Context analysis
RECRUITMENT
The strata analysis did not identify any significant efficacy of the patient navigation intervention at the district level, even after adjustment for age and gender (tables SHowever, figures for participation evolution over time according to time and groups display a heterogenous process of participation according to district and also according to patient navigator (Fig. Strata analyses: evolution of participation rate by time (Kaplan Meier curves) according to the group by districts. Context interactions were explored through the ethnographic analysis. Navigators identified the main characteristic of their intervention area as the predominance of poverty among the people encountered. This poverty puts CRC screening far behind in the order of these people's priorities. Since the targeted population was the deprived population, the poverty barriers were all the more present. The navigators first had to discuss and propose solutions about bills, rents, children's job search and problems with the justice system. Another main contextual characteristic underlined was the language: navigators encountered many people who did not speak French. Navigators sharing a common language with the local communities were more adapted to their function, since they manage to lower this barrier. Another contextual factor that affected navigators’ actions was the behavior of the institutions supposed to give navigators legitimacy: some were helpful and opened doors for him/her, while some were real obstacles for the navigation. Navigators had to develop two contextual modes of action to establish first contact with people and to address those issues: Navigators from Loire, Rhône and Côte d’Or adopted a strategy of direct contact. This because the 3 navigators were already integrated in the intervention zone before the study. They were already known by a part of the population they were meeting. On the other hand, the difficulty was to be recognized as professionals: all 3 of them had to approach an institution frequented by the inhabitants, which made it possible to legitimize their function. Subsequently, they came into contact with the population in various places of daily life (markets, mosque, bus stop). From the very first meeting they started discussing screening. The other strategy was that of the Val de Marne and Ardeche navigators. they were both foreign to their field of action before the study began. They needed to gain the trust of the population, and to do so, they needed to become visible. They felt that a direct contact could be considered intrusive and therefore counterproductive. One of the navigators ensured visibility by first helping NGO volunteers (meal distribution). He spoke of CRC screening only when he was well known by the people. The other one was the only navigator who had real difficulties in reaching the targeted population. His strategy was to hold permanent meetings and organize workshops. He presented the test to the people who came to meet him, never the other way around. No official institution helped him.From these broad contextual characteristics each navigator invented her/his own original operating procedures. The populations in the intervention areas were all heterogeneous and therefore a community approach was difficult to apply. As a result, navigators favored the recruitment of part of the population, depending on their ethnicity or social level. Patients Navigators developed their mode of operation on the model of the “bricoleur “ (Do It Yourself building) in the sense of C. Levi-Strauss [