Contrasts in Rural and Urban Barriers to Colorectal Cancer Screening

Davis, Terry C.; Rademaker, Alfred; Bailey, Stacy Cooper; Platt, Daci J.; Esparza, Julia M.; Wolf, Michael S.; Arnold, Connie L.

doi:10.5993/ajhb.37.3.1

Cited by 26 publications

(25 citation statements)

References 32 publications

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“…Our study results suggest that continuing to expand access to care for this population would be helpful; however, additional efforts are needed to address other barriers to increase compliance. Rural residents are less likely to have routine preventive visits or to receive physician recommendations, the 2 most commonly identified facilitators for CRC screening, than are urban residents . Rural residents are also more likely to report having a PCP, but they make fewer visits to health care providers than do urban residents .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, some important factors such as physician recommendations for CRC screening and patient marriage status and income are related to patient screening status, but such data were not available consistently in the EMRs for our analysis. Finally, patient fear and embarrassment about colonoscopy and perceived financial burden have been suggested as major barriers for CRC screening, especially in rural areas . Nevertheless, the EMRs of the clinics did not contain such data to quantify these associations with actual rates of CRC screening.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Barriers and Facilitators of Colorectal Cancer Screening for Patients of Rural Accountable Care Organization Clinics: A Multilevel Analysis

Wang

Qiu

Gregg

et al. 2017

The Journal of Rural Health

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Barriers and Facilitators of Colorectal Cancer Screening for Patients of Rural Accountable Care Organization Clinics: A Multilevel Analysis

Wang

Qiu

Gregg

et al. 2017

The Journal of Rural Health

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“…A review of factors that influence CRC screening show an association with screening and the HBM constructs of perceived barriers, perceived benefits, and perceived susceptibility [27]. Despite these potential explanations, studies using the HBM as a framework to contrast CRC screening practices in rural and urban populations are limited [28]. The use of a conceptual model, such as the HBM, is useful in understanding the underlying issues surrounding the screening disparity in rural areas.…”

Section: Introductionmentioning

confidence: 99%

Rural–Urban Differences in Colorectal Cancer Screening Barriers in Nebraska

et al. 2015

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Nebraska ranks 36th nationally in colorectal cancer screening. Despite recent increases in CRC screening rates, rural areas in Nebraska have consistently shown lower rates of CRC screening uptake, compared to urban areas. The objective of this study was to investigate reasons for lower CRC screening rates among Nebraska residents, especially among rural residents. We developed a questionnaire based on Health Belief Model (HBM) constructs to identify factors associated with the use of CRC screening. The questionnaire was mailed in 2014 to adults aged 50–75 years in an urban community in the east and a rural community in the west regions of the state. Multiple logistic regression models were created to assess the effects of HBM constructs, rural residence, and demographic factors on CRC screening use. Of the 1,200 surveys mailed, 393 were returned (rural n=200, urban n=193). Rural respondents were more likely to perceive screening cost as a barrier. Rural residents were also more likely to report that CRC cannot be prevented and it would change their whole life. In multiple regression models, rural residence, perceived embarrassment, and perceived unpleasantness about screening were significantly associated with reduced odds of receiving colonoscopy. Older age (62 years and older), having a personal doctor, and perceived risk of getting CRC were significantly associated with increased odds of receiving colonoscopy. Interventions to increase uptake of colorectal cancer screening in rural residents should be tailored to acknowledge unique perceptions of screening methods and barriers to screening.

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“…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.…”

Section: Structured Surveymentioning

confidence: 99%

“…16 Even among those individuals who have health insurance, patients with Medicaid are significantly less likely to complete CRC screening compared with those with private insurance. 7,10,[20][21][22][23][24][25][26] Cancer October 15, 2019 Healthy People 2020 has set a goal of 70% of eligible adults being up to date with CRC screening. 7,10,[20][21][22][23][24][25][26] Cancer October 15, 2019 Healthy People 2020 has set a goal of 70% of eligible adults being up to date with CRC screening.…”

Section: Introductionmentioning

confidence: 99%

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

Arnold

Rademaker

Morris

et al. 2019

Cancer

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BACKGROUND: Significant disparities exist in colorectal cancer (CRC) screening rates among those of low socioeconomic status, with fewer years of education, lacking health insurance, or living in rural areas. METHODS: A randomized controlled trial was conducted to compare the effectiveness of 2 follow-up approaches to a health literacy intervention to improve CRC screening: automated telephone call or personal call. Patients aged 50 to 75 years residing in 4 rural community clinics in Louisiana were given a structured interview that assessed demographic, health literacy and CRC screening barriers, knowledge, and attitudes. All were given health literacy-informed CRC education, a patient-friendly CRC screening pamphlet, simplified fecal immunochemical test (FIT) instructions, and a FIT kit, and a "teach-back" method was used to confirm understanding. Patients were randomized to 1 of 2 telephone follow-up arms. If they did not mail their FIT kit within 4 weeks, they received a reminder call and were called again at 8 weeks if the test still was not received. RESULTS: A total of 620 patients were enrolled. Approximately 55% were female, 66% were African American, and 40% had limited literacy. The overall FIT completion rate was 68%: 69.2% in the automated telephone call arm and 67% in the personal call arm. Greater than one-half of the patients (range, 58%-60%) returned the FIT kit without receiving a telephone call. There was no difference noted with regard to the effectiveness of the follow-up calls; each increased the return rate by 9%. CONCLUSIONS: Providing FIT kits and literacy-appropriate education at regularly scheduled clinic visits with a follow-up telephone call when needed was found to increase CRC screening among low-income, rural patients. The lower cost automated call was just as effective as the personal call. Cancer 2019;125:3615-3622.

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Contrasts in Rural and Urban Barriers to Colorectal Cancer Screening

Cited by 26 publications

References 32 publications

Barriers and Facilitators of Colorectal Cancer Screening for Patients of Rural Accountable Care Organization Clinics: A Multilevel Analysis

Barriers and Facilitators of Colorectal Cancer Screening for Patients of Rural Accountable Care Organization Clinics: A Multilevel Analysis

Rural–Urban Differences in Colorectal Cancer Screening Barriers in Nebraska

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

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