Knowledge and perceptions of colorectal cancer screening among urban African Americans

Abstract

OBJECTIVE: To explore colorectal cancer (CRC) screening knowledge, attitudes, barriers, and preferences among urban African Americans as a prelude to the development of culturally appropriate interventions to improve screening for this group. DESIGN:Qualitative focus group study with assessment of CRC screening preferences.SETTING: Community health center serving low-income African Americans. PARTICIPANTS:Fifty-five self-identified African Americans over 40 years of age. MEASUREMENTS AND MAIN RESULTS:Transcripts were analyzed using an iterative coding process with consensus and triangulation on final thematic findings. Six major themes were identified: (1) Hope-a positive attitude toward screening, (2) Mistrust-distrust that the system or providers put patients first, (3) Fear-fear of cancer, the system, and of CRC screening procedures, (4) Fatalism-the belief that screening and treatment may be futile and surgery causes spread of cancer, (5) Accuracy-a preference for the most thorough and accurate test for CRC, and (6) Knowledge-lack of CRC knowledge and a desire for more information. The Fear and Knowledge themes were most frequently noted in transcript theme counts. The Hope and Accuracy themes were crucial moderators of the influence of all barriers. The largest number of participants preferred either colonoscopy (33%) or home fecal occult blood testing (26%).CONCLUSIONS: Low-income African Americans are optimistic and hopeful about early CRC detection and believe that thorough and accurate CRC screening is valuable. Lack of CRC knowledge and fear are major barriers to screening for this population along with mistrust, and fatalism. Studies show CRC screening disparities between whites and African Americans, 15-18 especially for sigmoidoscopy. [19][20][21][22] African Americans have exhibited higher rates of late-stage CRC diagnosis and less overall decline in colorectal deaths than whites over the past decade. [23][24][25] Barriers to CRC screening include the inconvenient or impractical nature of the tests, 26-29 the embarrassing or unpleasant nature of the tests, 28,29 fatalistic cancer beliefs, 30,31 and participants not wanting to know that something is wrong. 28,32,33 Studies of African Americans have shown that these barriers and others, such as lack of physician recommendation, limited CRC knowledge, and the uncomfortable nature of tests, may contribute to inadequate screening 16,[34][35][36] Although prior qualitative studies have explored how knowledge, socio-culturally mediated attitudes and perceptions, and testing preferences influence screening for breast and prostate cancer among African Americans, 37-40 few qualitative studies have been conducted with African Americans on CRC screening. 20,41,42 These qualitative studies had enrolled from multiethnic populations and had not specifically focused on the attitudes, opinions, and preferences of African Americans. The purpose of our focus group study was to explore CRC screening knowledge, attitudes, barriers, and preferences among urban African A...

Colorectal Cancer Screening and African Americans: Findings from a Qualitative Study

“…Although other published studies that have examined cancer screening have identified these factors as relevant, 23,24 the lack of confirmation in our study does not imply they are not important. Fatalistic beliefs have been clearly identified in the cancer screening literature as reasons why African Americans do not pursue cancer screening.…”

“…This finding is shared in other qualitative studies examining CRC screening. 23,24,29 The reasons for this distrust were not well established in this study or in previous studies. Future research needs to clearly delineate what influences these perceptions.…”

“…This finding supports others that have also identified a relationship between CRC screening and perceived cancer risk. [23][24][25]28 Our findings indicate that those who felt at risk were screened, while the majority of nonadherent participants felt they had no risk or were at low risk for CRC. Finding new ways to communicate and portray actual risk might be an intervention strategy that could increase participation in CRC screening.…”

“…To date, qualitative studies using focus groups have examined CRC screening in African Americans and have failed to differentiate differences between those who have undergone screening and those who have not. 19,[23][24][25] These studies have generally provided reasons why African Americans are not screened. Understanding why African Americans are screened can provide an important insight on how to activate individuals who are disengaged or in precontemplation.…”

“…9 In comparison with non-Hispanic whites in the United States, African Americans suffer disproportionately higher incidence (62.3 vs 52.6 per 100,000) and far are limited in number and have primarily used focus group methodology consisting of study populations not adherent to screening guidelines. 19,[23][24][25] Differentiating why African Americans participate or fail to participate in CRC screening has not been well established. This study seeks to add context to the issue by conducting in-depth personal interviews to help identify what differentiates individuals who have and have not undergone screening for CRC.…”