Barriers and Facilitators to Colorectal Cancer Screening in Vietnamese Americans: A Qualitative Analysis

Abstract

Background Vietnamese Americans are the fourth largest Asian ethnic group in the United States. Colorectal cancer (CRC) ranks as one of the most common cancers in Vietnamese Americans. However, CRC screening rates remain low among Vietnamese Americans, with 40% of women and 60% of men reporting never having a sigmoidoscopy, colonoscopy, or Fecal Occult Blood Test. Methods We partnered with a Federally Qualified Health Center (FQHC) in Seattle, Washington, to conduct focus groups as part of a process evaluation. Using interpreters, we recruited and conducted three focus groups comprised of 6 women screened for CRC, 6 women not screened for CRC, and 7 men screened for CRC, which made up a total of 19 FQHC patients of Vietnamese descent between 50 and 79 years old. Three team members analyzed transcripts using open coding and axial coding. Major themes were categorized into barriers and facilitators to CRC screening. Results Barriers include lack of health problems, having comorbidities, challenges with medical terminology, and concerns with the colonoscopy. Participants singled out the risk of perforation as a fear they have towards colonoscopy procedures. Facilitators include knowledge about CRC and CRC screening, access to sources of information and social networks, and physician recommendation. Conclusion Our focus groups elicited information that adds to the literature and has not been previously captured through published surveys. Findings from this study can be used to develop more culturally appropriate CRC screening interventions and improve upon existing CRC screening programs for the Vietnamese American population.

Effectiveness and cost of multilayered colorectal cancer screening promotion interventions at federally qualified health centers in Washington State

“…Despite potential facilitators, such as receiving mailings in their preferred language and wordless instructions, most of those who received the FIT kits did not complete the screenings. Prior studies have identified several potential barriers, including fear about what the test may indicate, the cost of follow‐up colonoscopy, the potential risk of perforation, embarrassment of a fecal collection procedure, concerns about mailing fecal matter, and being busy or forgetful . Future efforts to improve the uptake of CRC screening in MailedFIT programs should address these concerns.…”

“…Prior studies have identified several potential barriers, including fear about what the test may indicate, the cost of follow-up colonoscopy, the potential risk of perforation, embarrassment of a fecal collection procedure, concerns about mailing fecal matter, and being busy or forgetful. [18][19][20][21] Future efforts to improve the uptake of CRC screening in MailedFIT programs should address these concerns. The variation we observed in the FIT kit return rate by patient language should be further evaluated.…”

Barriers and facilitators for colorectal cancer screening in a low-income urban community in Mexico City

“…At the interpersonal level, lack of social support has also been reported as a barrier to CRC screening participation (30). Finally, at the individual level, previously reported barriers include lack of knowledge about detection and disease (22,(31)(32)(33)(34), underestimation of CRC risk(35, 36), procrastination(37), fear of a cancer diagnosis (21,28,34,(37)(38)(39), fear of discomfort or pain during colonoscopy (34,40,41), and shame about getting a colonoscopy (34,40,41). Our study participants perceived as hypothetical facilitators the removal of financial barriers and implementation of educational interventions for patients and providers.…”

Barriers and facilitators for colorectal cancer screening in a low-income urban community in Mexico City

“…At the interpersonal level, lack of social support has also been reported as a barrier to CRC screening participation (30). Finally, at the individual level, previously reported barriers include lack of knowledge about detection and disease (22,(31)(32)(33)(34), underestimation of CRC risk (35,36), procrastination (37), fear of a cancer diagnosis (21,28,34,(37)(38)(39), fear of discomfort or pain during colonoscopy (34,40,41), and shame about getting a colonoscopy (34,40,41). Our study participants perceived as hypothetical facilitators the removal of financial barriers and implementation of educational interventions for patients and providers.…”