A qualitative analysis of barriers to colorectal screening and strategies to improve screening uptake among African Americans and Latinos in Nebraska

Abstract As part of a statewide cancer needs assessment, this study aimed to elicit perspectives from African American (AA) and Latino communities about colorectal cancer (CRC) screening. Four virtual focus groups were held April-August 2021 conducted by AA and Latina researchers, respectively, with Latino groups conducted in Spanish. Groups were 60-90 minutes, used a structured guide, and were audio recorded. Eligibility criteria included age 30+, cancer survivor or caregiver, and Nebraska resident. Participants (n=7 AA, n=12 Latinos) received a $40 gift card. Transcripts were inductively coded using directed content analysis. Most participants were female (84%) and survivors (58%). Only 3 participants (rural Latino) had not heard of colonoscopy, two of whom had not heard of any screening. Across groups, awareness of fecal testing was low, with confusion about tests. Physician bias about testing recommendations contributed to lack of knowledge about options; some providers did not make screening recommendations. A barrier is limited use of healthcare. Cultural and economic factors lead to care seeking only when people “have a major problem.” The female AA group brought forward distrust in the health system; historical angst led them not to trust and listen to providers who do not look like them. All groups stated access barriers include costs, work, transportation, and insurance. Hourly workers cannot afford to take time off for care. Such usage patterns lead to lack of preventive care and education about cancer screening. Across groups, colonoscopy is treated as a joke associated with fear, embarrassment, and sexual innuendo. It “kind of scares you away from even having to go get checked out.” Negative perceptions of colonoscopy led an AA man with family history of CRC to “forego the screening.” Latino groups identified machismo as a limiting factor for males. Fear of a cancer diagnosis (“death sentence”) and denial (“I don’t think it’s going to happen to me”) contribute to screening avoidance. Suggested approaches to improve CRC screening included 1) increasing awareness at a grassroots level (e.g., health fairs, community education programs, presentations at churches and schools), 2) using social media to share information about the importance of screening, and 3) having healthcare providers consistently recommend CRC screening. Message delivery can be done by survivors, navigators, and group texts. Messages shared by survivors encourage a sense of hope that “diagnosis is taking that step to live.” AA participants indicated that healthcare facilities must build networks and trust with their communities by being present at community events. Healthcare providers need to consistently recommend CRC screening and provide detailed explanations about screening options. “Explain to us so that we can understand what it is like and why it is important.” Additionally, system-level barriers, including accessibility, need to be addressed to normalize routine check-ups and preventive screening in these communities. Citation Format: Kendra L. Ratnapradipa, Krishtee Napit, Keyonna M. King, Athena K. Ramos, Lady Beverly L. Luma, Danae Dinkel, Tamara Robinson, Laura Schabloske, Tatiana Tchouankam, Shinobu Watanabe-Galloway. A qualitative analysis of barriers to colorectal screening and strategies to improve screening uptake among African Americans and Latinos in Nebraska [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A115.