This project is funded by Minciencias (Colombia)
Background
Evidence shows that two-stage colorectal cancer screening using fecal immunochemical testing (iFOBT) followed by colonoscopy reduces CRC incidence and mortality. In Colombia, screening remains largely opportunistic and relies mainly on the guaiac fecal occult blood test (gFOBT), which has low sensitivity. Over the past decade, colorectal cancer incidence and mortality have increased in the country.
Objective
To implement and evaluate an organized two-stage colorectal cancer screening intervention using fecal immunochemical testing (iFOBT) followed by colonoscopy in Risaralda, Quindío, and Caldas, Colombia (2023–2026), incorporating innovative demand-induction strategies to increase screening uptake and strengthen coordinated CRC prevention efforts.
Methodology
We are conducting a matched-pair cluster randomized community intervention trial between 2023 and 2026. Municipalities are being matched on sociodemographic and economic characteristics, with one municipality per pair being assigned to the intervention group and the other to usual care. The intervention consists of a multicomponent demand-induction strategy to increase the two-stage colorectal cancer screening which consists in the uptake of fecal immunochemical testing (iFOBT) followed by colonoscopy in those who result positive.
In addition to Invitation during clinical consultations, other strategies where included such as: mass media outreach, telephone calls, text message reminders, and an immersive virtual reality (VR)– The VR strategy, is a primary innovative component that uses head-mounted displays to deliver immersive educational and behavioral persuasion content addressing CRC risk, screening benefits, and iFOBT use.
Virtual reality glasses were designed where the user can view images from a colonoscopy; the user can see the different colonic polyps and adenomas, allowing them to understand why occult blood in stool, could be a suspicion of premalignant lesions.
 
 
 
Results.
Preliminary results include participants in the intervention group (n = 1,860), Virtual reality–based invitation strategy, accounted 85.4% of all implemented strategies (Table No 1).
Table 1. Type of invitation intervention

Conclusions/Implications. 
Immersive virtual reality–based communication strategy is a highly effective approach for inducing demand for two-stage colorectal cancer screening within an organized program.  Immersive health education tools can overcome informational and behavioral barriers to screening uptake. Implementing innovative, technology-driven communication strategies may strengthen colorectal cancer screening coverage in settings with rising disease burden and limited sensitivity of conventional invitation approaches.

Type of invitation intervention