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Rural–Urban Differences in Colorectal Cancer Screening Barriers in Nebraska

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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 questionnaire was mailed in 2014 to adults aged 50–75 years in an urban community in the east and a rural community in the west regions of the state. Multiple logistic regression models were created to assess the effects of HBM constructs, rural residence, and demographic factors on CRC screening use. Of the 1200 surveys mailed, 393 were returned (rural n = 200, urban n = 193). Rural respondents were more likely to perceive screening cost as a barrier. Rural residents were also more likely to report that CRC cannot be prevented and it would change their whole life. In multiple regression models, rural residence, perceived embarrassment, and perceived unpleasantness about screening were significantly associated with reduced odds of receiving colonoscopy. Older age (62 years and older), having a personal doctor, and perceived risk of getting CRC were significantly associated with increased odds of receiving colonoscopy. Interventions to increase uptake of colorectal cancer screening in rural residents should be tailored to acknowledge unique perceptions of screening methods and barriers to screening.

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Acknowledgments

The authors thank Harlan Sayles, MS, for assistance with data analysis. Alejandro Hughes was supported by the Cancer Epidemiology Education in Special Populations (CEESP) Program at the University of Nebraska Medical Center (Grant R25 CA1123830) from the National Cancer Institute.

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Authors and Affiliations

  1. Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA

    Alejandro G. Hughes, Shinobu Watanabe-Galloway & Amr S. Soliman

  2. Department of Community Health, Regional West Medical Center, 3700 Avenue B, Scottsbluff, NE, 69361, USA

    Paulette Schnell

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  1. Alejandro G. Hughes
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  2. Shinobu Watanabe-Galloway
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  3. Paulette Schnell
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Correspondence to Shinobu Watanabe-Galloway.

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Hughes, A.G., Watanabe-Galloway, S., Schnell, P. et al. Rural–Urban Differences in Colorectal Cancer Screening Barriers in Nebraska. J Community Health 40, 1065–1074 (2015). https://doi.org/10.1007/s10900-015-0032-2

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