2015
DOI: 10.1007/s10900-015-0032-2
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Rural–Urban Differences in Colorectal Cancer Screening Barriers in Nebraska

Abstract: Nebraska ranks 36th nationally in colorectal cancer screening. Despite recent increases in CRC screening rates, rural areas in Nebraska have consistently shown lower rates of CRC screening uptake, compared to urban areas. The objective of this study was to investigate reasons for lower CRC screening rates among Nebraska residents, especially among rural residents. We developed a questionnaire based on Health Belief Model (HBM) constructs to identify factors associated with the use of CRC screening. The questio… Show more

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Cited by 47 publications
(68 citation statements)
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References 39 publications
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“…After considering the provider‐ and county‐level correlation, a majority of patient characteristics examined were found to be associated with CRC screening for patients of rural ACO clinics. Average‐risk patients of these rural ACO clinics who belonged to a minority group and who were relatively younger (age group 50‐65), whose preferred language was not English, and who were without insurance were less likely to receive CRC screening following the USPSTF guidelines, consistent with the findings in CRC screening literature . On the other hand, potential facilitators to CRC screening included patients who had chronic conditions or made a wellness visit in the past year .…”
Section: Discussionsupporting
confidence: 70%
See 1 more Smart Citation
“…After considering the provider‐ and county‐level correlation, a majority of patient characteristics examined were found to be associated with CRC screening for patients of rural ACO clinics. Average‐risk patients of these rural ACO clinics who belonged to a minority group and who were relatively younger (age group 50‐65), whose preferred language was not English, and who were without insurance were less likely to receive CRC screening following the USPSTF guidelines, consistent with the findings in CRC screening literature . On the other hand, potential facilitators to CRC screening included patients who had chronic conditions or made a wellness visit in the past year .…”
Section: Discussionsupporting
confidence: 70%
“…Rural residents are also more likely to report having a PCP, but they make fewer visits to health care providers than do urban residents . Rural residents also feel more strongly that a CRC diagnosis will change their entire lives and yet are less likely to believe that CRC can be prevented . These findings, combined with the findings in our study, suggest insufficient communication between physicians and patients in rural areas about CRC screening and disease.…”
Section: Discussionmentioning
confidence: 43%
“…Our findings align with prior studies which demonstrate that CRC testing rates are suboptimal in the US and identify barriers and facilitators to screening at three levels: patient, provider, and context Male gender and rural geography are two prevalent patient-level barriers (Wheeler et al, 2014; Ojinnaka et al, 2015; Anderson et al, 2013; Holden et al, 2010). Similarly, having a usual source of care is an important predictor of CRC test use, particularly for populations experiencing disparities (Jandorf et al, 2010; Wilkins et al, 2012; Hughes et al, 2015; Benarroch-Gampel et al, 2012). Contextual factors including area poverty rates, high unemployment and high levels of uninsurance have also been found to be significantly associated with lower CRC screening after controlling for patient-level characteristics (Lian et al, 2008; Mobley et al, 2010; Pruitt et al, 2009; Schootman et al, 2006; Calo et al, 2015).…”
Section: Discussionmentioning
confidence: 99%
“…National data consistently show lower rates of screening in rural areas, and among adults with less education, low income, or no health insurance (Wheeler et al, 2014; Cole et al, 2012; Morbidity, and Mortality Weekly Report (MMWR), 2013; Ojinnaka et al 2015; Anderson et al, 2013; Holden et al, 2010). While patient preferences influence CRC testing (Lian et al, 2008; Mobley et al, 2010; Pruitt et al, 2009; Schootman et al, 2006; Calo et al, 2015; Pignone et al, 1999; Jones et al, 2010), contextual factors such as provider preferences, clinical workflows or regional characteristics, also play an important role in determining if screening occurs and which screening modalities are used in practice (Pignone et al, 1999; Wolf et al, 2006; Marshall et al, 2007; Mansfield et al, 2016; Martens et al, 2015; Jandorf et al, 2010; Wilkins et al, 2012; Hughes et al, 2015; Benarroch-Gampel et al, 2012). For example, an individual's insurance coverage may influence where they seek care and thus the screening services they are offered.…”
Section: Introductionmentioning
confidence: 99%
“…The outcome measure was assessed by a single item asking whether participants ever had a colonoscopy or flexible sigmoidoscopy. Demographic and health‐related correlates of this outcome were selected based on past studies of rural populations . Table displays these correlates.…”
Section: Methodsmentioning
confidence: 99%