Understanding Barriers to Colorectal Cancer Screening in Kentucky

Abstract

IntroductionColorectal cancer screening rates have increased significantly in Kentucky, from 35% in 1999 to 66% in 2012. A continued improvement in screening requires identification of existing barriers and implementation of interventions to address barriers.MethodsThe state of Kentucky added a question to the 2012 Kentucky Behavioral Risk Factor Surveillance System survey for respondents aged 50 years or older who answered no to ever having been screened for colorectal cancer by colonoscopy or sigmoidoscopy to assess the reasons why respondents had not been screened. Combined responses constituted 4 categories: attitudes and beliefs, health care provider and health care systems barriers, cost, and other. Prevalence estimates for barriers were calculated by using raking weights and were stratified by race/ethnicity, sex, education, income, and health insurance coverage. Logistic regression estimated odds ratios for barriers to screening.ResultsThe most common barriers in all areas were related to attitudes and beliefs, followed by health care provider and systems, and cost. Non-Hispanic whites and respondents with more than a high school education were more likely to choose attitudes and beliefs as a barrier than were non-Hispanic blacks and those with less than a high school education. Respondents with low incomes and with no insurance were significantly more likely to select cost as a barrier. No significant associations were observed between demographic variables and the selection of a health care provider and a health care system.ConclusionBarriers related to education, race/ethnicity, income, and insurance coverage should be considered when designing interventions. Expansion of Medicaid and implementation of the Affordable Care Act in Kentucky could have an impact on reducing these barriers.

Colorectal Cancer: Applying the Value Transformation Framework to increase the percent of patients receiving screening in Federally Qualified Health Centers

“…The most current national health center data show the percent of health center patients 50–75 years who had an appropriate screening test for CRC is 39.89% (HRSA, 2018). While data from the 2015 National Health Interview Survey indicate that there are disparities in CRCS based on race/ethnicity, a lack of health insurance or a lack of a usual source of care are the most common factors associated with lower screening rates (White et al, 2017; Knight et al, 2015; Klabunde et al, 2011; Ayanian et al, 1993). Data also show that higher education and income levels are associated with a greater proportion of persons receiving CRCS (Solbak et al, 2018; White et al, 2017; Klabunde et al, 2011).…”

YouTube Videos as a Source of Information on Colorectal Cancer: What Do Our Patients Learn?

“…More specifically, commonly cited barriers to colonoscopy or sigmoidoscopy are fear of these procedures and the required bowel preparation [25–27]. Certain patients fear that physicians seek financial profit by suggesting these procedures [26, 27]. Screening programs must therefore be tailored to the patients’ beliefs [26].…”

Commentary: Predictors of Colorectal Cancer Screening in Two Underserved U.S. Populations: A Parallel Analysis

“…While the authors highlighted the importance of future interventions in underserved areas to increase CRC screenings, specific recommendations regarding how the study's findings translate into specific health behavior change interventions were not provided. Lack of health insurance, low income, and smoking are well-documented colon cancer risk factors screening as well as viable opportunities for preventative intervention (14)(15)(16). Furthermore, the Community Guide recommends multicomponent interventions to increase screening for colorectal cancer, and the National Cancer Institute (NCI) provides a list of research-tested intervention programs (RTIPs) specifically aimed at increasing colorectal cancer screening (17,18).…”