Christou et al. BMC Public Health 2010, 10:373 http://www.biomedcentral.com/1471-2458/10/373 Page 16 of 21 Table 5: Interventions for improving uptake of CRC screening in disadvantaged and minority groups (Continued) Telephone support intervention [134] RCT Any CRC screening Minority, low income women Tailored telephone outreach [135] RCT Minority Education with Elderly Educators [136] 2-by-2 factorial design Four educational methods: 1. Elderly Educators 2. Elderly Educators plus Adaption for Aging Changes method 3. Adaption for Aging Changes method 4. Traditional method Video-based education [137] RCT FOBT further exploration so that alternative approaches could be considered. For example, an individual could provide a stool sample to a clinic where a nurse or health worker could be responsible for completing the test with the kit. This would also ensure the test is com- pleted correctly. Currently Australia only offers one option for CRC screening - the FOBT. Exploring prefer- ences for screening methodologies among different groups and incorporating their preferences into practice is a possibility for increasing adherence to CRC screen- ing [103,104]. ix) Barriers to compliance with follow-up and treat- ment Completion of the screening test is only one part of the screening process. A positive test must be fol- lowed up with appropriate diagnostic evaluation such as a colonoscopy. This step in the screening pathway poses a great challenge for Indigenous people, particularly those living in rural areas, where colonoscopies are not available locally requiring them to travel long distances. Leaving the community and family is known to be a sig- nificant barrier to compliance with cancer treatment in Indigenous people [3,74]. Results from the 2009 NBCSP monitoring report show that only 43% of total partici- pants with a positive FOBT were followed up by GPs [10] with inadequate follow-up following a positive FOBT test an identified issue for CRC screening [25,105]. Although the NBCSP monitoring reports indicate no differences between the follow-up of Indigenous and non-Indigenous people, it is likely to be worse among Indigenous and minority populations particularly those living remotely. This area needs to be addressed through Any CRC screening FOBT Proportion of women completing CRC screening increased from 39% to 54% in the intervention group and 39% to 50% in the control group (p = 0.13) CRC screening compliance 6 months post intervention was 27% in intervention group vs 6.1% in control group (mailed print material) Socioeconomically disadvantaged African Americans Participation in FOBT was 93% in those and White receiving combination of Elderly Educators plus Adaption for Aging Changes method, 63% in those exposed to Elderly Educators only and 43% participation in those receiving Adaptation for Aging changes method only and 56% exposed to traditional method. Majority had less than high school education 69.6% of intervention group returned FOBT vs 54.4% in control group (p = 0.035) intensive follow-up and interventions to encourage con- firmation of diagnosis and subsequent access to and compliance with treatment. 2.3 Strategies used for improving participation in CRC screening of Indigenous and ethnic minorities internationally In recent years there has been a proliferation of litera- ture investigating CRC screening in minority and under- served groups, identifying barriers to screening and examining how program design can be improved to reduce disparities in cancer outcomes. Intervention stu- dies for improving CRC screening uptake and adherence have been undertaken in the USA. However, the num- ber of studies targeting Indigenous people is minimal with the majority focusing on other ethnic minority and low literacy groups including African American, Latino and Chinese immigrants. However, these studies provide some information on what may or may not work in considering implementation in Australia. The approaches taken have included education and educational sessions, community based interventions, the use of lay health workers, storytelling, mailed inter- ventions, mail-out reminder systems, telephone inter- views, and more recently the utilisation of patient navigators and electronic/educational decision aids [106-110]. The majority are tailored to the characteris- tics of the target group, incorporating their own lan- guages and motifs. A review by Vernon [111] found that those incorporating intensive and personal follow-up appeared to increase adherence more successfully [111]. A more recent systematic review of interventions identi- fied organisational level changes as being most effective