Arnold C, et al. - Although colorectal cancer (CRC)—the second leading cause of US cancer death—can be significantly reduced upon early detection and screening rates have significantly increased, there exist disparities among low-income individuals, adults with low literacy, and those living in rural areas. Authors conducted this randomized controlled trial to evaluate the efficacy of two health-literacy informed phone follow-up strategies for improving annual screening with Fecal Immunochemical Test (FIT) in four rural community clinics. Completion rates of all patients, particularly those with limited literacy were facilitated by the simplified instructions and accompanied by a face-to-face demonstration of FIT, use of “teach back” to confirm understanding, and follow-up call if needed. Findings suggested equal efficacy of the less costly and time-consuming automated call as that of a personal call. A decline was observed in the screening rates in years 2 and 3. Efficacy of CRC screening with FIT was observed only when completed annually.