Perceptions of Colorectal Cancer Screening in Urban African American Clinic Patients: Differences by Gender and Screening Status
African Americans have higher colorectal cancer (CRC) morbidity and mortality than whites, yet have low rates of CRC screening. Few studies have explored African Americans’ own perceptions of barriers to CRC screening or elucidated gender differences in screening status. Focus groups were conducted with 23 African American patients between 50 and 70 years of age who were patients in a general internal medicine clinic in a large urban teaching hospital. Focus groups were delimited by gender and CRC screening status. Focus group transcripts were analyzed using an iterative coding process with consensus and triangulation to develop thematic categories. Results indicated key thematic differences in perceptions of screening by gender and CRC screening status. While both men and women who had never been screened had a general lack of knowledge about CRC and screening modalities, women had an overall sense that health screenings were needed and indicated a stronger need to have a positive relationship with their doctor. Women also reported that African American men do not get colonoscopy because of the perceived sexual connotation. Men who had never been screened, compared to those who had been screened, had less trust of their doctors and the health care system and indicated an overall fear of going to the doctor. They also reiterated the sexual connotation of having a colonoscopy and were apprehensive about being sedated during the procedure. Overall, men expressed more fear and were more reluctant to undergo CRC screening than women, but among those who had undergone CRC screening, particularly colonoscopy, men expressed advantages of having the screening. All groups were also found to have a negative attitude about the use of fecal occult blood testing and felt colonoscopy was the superior screening modality. Results suggest that messages and education about CRC screening, particularly colonoscopy, might place more emphasis on accuracy and might be more effective in increasing screening rates among African Americans if tailored to gender and screening status.
KeywordsCRC screening Colonoscopy African American
- 1.American Cancer Society. 2009. Leading sites of new cancer cases and deaths—2009 estimates. http://www.cancer.org/downloads/stt/CFF2009_EstCSt_4.pdf. Accessed 12 January 2010.
- 2.American Cancer Society. 2009. Colorectal Cancer facts & figures 2008–2010. http://www.cancer.org/downloads/STT/F861708_finalforweb.pdf. Accessed 12 January 2010
- 4.Centers for Disease Control and Prevention (CDC). 2007. Behavioral risk factor surveillance system survey data. http://www.cdc.gov/brfss/. Accessed 12 January 2010
- 6.James AS, Campbell MK, Hudson MA (2002) Perceived barriers and benefits to colon cancer screening among African Americans in North Carolina: how does perception relate to screening behavior? Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research Cosponsored by the American Society of Preventive Oncology 11(6):529–534Google Scholar
- 9.U.S. Preventive Services Task Force (2002) The guide to clinical preventive services: report of the United States preventive services task force, 3rd edn. International Medical Publishing, Inc, McLeanGoogle Scholar
- 11.Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, Dash C, Giardiello FM, Glick S, David Johnson C, Johnson D, Levin TR, Pickhard PJ, Rex DK, Smith RA, Thorson A, Winawer SJ (2008) Screening and surveillance for the early detection of colorectal cancer and adenomatour polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force of Colorectal Cancer, and the American College of Radiology. Gastroenterology 134(5):1570–1595CrossRefPubMedGoogle Scholar
- 12.American Cancer Society. 2009. Cancer Prevention and early detection, facts and figures. http://www.cancer.org/downloads/STT/860009web_6-4-09.pdf. Accessed 12 January 2010
- 22.Palmer R, Midgette LA, Dankwa I (2008) Colorectal cancer screening and African Americans: findings from a qualitative study. Cancer Control: Journal of the Moffitt Cancer Center 15(1):72–79Google Scholar
- 23.Pope C, Mays N (2006) Qualitative methods in health and health services research. In Qualitative Research in Health Care, 1-11. Wiley-Blackwell, MaldenGoogle Scholar