‘You Ain’t Going in There’: Patient Perceived Promoters and Barriers to Colonoscopy Screening in an Urban Population, Baltimore, Maryland

Introduction: Colorectal cancer (CRC) is the third leading cause of new cancer cases and the second leading cause of cancer mortality. Moreover, African-American women and men are more likely to die from colorectal cancer than their white counterparts. We report qualitative data from nine focus group discussions (FGD) conducted in centers serving a low-income, primarily African- American population in East Baltimore.

Methods: Nine FDGs were conducted in health, drug treatment and social service centers across East Baltimore with a total of 127 individuals. A structured interview guide was developed with a focus on three key areas: 1) participants’ understanding and interpretations of health, 2) understandings and knowledge about cancer and colorectal cancer, and 3) promoters and barriers to colorectal cancer screening. Transcripts of interviews were coded and analysis was performed using grounded theory methodology and Nvivo software.

Results: Key facilitators for seeking colonoscopy were friend and family support systems, having a family member with CRC, seeking medical care for symptoms, viewing the doctor as a partner, and radio, television, and print advertisements. Participants also described barriers to undergo screening including challenges with colonoscopy preparation, colonoscopic procedural and testspecific concerns, insurance and cost concerns, generalized fear, poor relations with physician, and failure of a physician to make a recommendation and referral.

Conclusions: Knowledge about facilitators of and barriers to CRC screening (CRCS) are necessary for effective initiatives. Interventions targeted at increasing education, knowledge of CRC, and open conversations between patients and providers may be viable options to improve CRCS, early diagnosis and treatment.