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. 2008 Jun;23(6):834-40.
doi: 10.1007/s11606-008-0572-6. Epub 2008 Mar 19.

Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center

Alexander R Green  1 , Angelleen Peters-Lewis, Sanja Percac-Lima, Joseph R Betancourt, James M Richter, Maria-Pamela R Janairo, Gloria B Gamba, Steven J Atlas
Affiliations

Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center

Alexander R Green et al. J Gen Intern Med. 2008 Jun.

Abstract

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.

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Figures

Figure 1
Figure 1
Interview guide.
Figure 2
Figure 2
Barriers to screening colonoscopy and potential solutions.
See this image and copyright information in PMC

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