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Examining Psychological and Knowledge Barriers to Colorectal Cancer Screening in Rural Appalachian Kentucky

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Abstract

While recent rates of colorectal cancer (CRC) screening have improved in Appalachian Kentucky due to public health efforts, they remain lower compared to both KY as a whole, and the USA. Suboptimal screening rates represent a missed opportunity to engage in early detection and prevention. The purpose of this study is to determine the impact that lack of knowledge has on psychological barriers (e.g., fear and embarrassment) to CRC screening as well as the potential effect of a psychosocial intervention to reduce these barriers. Participants were recruited through faith-based organizations and other community sites. After randomizing participants to either an early or delayed group, a faith-based group education and motivational interviewing intervention was administered. Existing and pilot tested instruments were used to assess knowledge and potential psychological barriers. Data were analyzed using paired t tests and linear regression. We hypothesized that (1) psychological barriers are associated with inadequate knowledge and (2) the intervention, by improving knowledge, could reduce these barriers and increase screening rates. There was a small but significant reduction in psychological barriers (−0.11, p value = 0.015) and moderate increases in CRC knowledge scores (+0.17, p value = 0.06). There was no evidence that the intervention affected these measures (+0.10, p value = 0.58). The relationship between lower barrier scores and increased knowledge was significant at follow up (−0.05, 95% CI (−0.09, −0.00)). An increase in CRC knowledge was correlated with a small but significant decrease in psychological barriers, although there was no evidence that these changes were associated with one another. Future cognitive-based interventions may be effective in increasing CRC knowledge and reducing barriers, but new intervention approaches should be considered.

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Data Availability

Data re-available upon request to the PI, Dr Nancy Schoenberg, nesch@uky.edu.

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Code Availability

Software: R Core Team (2018). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/. Custom code: Available upon request

Funding

Support for this research was provided by National Institutes of Health/National Center on Minority Health and Health Disparities for “Faith Moves Mountains: A CBPR Appalachian Wellness & Cancer Prevention Program.” (Schoenberg R24 MD002757). Support was also provided by the Markey Cancer Center’s Appalachian Career Training in Oncology Program (R25 CA221765).

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Authors and Affiliations

  1. University of Kentucky College of Medicine, 800 Rose Street, Lexington, KY, 40506, USA

    Caroline R. Jenkins

  2. The Travelers Companies, Inc., New York, NY, USA

    Matthew Rutledge

  3. Markey Cancer Center, University of Kentucky, 800 Rose Street, Lexington, KY, 40536, USA

    Lauren Hudson & Nathan L. Vanderford

  4. Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, 800 Rose Street, Lexington, KY, 40536, USA

    Nathan L. Vanderford

  5. Department of Behavioral Science, University of Kentucky, Lexington, KY, 40508, USA

    Nancy E. Schoenberg

  6. Center for Health Equity Transformation, University of Kentucky, 372 Healthy Kentucky Research Building, Lexington, KY, 40536-0086, USA

    Nancy E. Schoenberg

Authors
  1. Caroline R. Jenkins
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  2. Matthew Rutledge
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  3. Lauren Hudson
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  4. Nathan L. Vanderford
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  5. Nancy E. Schoenberg
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Contributions

Caroline Jenkins wrote much of the introduction, results, and discussion and provided leadership for the writing project. Matthew Rutledge undertook all of the data analyses, wrote much of the methods section, and reviewed the entire manuscript. Lauren Hudson and Nathan Vanderford assisted with many of the revisions, as well as reviewed and added to the whole manuscript. Nancy Schoenberg conceptualized the project, and her team implemented the study. She also contributed to the manuscript development and review.

Corresponding author

Correspondence to Caroline R. Jenkins.

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Ethics Approval and Consent to Participate

This research was approved by the University of Kentucky’s Office of Research Integrity, protocol #08-0119-P2H. Informed consent was obtained from all participants through protocol #08-0119-P2H.

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All participants have consented to the anonymization and publication of the data.

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The authors declare no competing interests.

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Jenkins, C.R., Rutledge, M., Hudson, L. et al. Examining Psychological and Knowledge Barriers to Colorectal Cancer Screening in Rural Appalachian Kentucky. J Canc Educ 38, 325–332 (2023). https://doi.org/10.1007/s13187-021-02120-0

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