred language, education, income, marital status, and employment status. Health-related information was also collected: self-reported health, having a regular physician, prior awareness of CRC, previous physician recommendation for CRC screening, and CRC screening history.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eNavigator Activity Coding\u003c/h2\u003e \u003cp\u003eAll patient encounters (phone, in-person, and via postal mail) were entered into the program database by the navigator including time spent, type of activities, and barriers. A coding system was used to classify barrier types and activities for each encounter. Patient barriers were categorized as \u0026ldquo;structural\u0026rdquo; if pertaining to policies, practices, or norms of healthcare facilities or systems (e.g., lack of transportation, prohibitive cost of care) or \u0026ldquo;personal or cultural\u0026rdquo; if related to individual or community characteristics of the participant (e.g., fear of pain, language, lack of time to complete testing).(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to examine the distribution of sociodemographic characteristics. The mean number of contacts per participant and the average duration of each contact were calculated. The mean and range of reported barriers and navigation contacts were assessed separately for the diagnostic colonoscopy group (FIT Positive) and the screening colonoscopy group (High-Risk). Frequency and percentage were also used to describe barriers among the two groups and overall.\u003c/p\u003e \u003cp\u003eA multiple linear regression was conducted to predict the number of navigation contacts based on sociodemographic variables and health-related factors. Categorical variables were treated as factors, with the most common category used as the reference level.\u003c/p\u003e \u003cp\u003eIndependent t-tests were conducted to examine differences in navigation activities and navigation duration between the FIT Positive and High-Risk groups. Additionally, chi-square tests and t-tests were used to assess barriers to screening and navigation activities among participants with longer navigation durations compared to those with shorter durations. All analyses were conducted in R (version 4.2.2).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Profile\u003c/h2\u003e \u003cp\u003eA total of 200 colonoscopy-eligible ACCION program participants were included in the study (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The average age was 56.3 years (SD\u0026thinsp;=\u0026thinsp;5.72), the majority were female (74.0%), Hispanic (96.5%), born in Mexico (81.0%), and Spanish speakers (80.5%). The average number of years living in the US was 28.75 (SD\u0026thinsp;=\u0026thinsp;17.28); 60% of participants reported their health to be Very Good/Excellent; 54.9% reported not having a regular doctor; and 43.0% reported a family history of CRC. Most participants (81.6%) reported never being screened for CRC (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Overall, the colonoscopy completion rate was 84.5%. 89.0% of FIT Positive participants completed a diagnostic colonoscopy, and 80.0% of High-Risk participants completed a screening colonoscopy (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant Demographics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh-Risk\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;100\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFIT Positive\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;100\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;200\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (24.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (26.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (76.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (72.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e148 (74.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, Mean Yrs (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.5 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.2 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.3 (5.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCountry of Birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMexico\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (78.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (84.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e162 (81.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace/Ethnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMexican or Mexican American, Hispanic or Latino\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (96.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (97.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e193 (96.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic Black or African American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian/Pacific Islander\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmerican Indian/Alaskan Native\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime in US, Mean Yrs (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.9 (17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.6 (17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.8 (17.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreferred Language\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnglish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpanish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (81.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e161 (80.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (17.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (13.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHigh School Diploma\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (51.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (63.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114 (57.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (49.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (37.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86 (43.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncome Category\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (50.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80 (58.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10,000-\u0026lt;25,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (38.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (29.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (33.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;25,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (7.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (47.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (36.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (41.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (53.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (64.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117 (58.50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (57.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (56.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, part time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (21.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, full time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-Reported Health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor/Fair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (8.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (9.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (8.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (33.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63 (31.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery Good/Excellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (59.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (61.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas a regular physician\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (57.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (52.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107 (54.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (42.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (48.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88 (45.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBefore today, heard of CRC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (29.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (71.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131 (65.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDoctor previously recommended testing for CRC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (71.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (88.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e159 (79.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (29.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (12.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEver screened for CRC in the past\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (92.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (72.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151 (81.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (18.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily History of CRC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114 (57.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (86.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86 (43.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;n (%); Mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage of study participants completing a screening or diagnostic colonoscopy in the FIT positive and high-risk groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;200\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFIT Positive\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;100\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh-Risk\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;100\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCompleted Colonoscopy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (11.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169 (84.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (89.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;n (%)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eNavigation Contacts\u003c/h2\u003e \u003cp\u003eA total of 1,931 navigation contacts were recorded across our sample for a total duration of 10,978.41 minutes (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The FIT Positive group had significantly more total contacts (M\u0026thinsp;=\u0026thinsp;10.50, SD\u0026thinsp;=\u0026thinsp;3.6) than the High-Risk group (M\u0026thinsp;=\u0026thinsp;8.81, SD\u0026thinsp;=\u0026thinsp;3.50); \u003cem\u003et\u003c/em\u003e (198)\u0026thinsp;=\u0026thinsp;3.33, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.0010), but not significantly longer average contacts (FIT Positive: M\u0026thinsp;=\u0026thinsp;54.41, SD\u0026thinsp;=\u0026thinsp;29.24; High-Risk: M\u0026thinsp;=\u0026thinsp;55.37, SD\u0026thinsp;=\u0026thinsp;31.06; (198)\u0026thinsp;=\u0026thinsp;.224, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.82).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNavigation Contacts: Frequency and duration by colonoscopy indication\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFIT Positive\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;100\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh-Risk\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;100\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;200\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003ePhone Calls\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Phone Calls (sum)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e850\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1492\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Phone Call Minutes (sum)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2316.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5190.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhone Calls Per Person (M, Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.50 (2.0\u0026ndash;23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.42 (1.00\u0026ndash;17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.46 (1.00\u0026ndash;23.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhone Call Duration Per Person (M, Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.16 (1.0\u0026ndash;163.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.74 (1.00\u0026ndash;188.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.95 (1.0\u0026ndash;188.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eIn-Person\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn-Person Activities (sum)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn-Person Activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (37.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (31.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74 (74.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (62.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136 (68.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal In-Person Minutes (sum)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5774\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn-Person Activities Duration (M, Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.03 (25.0\u0026ndash;90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.27 (20.0\u0026ndash;90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.14 (20.0\u0026ndash;90.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eOverall Contacts\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Contact (sum)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e881\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1931\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Contact Minutes (sum)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5441.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10978.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Number of Contacts Per Person (M, Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.50 (2.0\u0026ndash;26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.81 (1.0\u0026ndash;18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.66 (1.0\u0026ndash;26.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Overall Contacts Per Person (M, Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.41 (1.0\u0026ndash;163.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.37 (1.0\u0026ndash;188.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.89 (1.0\u0026ndash;188.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;Mean (Min \u0026ndash; Max); n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePhone Call Encounters\u003c/h2\u003e \u003cp\u003eNavigators made 1,492 phone calls to this sample of participants for a total of 5,190 minutes (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The mean number of phone calls participants received was 7.46 (range: 1 to 23) and the mean duration of a phone call was 25.95 minutes. The shortest phone calls were reminder calls or voicemails (duration of one minute) and the longest call (188 minutes) consisted of an intake assessment, although this was typically conducted in-person. Participants in the FIT Positive group received significantly more phone calls on average (M\u0026thinsp;=\u0026thinsp;8.50, SD\u0026thinsp;=\u0026thinsp;3.29) compared to the High-Risk group (M\u0026thinsp;=\u0026thinsp;6.42, SD\u0026thinsp;=\u0026thinsp;2.71, \u003cem\u003et\u003c/em\u003e (198)\u0026thinsp;=\u0026thinsp;4.88, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Although more time was spent on phone calls with the High-Risk group (2,874 minutes and 642 calls) compared with the FIT Positive group (2,316 minutes and 850 calls), this did not differ significantly (\u003cem\u003et\u003c/em\u003e (-1.45), \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.15).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eIn-person Navigation Encounters\u003c/h2\u003e \u003cp\u003eA total of 140 in-person contact encounters were registered with an average of 42.14 minutes spent per participant (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e; range: 20 to 90 minutes) and a total of 5,774 minutes. Most participants had one in-person contact (68%), and FIT Positive participants were marginally more likely to have an in-person visit compared to High-Risk participants (\u003cem\u003et\u003c/em\u003e(198)\u0026thinsp;=\u0026thinsp;1.84, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.067). Only 25% of FIT Positive participants did not have an in-person contact, whereas 37% of High-Risk participants did not. There were no differences in the average time spent on in-person activities between screening groups (\u003cem\u003et\u003c/em\u003e(198)\u0026thinsp;=\u0026thinsp;.11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.91).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eReasons for Navigation Encounters\u003c/h2\u003e \u003cp\u003eSeventeen different navigation objectives were identified, coded, and used for classification for encounters (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The four most common reasons for navigation contact included: scheduling pre-op or colonoscopy appointments (n\u0026thinsp;=\u0026thinsp;528), unsuccessful contact, or no answer (n\u0026thinsp;=\u0026thinsp;378), appointment reminders (n\u0026thinsp;=\u0026thinsp;310), and communicating colonoscopy results (n\u0026thinsp;=\u0026thinsp;241). The least common navigation contact reasons were attending a medical appointment with the participant (n\u0026thinsp;=\u0026thinsp;1), helping to explain or get resources for additional treatment (n\u0026thinsp;=\u0026thinsp;2) or additional testing or scans (n\u0026thinsp;=\u0026thinsp;3), and communicating with the participant\u0026rsquo;s PCP for colonoscopy results (n\u0026thinsp;=\u0026thinsp;4).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNavigation Activity Objective by Colonoscopy Indication.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNavigation Activity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFIT Positive\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;100\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh-Risk\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;100\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScheduling\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e290 (28.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e237 (23.68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e528 (26.39%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUnsuccessful Contact\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e194 (19.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e184 (18.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e378 (18.89%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReminder Calls\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186 (18.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124 (12.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e310 (15.49%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunicating Results\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e175 (17.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (6.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e241 (12.04%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGathering Medical Information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66 (6.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84 (8.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e150 (7.50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntake Visit\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78 (7.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72 (7.19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e150 (7.50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArrange Transportation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (1.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (1.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35 (1.75%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHelp finding PCP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (0.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (1.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (1.25%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFollow-up Tracking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (0.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (0.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (0.90%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHelping access Community Resources\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (0.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (0.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (0.75%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiaising with PCP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (0.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (0.40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommunicating with PCP for results\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (18.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (12.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (0.20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHelping with Additional Testing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (0.20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (0.15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHelp with Treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (0.20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (0.10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttend Medical Appointment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (0.05%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHelping to set up other appointment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (2.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21 (1.05%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (0.20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (3.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32 (1.60%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNavigation activity type differed significantly by screening group (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Among the most common navigation activities, participants in the FIT Positive group had significantly more scheduling (M\u0026thinsp;=\u0026thinsp;2.90, SD\u0026thinsp;=\u0026thinsp;1.85; \u003cem\u003et\u003c/em\u003e(198)\u0026thinsp;=\u0026thinsp;2.17, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.031), reminder calls (M\u0026thinsp;=\u0026thinsp;1.86, SD\u0026thinsp;=\u0026thinsp;1.12; \u003cem\u003et\u003c/em\u003e(198)\u0026thinsp;=\u0026thinsp;4.20, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), and communicating result contacts (M\u0026thinsp;=\u0026thinsp;1.75, SD\u0026thinsp;=\u0026thinsp;.83; \u003cem\u003et\u003c/em\u003e(198)\u0026thinsp;=\u0026thinsp;11.12, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) than the High-Risk group. Participants in the High-Risk group had significantly more gathering medical information contacts (M\u0026thinsp;=\u0026thinsp;.84, SD\u0026thinsp;=\u0026thinsp;.60) than the FIT Positive group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean of most frequently performed navigation activities by screening group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNavigation Activity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFIT Positive\u003c/p\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh-Risk\u003c/p\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScheduling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.90 (1.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.37 (1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnsuccessful contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.94 (2.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.84 (1.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReminder Calls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.86 (1.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.24 (0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunicating results\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.75 (0.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.66 (0.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGathering medical information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.66 (0.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.84 (0.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntake visit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.78 (0.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.72 (0.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArrange transportation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.18 (0.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.17 (0.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic and Health-related Predictors of Navigation Contacts\u003c/h2\u003e \u003cp\u003eA multiple linear regression was conducted to examine whether sociodemographic and health-related factors predicted the number of overall navigation contacts (Supplementary Table A). The overall model was not statistically significant (\u003cem\u003eF\u003c/em\u003e(18,160)\u0026thinsp;=\u0026thinsp;1.068, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.389) and explained a small proportion of the variance in navigation activities (R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.11, Adjusted R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.007).\u003c/p\u003e \u003cp\u003eAmong the predictors, only the type of colonoscopy group was significantly associated with the number of navigation contacts. Participants in the High-Risk group received significantly fewer navigation activities than those in the FIT Positive group (\u003cem\u003eB\u003c/em\u003e = -1.60, SE\u0026thinsp;=\u0026thinsp;0.67, t = -2.67, p\u0026thinsp;=\u0026thinsp;.008).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eBarriers\u003c/h2\u003e \u003cp\u003eSeventy-three (36.5%) participants reported at least one barrier for testing completion (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). In general, structural barriers were more frequently reported (78.8% of total barriers reported) than personal/cultural barriers (21.2% of total barriers reported). A total of nine distinct barriers were identified (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e), with the most frequently reported barriers being transportation (33.6% of all barriers reported), cost (19.5%), and lack of time (16.8%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBarriers reported during from subsample of ACCION participants who were eligible for a diagnostic colonoscopy following a Positive FIT and High-Risk participants eligible for a screening colonoscopy.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFIT Positive\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh-Risk\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eType of Barrier\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransportation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (33.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStructural\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCost Prohibitive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStructural\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLack of Time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStructural\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLack of Doctor Recommendation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStructural\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Structural Barriers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNot Feeling Well\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePersonal or Cultural\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOut of Town\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePersonal or Cultural\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUnpleasantness of Tests\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePersonal or Cultural\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFear of Pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePersonal or Cultural\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFear of Bad Results\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePersonal or Cultural\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Personal or Cultural Barriers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic predictors of experiencing a barrier to screening\u003c/h2\u003e \u003cp\u003eA binary logistic regression was conducted to examine the association between demographic and health-related factors and the likelihood of reporting CRC screening barriers. The model included screening groups (FIT Positive, High-Risk), gender, income, age, language, country of birth, education, employment status, having a regular doctor, physician recommendation for CRC testing, CRC awareness, general health, and prior CRC screening status (Supplementary Table B).\u003c/p\u003e \u003cp\u003eThe overall model was statistically significant, χ\u0026sup2;(19, \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;179)\u0026thinsp;=\u0026thinsp;30.53, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.045, indicating that the predictors reliably distinguished between individuals who did and did not report barriers to CRC screening. The model accounted for approximately 12.9% of the variance in whether participants experienced a barrier (Nagelkerke R\u0026sup2; = .13) and correctly classified 72.6% of cases.\u003c/p\u003e \u003cp\u003eUsing full-time employment as the reference category, both part-time employment and being unemployed were significantly associated with increased odds of reporting barriers. Individuals employed part-time had significantly higher odds of reporting barriers compared to those employed full-time (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.43, SE\u0026thinsp;=\u0026thinsp;0.62, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.020; OR\u0026thinsp;=\u0026thinsp;4.17, 95% CI [1.25, 13.91]). Likewise, individuals not currently working had higher odds of reporting barriers (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.30, SE\u0026thinsp;=\u0026thinsp;0.55, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.019; OR\u0026thinsp;=\u0026thinsp;3.67, 95% CI [1.25, 10.80]) compared to those working full-time. No other predictors were associated with reporting at least one barrier to CRC screening.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eNavigation duration, participant barriers, and navigation activities\u003c/h2\u003e \u003cp\u003eTo examine the relationship between total navigation duration, barriers, and navigation activities, navigation time was standardized using z-scores. Participants with a z-score of 1 or greater (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;21) were classified as the high-duration group and compared to those with z-scores below 1 (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;179).\u003c/p\u003e \u003cp\u003eParticipants in the high navigation time group were more likely than participants in the lower navigation time group to experience a barrier (chi-square\u0026thinsp;=\u0026thinsp;14.092, df\u0026thinsp;=\u0026thinsp;1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and reported more total barriers (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.57, SD\u0026thinsp;=\u0026thinsp;1.4) than participants in the lower time group (M\u0026thinsp;=\u0026thinsp;.46, SD\u0026thinsp;=\u0026thinsp;.77; \u003cem\u003et\u003c/em\u003e(21.47)\u0026thinsp;=\u0026thinsp;3.58, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002). An independent samples t-test was used to examine if participants in the higher duration group had significantly more overall navigation contacts than those in the lower duration group. Participants in the high navigation duration group had significantly higher mean navigation contacts (M\u0026thinsp;=\u0026thinsp;12.10, SD\u0026thinsp;=\u0026thinsp;3.62) than lower duration participants (M\u0026thinsp;=\u0026thinsp;9.31, SD\u0026thinsp;=\u0026thinsp;3.43; \u003cem\u003et\u003c/em\u003e(198)\u0026thinsp;=\u0026thinsp;3.50, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; Supplementary Table C).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e Our findings reveal that most navigation contacts were completed by phone and included tracking, scheduling appointments, informing the participant about the colonoscopy procedure and prep, and procedure reminder calls. Participants requiring a screening colonoscopy had less navigation encounters compared to those needing a diagnostic colonoscopy.\u003c/p\u003e \u003cp\u003eIn general, navigation activities reported by ACCION navigators are similar to those seen by navigators of other CRC screening programs. These activities included addressing barriers to screening, scheduling appointments, making reminder calls, arranging transportation, providing social support, and conveying bowel prep instructions.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13 CR14 CR15 CR16\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe average duration of navigation telephone calls in this program was 25.95 minutes, and in-person encounters were 42.14 minutes. This corroborates findings from two other studies that report an average of 28 and 44 minutes of navigation encounters per patient, including both telephone and in-person contacts.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) One of the studies found that approximately 30 minutes of navigation was spent reviewing bowel preparation instructions and colonoscopy appointment scheduling and the most common barriers addressed through navigation included providing information about the colonoscopy, scheduling appointments, cost, and transportation. These are categorized as structural barriers, which were also commonly found in our program. The only other studies that specifically measured duration of navigation contacts were for individuals already diagnosed with cancer.\u003c/p\u003e \u003cp\u003eWith regards to the demographic characteristics of participants reporting a barrier, we found that participants reporting full-time employment were less likely to experience barriers than those who either worked part-time or were not employed. This is in contrast to what has been found from other cancer screening studies in which those who work full-time typically are less likely to be screened and that time barriers to screening particularly relate to missed work.(\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) One study found that those in areas with paid sick leave mandates were more likely to complete CRC screening compared to those in areas without these mandates.(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) Therefore, it is possible that taking sick leave from work is an option for our participants who work full-time or that our navigators were able to better arrange appointments at convenient times for the participant. It is also possible that those working full-time may have access to regular transportation, removing the most common structural barrier reported by part-time or unemployed participants.\u003c/p\u003e \u003cp\u003eOne strength of our study is that the colonoscopy completion rate (84.5%) was higher than most other CRC screening patient navigation programs that ranged from 35% to 70%, suggesting that our culturally tailored program was particularly effective.(\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) We attribute this in part to the fact that our tailored program database was specifically developed to track all participant encounters and incorporated alerts designed to facilitate reminders and protocol-based navigation contacts. Additionally, navigators were bilingual and from similar ethnic backgrounds as participants which may have contributed to higher rates of screening success. Our finding that neither preferred language nor country of birth were associated with the number of navigation contacts or whether a barrier to screening was reported might suggest that navigator characteristics were closely aligned with unique participant needs in this area.\u003c/p\u003e \u003cp\u003e A challenge to consider is that many times, the two phone call attempts to participants were unsuccessful due to participants not answering, changing numbers, or moving. One pilot study among community health center patients documented between 8 and 11 call attempts to successfully reach patients from multi-cultural, low-income backgrounds, which would require more resources.(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) In addition, due to the study location being a Texas-Mexico border county, one limitation is that the findings may not be generalizable to Hispanics throughout the U S; however, they can be useful for building a framework for Spanish-speaking populations in similar regions.\u003c/p\u003e \u003cp\u003eFuture studies should provide detailed information on time intensity and details of navigation encounters. Further, navigator training should be standardized across the state, and potentially across the nation, to provide a certificate for those who have completed a specific number of training courses and hours with patients, similar to the CHW Core Consensus Project.(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) This standardized training should focus on structural barriers as our study, along with others, have noted that participants who required the most navigation time reported experiencing more structural barriers than those who required less navigation time. Furthermore, a standardized framework should be developed and implemented throughout patient navigation programs to ensure that efficacy of screening programs can be replicated in various settings and among different populations.\u003c/p\u003e \u003cp\u003eConsidering program scalability, navigator caseloads may not be determined solely by number of participants but could account for the expected intensity of navigation required. Without considering the variability in navigation requirements per participant, programs could overburden navigators, particularly during periods with high proportions of participants facing more complex barriers.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere are many consistent findings with two other studies that provide this level of detail about navigation for supporting CRC screening in similar populations in other settings.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) The primary barrier of cost was mitigated in all three studies. In these settings, navigation helped individuals overcome similar logistical barriers, although their order of importance and pattern varied according to context. In our study, navigators effectively address primarily structural, and to a lesser extent, personal and cultural barriers to screening through various types of encounters. In all three studies, each participant had multiple navigation encounters, and it remains unclear how important the relationship component of navigation is to positive outcomes. It is also difficult to estimate the exact case load or number or type of encounters that guarantee a significant increase in CRC screening completion. What is certain is that patient navigation consistently proves to be a key component in lessening the burden of CRC and other cancers, especially for under screened and underserved communities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor Affiliations:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAff1: The University of Texas at Austin Dell Medical School, Austin, Texas, USA\u003c/p\u003e\n\u003cp\u003eAff2: UTHealth Houston School of Public Health, San Antonio Regional Campus\u003c/p\u003e\n\u003cp\u003eSan Antonio, Texas, USA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthor Responsibilities:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors participated in the design, analysis, writing, and revisions of the manuscript.\u003c/p\u003e\n\u003cp\u003eDr. Calder\u0026oacute;n-Mora and Dr. Shokar hold accountability for this manuscript and provided final approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData Availability Statement:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding statement:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by a grant from the Cancer Prevention and Research Institute of Texas [PP130068].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eHuman Ethics Approval and Consent to Participate Declaration:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board (IRB) of Texas Tech University Health Sciences Center El Paso (IRB No. E18157). All participants were consented to participate prior to enrollment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConflict of Interest Statement:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflict of interest and no financial interest related to the work submitted for publication.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors participated in the design, analysis, writing, and revisions of the manuscript.Dr. Calder\u0026oacute;n-Mora and Dr. Shokar hold accountability for this manuscript and provided final approval.\u003c/p\u003e\u003c"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUS Preventive Services Task Force, Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(19):1965.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColorectal Cancer Facts \u0026amp;. Figures | Facts About Colon Cancer | American Cancer Society [Internet]. [cited 2025 May 30]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cancer.org/research/cancer-facts-statistics/colorectal-cancer-facts-figures.html\u003c/span\u003e\u003cspan address=\"https://www.cancer.org/research/cancer-facts-statistics/colorectal-cancer-facts-figures.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJandorf L, Ellison J, Villagra C, Winkel G, Varela A, Quintero-Canetti Z, et al. Understanding the barriers and facilitators of colorectal cancer screening among low income immigrant hispanics. 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Patient navigator reported patient barriers and delivered activities in two large federally-funded cancer screening programs. Prev Med. 2019;129:105858.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreund KM. Implementation of evidence-based patient navigation programs. Acta Oncol. 2017;56(2):123\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoronado GD, Ferrari RM, Barnes A, Casta\u0026ntilde;eda SF, Cromo M, Davis MM et al. Characteristics of patient navigation programs in the Cancer Moonshot ACCSIS colorectal cancer screening initiative. J Natl Cancer Inst 2023 June 8;115(6):680\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMosquera I, Todd A, Balaj M, Zhang L, Benitez Majano S, Mensah K, et al. Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: A systematic review. Cancer Med. 2023 July;12(13):14584\u0026ndash;611.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEscoffery C, Fernandez ME, Vernon SW, Liang S, Maxwell AE, Allen JD, et al. Patient Navigation in a Colorectal Cancer Screening Program. J Public Health Manag Pract JPHMP. 2015;21(5):433\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeGroff A, Coa K, Morrissey KG, Rohan E, Slotman B. Key Considerations in Designing a Patient Navigation Program for Colorectal Cancer Screening. Health Promot Pract. 2014 July;15(4):483\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRohan EA, Slotman B, DeGroff A, Morrissey KG, Murillo J, Schroy P. Refining the Patient Navigation Role in a Colorectal Cancer Screening Program: Results From an Intervention Study. J Natl Compr Cancer Netw JNCCN. 2016;14(11):1371\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobinson CM, Beach ML, Greene MA, Cassells A, Tobin JN, Dietrich AJ. Staffing time required to increase cancer-screening rates through telephone support. J Ambul Care Manage. 2010;33(2):143\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYao X, Dembe AE, Wickizer T, Lu B. Does time pressure create barriers for people to receive preventive health services? Prev Med. 2015;74:55\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCallison K, Pesko MF, Phillips S, Sosa JA. Cancer Screening after the Adoption of Paid-Sick-Leave Mandates. N Engl J Med. 2023;388(9):824\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones RM, Devers KJ, Kuzel AJ, Woolf SH. Patient-reported barriers to colorectal cancer screening: a mixed-methods analysis. Am J Prev Med. 2010;38(5):508\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStimpson JP, Park S, Morenz AM, Gurley T, Wilson FA. Examining Employment Status, Paid Sick Leave, and Access to Care in Relation to Colorectal Cancer Screening Among U.S. Workers: A Structural Equation Modeling Approach. Cancer Control J Moffitt Cancer Cent. 2025;32:10732748251347731.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoneycutt S, Green R, Ballard D, Hermstad A, Brueder A, Haard\u0026ouml;rfer R, et al. Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA. Cancer. 2013;119(16):3059\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBensink ME, Ramsey SD, Battaglia T, Fiscella K, Hurd TC, McKoy JM, et al. Costs and outcomes evaluation of patient navigation after abnormal cancer screening: Evidence from the Patient Navigation Research Program. Cancer. 2014;120(4):570\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernardo BM, Zhang X, Beverly Hery CM, Meadows RJ, Paskett ED. The efficacy and cost-effectiveness of patient navigation programs across the cancer continuum: A systematic review. Cancer. 2019;125(16):2747\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLasser KE, Murillo J, Medlin E, Lisboa S, Valley-Shah L, Fletcher RH, et al. A multilevel intervention to promote colorectal cancer screening among community health center patients: results of a pilot study. BMC Fam Pract. 2009;10:37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHW Core Consensus P [Internet]. [cited 2025 June 9]. Home | CHW Core Consensus Project. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.c3council.org\u003c/span\u003e\u003cspan address=\"https://www.c3council.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Colorectal cancer, patient navigation, Hispanic population, health disparities","lastPublishedDoi":"10.21203/rs.3.rs-8264168/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8264168/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eColorectal cancer (CRC) screening is recommended for average-risk individuals aged 45\u0026ndash;75 years old; however, screening rates are suboptimal. An evidence-based strategy found to be effective at increasing screening uptake is patient navigation. The purpose of this paper is to describe patient navigation activities delivered in an effective culturally tailored community-based colorectal cancer screening program in an unscreened, underserved and predominantly Hispanic population.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA total of 690 participants recruited between March 2012 and January 2015 were eligible to receive a colonoscopy. A random sample of 100 high-risk participants and 100 participants who had a positive FIT test were selected for inclusion. We characterized participant identified barriers, navigation contact types, frequency and duration. Linear and logistic regression models were used to examine associations between sociodemographic and health-related factors and two outcomes: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the number of navigation activities participants required, and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) whether participants reported experiencing at least one barrier to screening.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eThe average age of participants in our sample was 56.3 years (SD\u0026thinsp;=\u0026thinsp;5.72), with the majority being female (74.0%) and Hispanic (96.5%). On average, participants received 9.66 navigation contacts in the program, and navigators spent 54.89 minutes per participant delivering navigation services. The most common activities identified were scheduling appointments, reminder phone calls, and communicating results.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eThese results provide detailed information about type and duration of navigation activities for CRC screening and colonoscopy completion within an effective community-based CRC screening program designed for and underserved and underscreened population.\u003c/p\u003e","manuscriptTitle":"Patient Navigation Activities in a Large Community -Based Colorectal Cancer Screening Program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-19 14:58:27","doi":"10.21203/rs.3.rs-8264168/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-05T07:07:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-03T17:50:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-30T19:11:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25457085428319919027465260043661728251","date":"2025-12-16T13:39:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26902591355011434083630144155369726691","date":"2025-12-16T13:15:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-16T13:08:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-09T00:40:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-09T00:39:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2025-12-02T21:15:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9feb9350-5ca3-4602-a0f2-26278863ee32","owner":[],"postedDate":"December 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T16:03:11+00:00","versionOfRecord":{"articleIdentity":"rs-8264168","link":"https://doi.org/10.1186/s12875-026-03187-8","journal":{"identity":"bmc-primary-care","isVorOnly":false,"title":"BMC Primary Care"},"publishedOn":"2026-01-30 15:59:08","publishedOnDateReadable":"January 30th, 2026"},"versionCreatedAt":"2025-12-19 14:58:27","video":"","vorDoi":"10.1186/s12875-026-03187-8","vorDoiUrl":"https://doi.org/10.1186/s12875-026-03187-8","workflowStages":[]},"version":"v1","identity":"rs-8264168","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8264168","identity":"rs-8264168","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}