Original Paper

Journal of Community Health

, Volume 34, Issue 2, pp 79-89

First online:

Factors Influencing Choices for Colorectal Cancer Screening Among Previously Unscreened African and Caucasian Americans: Findings from a Triangulation Mixed Methods Investigation

  • Mack T. RuffinIVAffiliated withDepartment of Family Medicine, University of Michigan Health System
  • , John W. CreswellAffiliated withDepartment of Educational Psychology, University of Nebraska-Lincoln
  • , Masahito JimboAffiliated withDepartment of Family Medicine, University of Michigan Health System
  • , Michael D. FettersAffiliated withDepartment of Family Medicine, University of Michigan Health System Email author 

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We investigated factors that influence choice of colorectal cancer (CRC) screening test and assessed the most- and least-preferred options among fecal occult blood testing (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast barium enema among adults with varied race, gender, and geographic region demographics. Mixed methods data collection consisted of 10 focus group interviews and a survey of the 93 focus group participants. Participants were ≥50 years of age and reported not having been screened for colorectal cancer in the last ten years. Analyses examined differences by race, gender, and geographic location. Participants had modest knowledge about CRC and there were fewer correct answers to knowledge questions by African Americans. Participants recognized value of early detection, and identified health symptoms and their doctor’s recommendation as influential for obtaining CRC screening. They chose colonoscopy and FOBT as the most preferred tests, while barium enema was least preferred. The analysis revealed intra-group variations in preference, though there were no significant differences by race, gender, or location. Openness of discussing this sensitive topic, lack of knowledge about colorectal cancer and screening costs, and diversity of preferences expressed within study groups suggest the importance of patient-physician dialogue about colorectal cancer screening options. New approaches to promoting colorectal cancer screening need to explore methods to facilitate patients establishing and expressing preferences among the screening options.


Colorectal cancer screening Decision making Gender Race