Journal of Community Health

, Volume 25, Issue 3, pp 263–278 | Cite as

Colorectal Cancer Screening in Older Men and Women: Qualitative Research Findings and Implications for Intervention

  • Carolyn Beeker
  • Joan Marie Kraft
  • Brian G. Southwell
  • Cynthia M. Jorgensen


As part of the formative research for developing interventions to increase colorectal cancer screening in men and women aged 50 and older, 14 focus groups were conducted to identify (1) knowledge, attitudes, and beliefs about colorectal cancer and colorectal cancer screening, (2) barriers to screening, and (3) strategies for motivating and supporting behavior change. Participants had either private insurance or Medicare and reported different levels of experience with colorectal cancer screening. Overall, they were poorly informed about colorectal cancer and the possible benefits of screening, reporting little or no information from physicians or mass media, negative attitudes toward screening procedures, and fear of cancer. Despite references to the subject matter as embarrassing or private, both men and women, African Americans and whites, appeared to talk candidly and comfortably in the permissive context of the focus group. This study's findings suggest that public education campaigns, decision aids, and targeted interventions are urgently needed to put colorectal cancer screening on the public's “radar screen,” to increase awareness of the prevention and early detection benefits of screening, and to encourage people 50 and older—and the health care providers who serve them—to make screening a high priority.

colorectal cancer screening 


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  1. 1.
    American Cancer Society. Cancer Facts and Figures-1999. Atlanta: American Cancer Society, 1999.Google Scholar
  2. 2.
    Ries LAG, Kosary CL, Hankey BF, Miller BA, Edwards BK (Eds). SEER Cancer Statistics Review, 1973-1995. Bethesda, MD: National Cancer Institute, 1998.Google Scholar
  3. 3.
    Winawer S, Fletcher R, Miller L, et al. Colorectal cancer screening: Clinical guidelines and rationale. Gastroenterology 1997; 112:594-642.Google Scholar
  4. 4.
    Byers T, Levin B, Rothenberger D, Dodd G, Smith R. American Cancer Society guidelines for screening and surveillance for early detection of colorectal polyps and cancer: Update 1997. Ca Cancer J Clin 1997; 47:154-160.Google Scholar
  5. 5.
    Centers for Disease Control and Prevention. Screening for colorectal cancer-United States, 1997. MMWR 1999; 48(6):116-121.Google Scholar
  6. 6.
    Vernon S. Participation in colorectal cancer screening: A review. J Natl Cancer Inst 1997; 89: 1406-22.Google Scholar
  7. 7.
    Neilson A, Whynes D. Determinants of persistant compliance with screening for colorectal cancer. Soc Sci Med 1995; 41:365-374.Google Scholar
  8. 8.
    Blalock S, DeVellis B, Sandler R. Participation in fecal occult blood screening: A critical review. Prev Med 1987; 16:9-18.Google Scholar
  9. 9.
    Green L, Kreuter M. Health Promotion Planning: An Educational and Environmental Approach (2nd edition). Mountain View, CA: Mayfield Publishing Company, 1991.Google Scholar
  10. 10.
    Hall J, Roter D, Katz N. Meta-analysis of correlates of provider behavior in medical encounters. Med Care 1988;26:657-675.Google Scholar
  11. 11.
    Miles M, Huberman A. Qualitative Data Analysis: A Sourcebook of New Methods. Newbury Park, CA: Sage Publications, 1984.Google Scholar
  12. 12.
    Yin R. Applications of Case Study Research. Newbury Park, CA: Sage Publications, 1993.Google Scholar
  13. 13.
    Hiatt RA. Behavioral research contributions and needs in cancer prevention and control: Adherence to cancer screening advice. Prev Med 1997; 26:S11-S18.Google Scholar
  14. 14.
    Carmody J. The TV column. Washington Post, June 6, 1997; B6.Google Scholar
  15. 15.
    Maske M. Davis has cancerous cells removed. Washington Post, June 18, 1997; C1.Google Scholar
  16. 16.
    Olney B. Strawberry to have surgery for colon cancer. New York Times, October 2, 1998; D1.Google Scholar
  17. 17.
    Hynam K, Hart A, Gay S, Inglis A, Wicks A, Mayberry J. Screening for colorectal cancer: Reasons for refusal of faecal occult blood testing in a general practice in England. J Epidemiol Community Health 1995; 49:84-86.Google Scholar
  18. 18.
    Chaffee SH. Mass media and interpersonal channels: Competitive, convergent, or complementary? In G Gumpert and R Cathcart (Eds). Inter/media: Interpersonal Communication in a Media World. New York: Oxford University Press, 1982, pp. 55-77.Google Scholar
  19. 19.
    Hornik RC. Channel effectiveness in development communication programs. In RE Rice and CK Atkin (Eds). Public Communication Campaigns (2nd edition). Newbury Park, CA: Sage Publications, 1989, pp. 309-330.Google Scholar
  20. 20.
    Coleman CL. The influence of mass media and interpersonal communication on societal and personal risk judgments. Commun Res 1993; 20(4):611-628.Google Scholar
  21. 21.
    Gerlach KK, Marino C, Hoffman-Goetz L. Cancer coverage in women's magazines: What information are women receiving? J Cancer Educ 1997; 12:240-244.Google Scholar
  22. 22.
    Hoffman-Goetz L, Gerlach KK, Marino C, Mills SL. Cancer coverage and tobacco advertising in African-American women's popular magazines. J Community Health 1997; 22:261-270.Google Scholar
  23. 23.
    Brown ML, Potosky AL. The presidential effect: The public health response to media coverage about Ronald Reagan's colon cancer episode. Public Opin Q 1990; 54:317-329.Google Scholar
  24. 24.
    Myers R, Ross E, Jepson C, Wolf T, Balshem A, Millner L, Leventhal H. Modeling adherence to colorectal cancer screening. Prev Med 1994; 23:142-151.Google Scholar
  25. 25.
    Eddy D. Screening for colorectal cancer. Ann Intern Med 1990; 113:373-384.Google Scholar
  26. 26.
    Leard L, Savides T, Ganiats T. Patient preferences for colorectal screening. J Fam Pract 1997; 45: 211-218.Google Scholar
  27. 27.
    O'Connor A, Drake E, Fiset V, Page J, Curtin D, Llewellyn-Thomas H. Annotated Bibliography of Research on Shared Decision Making, 1966 to 1996: Patient Decision Support Interventions and Evaluation Measures. Toronto: National Cancer Institute of Canada, 1997.Google Scholar
  28. 28.
    Donavan J, Blake D. Patient noncompliance: Deviance or reasoned decision-making? Soc Sci Med 1992; 34:507-513.Google Scholar
  29. 29.
    Myers R, Ross E, Wolf T, Balshem A, Jepson C, Millner L. Behavioral interventions to increase adherence to colorectal cancer screening. Med Care 1991; 29:1039-1050.Google Scholar
  30. 30.
    McPhee S, Bird J, Jenkins C, Fordham D. Promoting cancer screening: A randomized, controlled trial of three interventions. Arch Intern Med 1989; 149:1866-1872.Google Scholar
  31. 31.
    Lieberman D. How to screen for colon cancer. Annu Rev Med 1998; 49:163-172.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2000

Authors and Affiliations

  • Carolyn Beeker
    • 1
    • 2
  • Joan Marie Kraft
    • 1
    • 2
  • Brian G. Southwell
    • 1
    • 2
  • Cynthia M. Jorgensen
    • 1
    • 2
  1. 1.Division of Cancer Prevention and ControlCommunication and Behavioral Sciences BranchUSA
  2. 2.Centers for Disease Control and PreventionNational Center for Chronic Disease Prevention and Health PromotionAtlanta

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