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Barriers and Facilitators to Stool-Based Screening for Colorectal Cancer Among Black Louisville Residents

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Knowledge of colorectal cancer (CRC) screening options remains suboptimal in Black populations, contributing to screening disparities. Guided by community-based participatory research (CBPR) principles, we partnered with five Black churches in Louisville, a region of Kentucky with high Black-white CRC screening disparities, to explore screening barriers and facilitators for CRC education and outreach. Project champions (n = 5) served as primary points of contact, developed project support within their churches, and were trained to recruit church and community members (n = 39) to participate in five semi-structured focus groups. Interview questions probed actual and perceived barriers to CRC screening, focusing on knowledge and perceptions of stool-based tests. Subsequent questions explored perceptions of different screening tests, CRC knowledge and beliefs, and trusted community locations for screening outreach. Transcripts were analyzed iteratively, and codes were derived inductively and refined to develop overarching themes. Participants experienced multilevel barriers to completing CRC screening. Primary themes about CRC screening included acknowledgment of importance, positive and negative personal experiences, need for increased outreach, and desire for greater cultural representation in educational materials. Participants frequently discussed perceptions of inadequate medical care, with most having only ever been offered colonoscopy; subsequently, knowledge of stool-based tests was low. To address this knowledge gap, participants stressed interpersonal communication from trusted individuals, such as local Black medical providers and CRC survivors. Given the low knowledge of stool-based testing among participants and identified inequities in receipt of clinical care, community-based CRC screening interventions are warranted to reduce Black-white CRC screening disparities.

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The authors wish to acknowledge our community and church partners, without whom this project would not have been possible. We thank them for their continued support, advocacy, and leadership in working to eliminate cancer disparities in Kentucky and beyond.


This research was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR001998 and by the National Cancer Institute through the Cancer Center Support Grant P30CA177558.

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Correspondence to Aaron J. Kruse-Diehr.

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Kruse-Diehr, A.J., Cegelka, D., Holtsclaw, E. et al. Barriers and Facilitators to Stool-Based Screening for Colorectal Cancer Among Black Louisville Residents. J Canc Educ 38, 1050–1058 (2023).

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