Identifying Barriers to Colonoscopy Screening for Nonadherent African American Participants in a Patient Navigation Intervention

• Published in: Health education & behavior 2013-08, Vol.40 (4), p.449-457
• Main Authors: Sly, Jamilia R., Edwards, Tiffany, Shelton, Rachel C., Jandorf, Lina
• Format: Article
• Language: English
• Subjects: Access to Health Care; Access to Information; African American Culture; African Americans; African Americans - psychology; Anxiety; Barriers; Biological and medical sciences; Cancer; Colonoscopy; Colonoscopy - psychology; Colorectal cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - ethnology; Colorectal Neoplasms - prevention & control; Digestive system. Abdomen; Early Detection of Cancer - psychology; Endoscopy; Ethnic Groups; Fear; Female; Health behavior; Health Knowledge, Attitudes, Practice - ethnology; Humans; Interviews; Interviews as Topic; Investigative techniques, diagnostic techniques (general aspects); Knowledge Level; Male; Medical sciences; Medical screening; Middle Aged; Miscellaneous; Misconceptions; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Patient Acceptance of Health Care - ethnology; Patient Acceptance of Health Care - psychology; Patient Navigation; Patients; Physicians; Prevention; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Qualitative Research; Racial Differences; Regular Articles; Screening Tests; Tumors; United States - epidemiology
• ISSN: 1090-1981; 1552-6127
• DOI: 10.1177/1090198112459514

African Americans have a higher rate of colorectal cancer (CRC) mortality than other racial/ethnic groups. This disparity is alarming given that CRC is largely preventable through the use of endoscopy (screening colonoscopy or sigmoidoscopy), yet rates of CRC screening among African Americans is suboptimal. Only 48.9% of African Americans are screened for CRC through endoscopy or fecal occult blood testing. As such, researchers have focused their efforts on the prevention of CRC through patient navigation (PN) services for colonoscopy screening. Although PN has been successful in increasing colonoscopy screening rates, screening rates of navigated participants could still be improved. Thus, the purpose of this exploratory study was to understand why patients, who received PN services, did not complete a colonoscopy. Sixteen participants were interviewed to identify salient themes related to noncompletion of the colonoscopy procedure. Major themes identified included the following: a lack of knowledge about CRC; fear/anxiety about the procedure, including unknown expectations, fear of pain, and fear of cancer diagnosis; inadequate physician communication about CRC and the colonoscopy exam; and believing that cancer leads to death. Participants felt that greater communication and explanation from their physician might help allay their fears. Our findings also suggest that a universal approach to PN, even within culturally targeted interventions, may not be appropriate for all individuals. Future interventions should consider genderspecific navigation and combining PN with nonmedicai interventions to address other identified barriers.