Abstract
Colorectal cancer (CRC) is a leading cause of death among Hispanics in the United States. Despite the benefits of CRC screening, many Hispanics are not being screened. Using a combined methodology of focus groups and discrete choice experiment (DCE) surveys, the objectives for this research were as follows: (1) to improve understanding of preferences regarding potential CRC screening program characteristics, and (2) to improve understanding of the barriers and facilitators around CRC screening with the Hispanic, immigrant community in North Carolina. Four gender-stratified focus groups were conducted and DCE surveys were administered to 38 Spanish-speaking individuals across four counties in North Carolina. In-depth content analysis was used to examine the focus group data; descriptive analyses and mean attribute importance scores for cost of screening and follow-up care, travel time, and test options were calculated from DCE data. Data analyses showed that this population has a strong interest in CRC screening but experience barriers such as lack of access to resources, cost uncertainty, and stigma. Some of these barriers are unique to their cultural experiences in the United States, such as an expressed lack of tailored CRC information. Based on the DCE, cost variables were more important than testing options or travel time. This study suggests that Hispanics may have a general awareness of and interest in CRC screening, but multiple barriers prevent them from getting screened. Special attention should be given to designing culturally and linguistically appropriate programs to improve access to healthcare resources, insurance, and associated costs among Hispanics.
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Brenner A, Howard K, Lewis C, Sheridan S, Crutchfield T, Hawley S, Reuland D, Kistler C, Pignone M (2014) Comparing 3 values clarification methods for colorectal cancer screening decision-making: a randomized trial in the US and Australia. J Gen Intern Med 29:507–13
Brown, A; Patten, E. 2014. Statistical Portrait of Hispanics in the United States, 2012: Pew Research Center. http://www.pewhispanic.org/files/2014/04/FINAL_Statistical-Portrait-of-Hispanics-in-the-United-States-2012.pdf. Accessed 10 June 2014.
American Cancer Society (2012) Cancer facts & figures for Hispanics/Latinos 2012–2014. American Cancer Society, Atlanta, GA
American Cancer Society (2012) Cancer prevention & early detection facts & figures 2012. American Cancer Society, Atlanta, GA
American Cancer Society (2011) Colorectal cancer facts & figures 2011–2013. American Cancer Society, Atlanta, GA
Demographic Profile of Hispanics in North Carolina, 2011. 2013. Hispanic Trends Project. Pew Research Center. http://www.pewhispanic.org/states/state/nc/. Accessed 10 June 2014.
Diaz JA, Roberts MB, Clarke JG, Simmons EM, Goldman RE, Rakowski W (2013) Colorectal cancer screening: language is a greater barrier for Latino men than Latino women. J Immigr Minor Health 15:472–475
Fernandez ME, Wippold R, Torres-Vigil I, Byrd T, Freeberg D, Bains Y, Guajardo J, Coughlin SS, Vernon SW (2008) Colorectal cancer screening among Latinos from U.S. cities along the Texas-Mexico border. Cancer Causes Control 19:195–206
Garcia-Dominic O, Lengerich EJ, Wray LA, Parrott R, Aumiller B, Kluhsman B, Renderos C, Dignan M (2012) Barriers to CRC screening among Latino adults in Pennsylvania: ACCN results. Am J Health Behav 36:153–167
Hopwood CJ, Flato CG, Ambwani S, Garland BH, Morey LC (2009) A comparison of Latino and Anglo socially desirable responding. J Clin Psychol 65:769–780
Jandorf L, Stossel LM, Cooperman JL, Graff Zivin J, Ladabaum U, Hall D, Thelemaque LD, Redd W, Itzkowitz SH (2013) Cost analysis of a patient navigation system to increase screening colonoscopy adherence among urban minorities. Cancer 119:612–620
Jibara G, Jandorf L, Fodera MB, DuHamel KN (2011) Adherence to physician recommendation to colorectal cancer screening colonoscopy among Hispanics. J Gen Intern Med 26:1124–1130
Ko LK, Reuland D, Jolles M, Clay R, Pignone M (2014) Cultural and linguistic adaptation of a multimedia colorectal cancer screening decision aid for Spanish-speaking Latinos. J Health Commun 19:192–209
Natale-Pereira A, Marks J, Vega M, Mouzon D, Hudson SV, Salas-Lopez D (2008) Barriers and facilitators for colorectal cancer screening practices in the Latino community: perspectives from community leaders. Cancer Control 15:157–165
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 27:1033–1046
Orme BK (2009) Getting started with conjoint analysis: strategies for product design and pricing research, 2nd edn. Research Publishers, LLC, Chicago
Passel, JS and Cohn, D. 2012. Unauthorized Immigrants: 11.1 Million in 2011. In Hispanic Trends Project: Pew Research. http://www.pewhispanic.org/2012/12/06/unauthorized-immigrants-11-1-million-in-2011/. Accessed 10 June 2014.
Philips BU Jr, Belasco E, Markides KS, Gong G (2013) Socioeconomic deprivation as a determinant of cancer mortality and the Hispanic paradox in Texas, USA. Int J Equity Health 12:26
Pignone MP, Brenner AT, Hawley S, Sheridan SL, Lewis CL, Jonas DE, Howard K (2012) Conjoint analysis versus rating and ranking for values elicitation and clarification in colorectal cancer screening. J Gen Intern Med 27:45–50
Pignone MP, Crutchfield TM, Brown PM, Hawley ST, Laping JL, Lewis CL, Lich K, Richardson LC, Tangka F, Wheeler SB (2014) Using a discrete choice experiment to inform the design of programs to promote colon cancer screening for vulnerable populations in North Carolina. BMC Health Serv Res 14:611
Pinheiro PS, Williams M, Miller EA, Easterday S, Moonie S, Trapido EJ (2011) Cancer survival among Latinos and the Hispanic Paradox. Cancer Causes Control 22:553–561
Reuland DS, Ko LK, Fernandez A, Braswell LC, Pignone M (2012) Testing a Spanish-language colorectal cancer screening decision aid in Latinos with limited English proficiency: results from a pre-post trial and four month follow-up survey. BMC Med Inform Decis Mak 12:53
Silberman P, Bazan-Manson A, Purves H, Odom CH, Easley MP, Weisner KK, DeFriese GH (2003) North Carolina Latino health, 2003. A report from the Latino Health Task Force. N C Med J 64:113–121
Sawtooth Software (2009) The CBC/HB Systemfor Hierarchical Bayes Estimation Version 5.0. Sequim, WA
Whitlock EP, Lin JS, Liles E, Beil TL, Fu R (2008) Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 149:638–658
Acknowledgements
Primary funding for this project was sponsored by the Centers for Disease Control and Prevention, Special Interest Project, “Behavioral economics of colorectal cancer screening in underserved populations” (CDC-SIP-11-041 3U48DP001944-03S1, Co-PIs: Pignone and Wheeler). Additional funding came from the Carolina Community Network Center to Reduce Cancer Health Disparities, a NCI-CRCHD Community Network Program Center (grant # U54CA153602). Dr. Wheeler’s time on this project was further supported by the Agency for Healthcare Research and Quality (AHRQ), 1-K-12 HS019468-01 Mentored Clinical Scientists Comparative Effectiveness Development Award (PI: Weinberger; Scholar: Wheeler). Dr. Reuland’s effort was supported by North Carolina Translational and Clinical Science’s (NC TraCS) Institute and Community Academic Resources for Engaged Scholarship (CARES) through National Institutes of Health Grant Award Number 1UL1TR001111.
The authors would like to acknowledge Connor Kane and Nacire Garcia for support with data collection through the NC TraCS Institute program on Expanding Networks for Latinos through Community Engagement (ENLaCE).
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Martens, C.E., Crutchfield, T.M., Laping, J.L. et al. Why Wait Until Our Community Gets Cancer?: Exploring CRC Screening Barriers and Facilitators in the Spanish-Speaking Community in North Carolina. J Canc Educ 31, 652–659 (2016). https://doi.org/10.1007/s13187-015-0890-4
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DOI: https://doi.org/10.1007/s13187-015-0890-4