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035 How to improve colorectal cancer screening in underserved areas: a qualitative evaluation of a combined, coproduced health literacy intervention
  1. Géraldine Cazorla1,
  2. Alix Boirot1,
  3. Aurore Lamouroux2,3,
  4. Niamh M Redmond4,5,
  5. Maria-Claudia Addamiano4,
  6. Raoudha Grami6,
  7. Françoise Couranjou7,
  8. Zineb Doukhi8,
  9. Clémence Casanova1,
  10. Julien Mancini1,9,
  11. Marie-Anne Durand4,10,11
  1. 1Aix Marseille Univ, Inserm, Ird, Isspam, Sesstim (Economic and Social Sciences of Health and Medical Information Processing), Marseille, France
  2. 2Assistance Publique – Hôpitaux de Marseille, Marseille, France
  3. 3Vaucluse Departmental Health Education Committee (CoDES 84), Avignon, France
  4. 4Cerpop, University of Toulouse III Paul Sabatier, Toulouse, France
  5. 5ARC West/Bristol Medical School, University of Bristol, UK
  6. 6Inserm, UMR 1290 Reshape University Lyon 1, Lyon, France
  7. 7Aix-Marseille Univ, CEReSS-Centre de recherche sur les services de santé et la qualité de vie, Marseille, France
  8. 8Clinical Epidemiology Unit, Inserm CIC 1426, Hôpital Robert Debré, University of Paris, France
  9. 9Biostatistique et Technologies de l’Information et de la Communication (BioSTIC), Hop Timone, APHM, Marseille, France
  10. 10The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
  11. 11Unisanté, University Centre for General Medicine and Public Health, Rue du Bugnon 44, CH-1011 Lausanne,Switzerland


Introduction Colorectal cancer (CRC) is one of the most common causes of cancer burden. In France, it is the second leading cause of cancer mortality. Although systematic uptake of CRC screening improves survival rates, its uptake remains insufficient, especially among people with limited health literacy (HL) and lower socioeconomic position. Our aim was to explore general practitioners’ (GPs) perceptions of the acceptability and implementation potential of a coproduced, combined intervention consisting of 1) e- learning and interactive training for GPs on HL and CRC screening and; 2) a patient-facing pictorial brochure and video.

Methods A qualitative study, nested within a cluster-randomized controlled trial (DECODE, NCT04631692) in four French regions. Semi-structured interviews were conducted (telephone or online) in 2023 to gain insight into the opinions, experiences and recommendations of MGs participating in the intervention arm. Thematic analysis using manual and NVivo coding was conducted.

Results Most of the 22 GPs interviewed regarded the training as acceptable, informative and offering great flexibility of use. The module on HL was considered more interesting than the one on CRC screening, as addressing HL was new or unfamiliar to many GPs. The patient-facing brochure was seen as redundant alongside the screening kit’s instruction manual. The video, sometimes described as disruptive to the consultation flow, was deemed highly beneficial for patients with low HL and/or difficulties in French. Suggestions for implementing the intervention into routine care while addressing time constraints included using the video with low HL patients and implementing task-sharing.

Discussion The interactive training sessions, although difficult to organize due to time limitations, were considered critical to discussing the implementation of the intervention in to practice. Keeping the training brief, self-paced and more focused on HL was recommended.

Conclusion Scaling-up the combined intervention was largely recommended by GPs to maximize screening uptake in France.

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