Colorectal cancer screening and African Americans: findings from a qualitative study.

Background: Colorectal cancer (CRC) screening has been found to be an effective tool for the control and prevention of this type of cancer, yet it is underutilized by African Americans. Consequently, African Americans with CRC are diagnosed at late stages and suffer disproportionately higher mortality rates for CRC.

Methods: To understand factors that influence the decision to participate in CRC screening, in-depth personal interviews were conducted with 36 African Americans in the Washington, DC, metropolitan area. Predisposing factors, enabling factors, and reinforcing factors were identified and categorized using the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation (PRECEDE) framework.

Results: Findings suggest that distinct differences exist between individuals who are adherent to screening guidelines and those who have not undergone screening. Adherent individuals were more knowledgeable about CRC and held positive beliefs about the benefits of screening. Nonadherent individuals placed little importance on prevention and early detection. Physician recommendation and insurance coverage/cost also differentiated the two groups.

Conclusions: Study findings suggest that efforts to increase awareness and promote the benefits of CRC screening are needed among African Americans. Also, efforts by healthcare providers to recommend CRC screening are important in promoting adherence. Further, low- or no-cost CRC screening is needed to increase participation by individuals who are economically disadvantaged.