Publication Date



Open access

Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Interdisciplinary Studies (Graduate)

Date of Defense


First Committee Member

Shihab S. Asfour

Second Committee Member

Lisa R. Metsch

Third Committee Member

Robert Duncan

Fourth Committee Member

Michael H. Antoni

Fifth Committee Member

Allan E. Rodriguez


Colorectal cancer (CRC) is the second leading cause of death in the United States and has the highest death rate among Blacks. Whereas studies have targeted patients to increase CRC adherence in the general population few studies have focused on improving providers’ adherence to screening guidelines. Also, CRC screening studies among HIV-positive patients consistently show lower screening rates compared to screening rates among HIV negative persons. Results of screening colonoscopy studies among HIV positive patients show higher prevalence of neoplastic lesions and colon cancer is diagnosed at advanced cancer stages; these patients have shorter disease-free survival compared to HIV-negative patients. The aim of this transdisciplinary retrospective–prospective and randomized control study is to examine providers’ adherence to screening colonoscopy guidelines before and after screening reminders, evaluate the impact of an educational screening video and review of colonoscopy decisions tree plus usual care on patient adherence compared to usual care only. Results showed that providers’ adherence to screening colonoscopy guidelines significantly increased after reminders to refer patients were placed in medical records. The randomized trial showed that patients in the intervention group were more adherent to screening colonoscopy appointments compared to patients in the usual care arm. Also, patients with little or no social support in the intervention arm were more likely to keep appointments. This is the first reported study of a Transdisciplinary prevention model integrating evidence-based medicine, behavioral medicine and human factors decision support through a multi-faceted intervention to increase screening colonoscopy adherence in the HIV population. We integrated a provider reminder system, patient informed decision support of colonoscopy educational video and decision tree review in addition to patient provider communication to promote increased provider and patient screening behavior. Further studies are needed to elucidate the impact of patient centered intervention strategies and social support on screening colonoscopy behavior.


Transdisciplinary; HIV/AIDS; Healthcare disparities; Screening colonoscopy; Adherence