Knowledge and perceptions of colorectal cancer screening among urban African Americans

OBJECTIVE: To explore colorectal cancer (CRC) screening knowledge, attitudes, barriers, and preferences among urban African Americans as a prelude to the development of culturally appropriate interventions to improve screening for this group. DESIGN: Qualitative focus group study with assessment of CRC screening preferences. SETTING: Community health center serving low-income African Americans. PARTICIPANTS: Fifty-five self-identified African Americans over 40 years of age. MEASUREMENTS AND MAIN RESULTS: Transcripts were analyzed using an iterative coding process with consensus and triangulation on final thematic findings. Six major themes were identified: (1) Hope-a positive attitude toward screening, (2) Mistrust-distrust that the system or providers put patients first, (3) Fear-fear of cancer, the system, and of CRC screening procedures, (4) Fatalism-the belief that screening and treatment may be futile and surgery causes spread of cancer, (5) Accuracy-a preference for the most thorough and accurate test for CRC, and (6) Knowledge-lack of CRC knowledge and a desire for more information. The Fear and Knowledge themes were most frequently noted in transcript theme counts. The Hope and Accuracy themes were crucial moderators of the influence of all barriers. The largest number of participants preferred either colonoscopy (33%) or home fecal occult blood testing (26%). CONCLUSIONS: Low-income African Americans are optimistic and hopeful about early CRC detection and believe that thorough and accurate CRC screening is valuable. Lack of CRC knowledge and fear are major barriers to screening for this population along with mistrust, and fatalism.