Knowledge, Barriers, and Predictors of Colorectal Cancer Screening in an Appalachian Church Population

INTRODUCTION: This study examined knowledge about and barriers to colorectal cancer screening and predictors of screening adherence among members from 16 Appalachian churches as part of a larger study on the prevention and early detection of colorectal cancer. METHODS: Baseline data were collected on 839 respondents aged 50 years and older through a self-administered survey, and 23 focus groups were conducted with 205 church members. RESULTS: Survey results showed that older age, male sex, being current for other cancer screening, being physically active, having perceived support from others for screening, better provider communication, knowledge about screening guidelines, greater perceived susceptibility to colorectal cancer, and a family history of the disease were predictors of screening adherence. Major barriers to screening in both surveys and focus groups were failure of providers to recommend screening, lack of knowledge about the need for screening, and the belief that screening was not necessary without symptoms. Fear of cancer, lack of knowledge about screening methods other than colonoscopy, reliance on physicians for screening information, and the need for people to feel at risk for screening to occur were other findings from the focus groups. Focus groups supported survey findings and provided further insights. CONCLUSION: Several factors predictive of colorectal cancer screening in this study can be modified through educational interventions. Recognizing and changing risk factors for colorectal cancer, raising awareness of screening guidelines, and encouraging adults aged 50 years and older to discuss screening with their health care provider could increase colorectal cancer screening.