Targeted outreach and fecal immunochemical testing (FIT) completion among vulnerable Rhode Island populations.

Abstract

e22516 Background: Colorectal cancer (CRC) is the second leading cause of cancer death in the United States, with disproportionate incidence and mortality among racial and ethnic minorities and residents of low socioeconomic status. Although FIT is an effective, non-invasive screening option, national screening rates remain suboptimal, including in Rhode Island. From 2023 to 2025, Blue Cross Blue Shield of Rhode Island (BCBSRI) implemented an outreach program targeting “vulnerable” members (identified as members of color by race or ethnicity, low-income, disabled, or dual eligibility status) to promote CRC screening and distribute FITs. Methods: A total of 3,829 BCBSRI members aged ≥40 years were contacted. A cluster analysis was employed to identify naturally occurring groups based on shared demographic characteristics. Multinomial logistic regression examined differences across these groups in the likelihood of completing the FIT and reasons for non-completion. Results: Of all members contacted, 120 (3.1%) completed FITs through the program, 317 (8.3%) had already completed screening, 462 (12%) refused screening, 761 (19.9%) had an out of service number, and 2,169 (56.7%) never responded or were lost to follow up. Four distinct groups were identified by age, language preference, and race. Groups 1 and 4 were composed predominantly of white members (56% and 100%, respectively), whereas race was other/unknown in Groups 2 and 3 (100% and 74%, respectively). Groups 3 and 4 consisted mainly of older (60s), English-preferring members, while Groups 1 and 2 were relatively younger (50s) members who were more likely to prefer a language other than English or Spanish. Group 3 (older, English-preferring, race other/unknown) demonstrated the highest FIT completion ( p = 0.0556). Groups 3 and 4 had significantly higher rates of prior FIT completion, and of those who were due, were more likely to refuse screening (p < 0.0001). Group 4, which was entirely White, also had the highest prevalence of having a primary care provider and low-income status. Lastly, Groups 1 and 2 exhibited significantly higher rates of out-of-service phone numbers (p<0.0001). Conclusions: Although FIT completion through the BCBSRI outreach program was low, the findings underscore key barriers to CRC screening among vulnerable populations. The majority of members were unreachable or lost to follow-up, and non-English-speaking and younger patients demonstrated higher rates of nonresponse, suggesting structural and communication barriers to engagement. Older, English-preferring members were more likely to have already completed FITs, indicating differing needs across demographic groups. These results highlight the importance of developing tailored outreach strategies that address language barriers, communication access, and patient education to reduce CRC screening disparities in Rhode Island.