Unwillingness to participate in colorectal cancer screening: examining fears, attitudes, and medical mistrust in an ethnically diverse sample of adults 50 years and older

Am J Health Promot. May-Jun 2012;26(5):295-300. doi: 10.4278/ajhp.110113-QUAN-20.


Purpose: Identify the influence of medical mistrust, fears, attitudes, and sociodemographic characteristics on unwillingness to participate in colorectal cancer (CRC) screening.

Design: Cross-sectional, disproportionally allocated, stratified, random-digit-dial telephone questionnaire of noninstitutionalized households.

Setting: New York City, New York; Baltimore, Maryland; San Juan, Puerto Rico.

Subjects: Ethnically diverse sample of 454 adults ≥50 years of age.

Measures: Health status, cancer screening effectiveness, psychosocial factors (e.g., perceptions of pain, fear, trust), and CRC screening intentions using the Cancer Screening Questionnaire, which addresses a range of issues related to willingness of minorities to participate in cancer screening.

Analysis: Multivariate logistic regression was used to model the probability of reporting unwillingness to participate in CRC screening.

Results: Fear of embarrassment during screening (odds ratio [OR] = 10.72; 95% confidence interval [CI], 2.15-53.39), fear of getting AIDS (OR = 8.75; 95% CI, 2.48-30.86), fear that exam might be painful (OR = 3.43; 95% CI, 1.03-11.35), and older age (OR = 1.10; 95% CI, 1.04-1.17) were positively associated with unwillingness to participate in CRC screening. Fear of developing cancer (OR = .12; 95% CI, .03-.57) and medical mistrust (OR = .19; 95% CI, .06-.60) were negatively associated with unwillingness to screen.

Conclusions: Findings suggest that CRC health initiatives should focus on increasing knowledge, addressing fears and mistrust, and normalizing CRC screening as a beneficial preventive practice, and should increase focus on older adults.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Attitude to Health / ethnology
  • Baltimore
  • Colonoscopy / statistics & numerical data
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / ethnology*
  • Cross-Sectional Studies
  • Fear*
  • Female
  • Guideline Adherence
  • Health Knowledge, Attitudes, Practice / ethnology
  • Health Status
  • Humans
  • Male
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • New York City
  • Occult Blood
  • Patient Compliance*
  • Puerto Rico
  • Surveys and Questionnaires
  • Trust*