The PRIME-CRC Trial to Promote CRC Screening in Rural Communities

The investigators will expand an existing, patient-centered, health literacy strategy to promote longer-term adherence to colorectal cancer (CRC) screening in resource-limited, rural health clinics via colonoscopy or annual fecal immunochemical test (FIT). In the proposed 2-arm study, both PRIME-CRC and enhanced usual care (control) will incorporate health literacy evidence-based practices for delivering CRC patient information and counseling to aid patient decision making for selecting FIT or colonoscopy, including simplified test instructions. In addition, the PRIME-CRC arm will use a "stepped care" approach for reminding patients on proper CRC screening preparation for scheduled colonoscopy or completion of annual FIT. Patients in the PRIME-CRC arm will receive frequent follow-up contact from their health care provider via audio-recorded, automated call or SMS text, based on patient preference.

Inclusion Criteria: 1. have been a patient at one of the participating FQHCs with at least one prior visit in the past 12 months; 2. age 45 to 75 (based on USPSTF guidelines); 3. English-speaking. Exclusion Criteria: 1. have a previous history of cancer other than non-melanoma skin cancer; 2. are up-to-date with CRC screening according to USPSTF guidelines (FOBT in less than a year, sigmoidoscopy less than 5 years, or colonoscopy less than 10 years); 3. a family history that requires a more complete history and possible colonoscopy because of their risk factor; 4. have a documented or uncorrectable cognitive, hearing, or visual impairment; 5. are too ill to participate