Barriers and Facilitators to Colorectal Cancer Screening Among Rural Women in Community Clinics by Heath Literacy

Abstract

Background Rural women lag rural men and urban women in colon cancer (CRC) screening completion. Objective To identify rural female patients’ knowledge, beliefs barriers, self-efficacy, prior recommendation and completion of CRC screening using an FOBT and to compare these factors by health literacy (HL) level. Methods This descriptive study was conducted between 2015 and 2016 in 4 rural community clinics in south Louisiana. Patients overdue for screening were given a structured interview by a research assistant. Results 339 women were enrolled, mean age 58.5, 32% had limited HL, 66% were African American. Most (91.7%) had heard of CRC, yet only 71% knew of any CRC screening tests. Women with adequate HL had greater knowledge of specific tests than those with limited HL (78.4% vs 56.6%, p<0.001). Only 25.7% had been given information on CRC testing; those with adequate HL were more likely to have received information (30.1% vs 16.8%; p=0.017). Most women (93.2%) indicated they would want to know if they had CRC, while 72.2% reported a provider had recommended CRC screening. Only 24.9% said a healthcare provider had ever given them an FOBT or that they had ever completed an FOBT (22.7%). There were no differences in women’s report of recommendation or completion by HL level. Self-efficacy for completing an FOBT was high; over 90% indicated they could get an FOBT, complete it and mail results to the lab. Level of confidence did not vary by literacy. Three of the four barrier items varied by HL with women with low HL being more likely to fear doing an FOBT because they thought FOBT instructions would be confusing (p=0.002), doing the test would be embarrassing (p=0.025) or messy (p=0.057). Conclusions Rural women are receptive to CRC screening and view FOBTs as effective. Rural community clinics need to provide low cost FOBTs with literacy, gender and culturally appropriate information.

A cost-effectiveness analysis of a colorectal cancer screening program in safety net clinics

“…However, each of these studies differ from ours in significant ways, ranging from multi-modality (Lewis) to clinical cost assessment (Tangka) to simulation-based budget impact analysis (Liss) to a multispecialty group practice (Sequist) to an integrated health care system in which all patients had insurance, with colonoscopy costs all or mostly covered and with easy access to endoscopy services (Meenan). This differs from community clinics, in which screening colonoscopies are less common because of less insurance coverage and limited access (Bass et al, 2011;Davis, Morris, Rademaker, Ferguson, & Arnold, 2017;Ferreira et al, 2005;Robinson et al, 2011).…”

Follow‐up approaches to a health literacy intervention to increase colorectal cancer screening in rural community clinics: A randomized controlled trial

“…23,[30][31][32][33][34][35][36] The survey was written on a fourth-grade level and administered orally. 23,[30][31][32][33][34][35][36] The survey was written on a fourth-grade level and administered orally.…”

“…The structured baseline interview included demographic and CRC screening items from validated questionnaires used previously by our group. 23,[30][31][32][33][34][35][36] The survey was written on a fourth-grade level and administered orally. It assessed self-report of CRC screening history, knowledge, beliefs, barriers, and self-efficacy to completing screening and has been reported previously.…”

“…27,[30][31][32][33][34][35][36] Building on national recommendations and our previous heath literacy-directed CRC screening research, the purpose of the current study was to compare the effectiveness of a health literacy education strategy to promote CRC screening among patients at rural community clinics using the FIT combined with 2 telephone follow-up strategies: an automated telephone call (AC) or a personal call (PC). 27,[30][31][32][33][34][35][36] Building on national recommendations and our previous heath literacy-directed CRC screening research, the purpose of the current study was to compare the effectiveness of a health literacy education strategy to promote CRC screening among patients at rural community clinics using the FIT combined with 2 telephone follow-up strategies: an automated telephone call (AC) or a personal call (PC).…”

“…Our research team previously has studied the effectiveness of specific interventions to enhance CRC screening and to reduce barriers to initial and repeat screening among lower income, lower health literacy, and racially/ethnically diverse adults within rural FQHC settings. 27,[30][31][32][33][34][35][36] Building on national recommendations and our previous heath literacy-directed CRC screening research, the purpose of the current study was to compare the effectiveness of a health literacy education strategy to promote CRC screening among patients at rural community clinics using the FIT combined with 2 telephone follow-up strategies: an automated telephone call (AC) or a personal call (PC).…”