African Americans have the highest burden of colorectal cancer (CRC) in the United States of America (USA) yet lower CRC screening rates than whites. Although poor screening has prompted efforts to increase screening uptake, there is a persistent need to develop public health interventions in partnership with the African American community. The aim of this study was to conduct focus groups with African Americans to determine preferences for the content and mode of dissemination of culturally tailored CRC screening interventions. In June 2013, 45–75-year-old African Americans were recruited through online advertisements and from an urban Veterans Affairs system to create four focus groups. A semi-structured interview script employing open-ended elicitation was used, and transcripts were analyzed using ATLAS.ti software to code and group data into a concept network. A total of 38 participants (mean age = 54) were enrolled, and 59 ATLAS.ti codes were generated. Commonly reported barriers to screening included perceived invasiveness of colonoscopy, fear of pain, and financial concerns. Facilitators included poor diet/health and desire to prevent CRC. Common sources of health information included media and medical providers. CRC screening information was commonly obtained from medical personnel or media. Participants suggested dissemination of CRC screening education through commercials, billboards, influential African American public figures, Internet, and radio. Participants suggested future interventions include culturally specific information, including details about increased risk, accessing care, and dispelling of myths. Public health interventions to improve CRC screening among African Americans should employ media outlets, emphasize increased risk among African Americans, and address race-specific barriers. Specific recommendations are presented for developing future interventions.
African American Colorectal cancer Screening Disparities Qualitative
Affordable Care Act
United States of America
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Conflict of Interest
None of the authors acknowledge any conflict of interest related to the conduction of this study.
This research was supported by the NIH Training grant (T32DK07180—40) for Dr. May. There was no sponsor for this research or publication.
The opinions and assertions contained herein are the sole views of the authors and are not to be construed as official or as reflecting the views of the Department of Veterans Affairs. The corresponding author confirms full access to all aspects of the research and writing process and takes final responsibility for the paper.
Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML (2011) Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst 103(2):117–128CrossRefPubMedPubMedCentralGoogle Scholar
Rise L, Eisner M, Kosary C (2003) SEER cancer statistic review 1975–2000. National Cancer Institute, BethesdaGoogle Scholar
Lieberman DA, Holub JL, Moravec MD, Eisen GM, Peters D, Morris CD (2008) Prevalence of colon polyps detected by colonoscopy screening in asymptomatic black and white patients. JAMA 300(12):1417–1422CrossRefPubMedGoogle Scholar
Ashktorab H, Nouraie M, Hosseinkhah F, Lee E, Rotimi C, Smoot D (2009) A 50-year review of colorectal cancer in African Americans: implications for prevention and treatment. Dig Dis Sci 54(9):1985–1990CrossRefPubMedGoogle Scholar
Murphy G, Devesa SS, Cross AJ, Inskip PD, McGlynn KA, Cook MB (2011) Sex disparities in colorectal cancer incidence by anatomic subsite, race and age. Int J Cancer 128(7):1668–1675CrossRefPubMedGoogle Scholar
Nishihara R, Wu K, Lochhead P, Morikawa T, Liao X, Qian ZR et al (2013) Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 369(12):1095–1105CrossRefPubMedGoogle Scholar
Hewitson P, Glasziou P, Watson E, Towler B, Irwig L (2008) Cochrane systematic review of colorectal cancer screening using the fecal occult blood test [hemoccult]: an update. Am J Gastroenterol 103(6):1541–1549CrossRefPubMedGoogle Scholar
Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF et al (2012) Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 366(8):687–696CrossRefPubMedPubMedCentralGoogle Scholar
Pignone M, Rich M, Teutsch SM, Berg AO, Lohr KN (2002) Screening for colorectal cancer in adults at average risk: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137(2):132–141CrossRefPubMedGoogle Scholar
May FP, Bromley EG, Reid MW, Baek M, Yoon J, Cohen E et al (2014) Low uptake of colorectal cancer screening among African Americans in an integrated Veterans Affairs health care network. Gastrointest Endosc 80(2):291–298CrossRefPubMedPubMedCentralGoogle Scholar
Agrawal S, Bhupinderjit A, Bhutani MS, Boardman L, Nguyen C, Romero Y et al (2005) Colorectal cancer in African Americans. Am J Gastroenterol 100(3):515–523CrossRefPubMedGoogle Scholar
Naylor K, Ward J, Polite BN (2012) Interventions to improve care related to colorectal cancer among racial and ethnic minorities: a systematic review. J Gen Intern Med 27(8):1033–1046CrossRefPubMedPubMedCentralGoogle Scholar
Jemal A, Simard EP, Dorell C, Noone AM, Markowitz LE, Kohler B et al (2013) Annual Report to the Nation on the Status of Cancer, 1975–2009, featuring the burden and trends in human papillomavirus [HPV]-associated cancers and HPV vaccination coverage levels. J Natl Cancer Inst 105(3):175–201CrossRefPubMedPubMedCentralGoogle Scholar
Christy SM, Perkins SM, Tong Y, Krier C, Champion VL, Skinner CS et al (2013) Promoting colorectal cancer screening discussion: a randomized controlled trial. Am J Prev Med 44(4):325–329CrossRefPubMedPubMedCentralGoogle Scholar
Palmer RC, Midgette LA, Mullan ID (2010) Colorectal cancer screening preferences among African Americans: which screening test is preferred? J Cancer Educ Off J Am Assoc Cancer Educ 25(4):577–581CrossRefGoogle Scholar
Winterich JA, Quandt SA, Grzywacz JG, Clark P, Dignan M, Stewart JH et al (2011) Men’s knowledge and beliefs about colorectal cancer and 3 screenings: education, race, and screening status. Am J Health Behav 35(5):525–534CrossRefPubMedPubMedCentralGoogle Scholar
Palmer RC, Midgette LA, Dankwa I (2008) Colorectal cancer screening and African Americans: findings from a qualitative study. Cancer Control 15(1):72–79PubMedGoogle Scholar
Bromley EG, May FP, Federer L, Spiegel BM, van Oijen MG (2013) A systematic review of patient, provider, and system barriers to colorectal cancer screening with colonoscopy in African-Americans. Gastroenterology. [AB Mo1110]:S581Google Scholar
Palmer RC, Chhabra D, McKinney S (2011) Colorectal cancer screening adherence in African-American men and women 50 years of age and older living in Maryland. J Community Health 36(4):517–524CrossRefPubMedGoogle Scholar
Wallace PM, Suzuki R (2012) Regional, racial, and gender differences in colorectal cancer screening in middle-aged African-Americans and Whites. J Cancer Educ Off J Am Assoc Cancer Educ 27(4):703–708CrossRefGoogle Scholar
American Cancer Society (2011) Colorectal cancer facts & figures 2011–2013. Atlanta G, ACSGoogle Scholar
McCleary-Jones V, Scheideman-Miller C, Rev Dorn JA Jr, Johnson B, Overall M, Dwyer K (2013) Health information technology use and health literacy among community-dwelling African Americans. ABNF J Off J Assoc Black Nurs Fac High Educ Inc 24(1):10–16Google Scholar
Mitchell SJ, Godoy L, Shabazz K, Horn IB (2014) Internet and mobile technology use among urban African American parents: survey study of a clinical population. J Med Internet Res 16(1):e9CrossRefPubMedPubMedCentralGoogle Scholar