Barriers to Screening Colonoscopy for Low-income Latino and White Patients in an Urban Community Health Center

• Published in: Journal of general internal medicine : JGIM 2008-06, Vol.23 (6), p.834-840
• Main Authors: Green, Alexander R., Peters-Lewis, Angelleen, Percac-Lima, Sanja, Betancourt, Joseph R., Richter, James M., Janairo, Maria-Pamela R., Gamba, Gloria B., Atlas, Steven J.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Colonic Neoplasms - diagnosis; Colonic Neoplasms - ethnology; Colonoscopy; Colorectal cancer; Community health care; Content analysis; Cultural Competency; European Continental Ancestry Group; Female; General aspects; Health care access; Health Knowledge, Attitudes, Practice; Healthcare Disparities; Hispanic Americans; Humans; Internal Medicine; Interviews as Topic; Low income groups; Male; Mass Screening - methods; Medical sciences; Medical screening; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous; Patient Acceptance of Health Care - ethnology; Populations at Risk; Poverty Areas; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Urban health care; Urban Population; White people
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-008-0572-6

Summary Background Colonoscopy is a screening modality for the early detection of colonic polyps and cancers but is underutilized, particularly among minorities. Objective To identify potential barriers to screening colonoscopy among low income Latino and white non-Latino patients in an urban community health center. Design, participants, and approach We conducted semistructured interviews with a convenience sample of patients 53 to 70 years old, eligible for colorectal cancer screening that spoke English or Spanish. Open-ended questions explored knowledge, beliefs, and experience with or reasons for not having screening colonoscopy. We performed content analysis of transcripts using established qualitative techniques. Results Of 40 participants recruited, 57% were women, 55% Latino, 20% had private health insurance, and 40% had a prior colonoscopy. Participants described a wide range of barriers categorized into 5 major themes: (1) System barriers including scheduling, financial, transportation, and language difficulties; (2) Fear of pain or complications of colonoscopy and fear of diagnosis (cancer); (3) Lack of desire or motivation , including “laziness” and “procrastination”; (4) Dissuasion by others influencing participants’ decision regarding colonoscopy; and (5) Lack of provider recommendation including not hearing about colonoscopy or not understanding the preparation instructions. Conclusions Understanding of the range of barriers to colorectal cancer screening can help develop multimodal interventions to increase colonoscopy rates for all patients including low-income Latinos. Interventions including systems improvements and navigator programs could address barriers by assisting patients with scheduling, insurance issues, and transportation and providing interpretation, education, emotional support, and motivational interviewing.