Beyond Adherence: Health Care Disparities and the Struggle to Get Screened for Colon Cancer

Qual Health Res. 2016 Jan;26(1):17-31. doi: 10.1177/1049732315593549. Epub 2015 Jul 9.


Dominant health care professional discourses on cancer take for granted high levels of individual responsibility in cancer prevention, especially in expectations about preventive screening. At the same time, adhering to screening guidelines can be difficult for lower income and under-insured individuals. Colorectal cancer (CRC) is a prime example. Since the advent of CRC screening, disparities in CRC mortality have widened along lines of income, insurance, and race in the United States. We used a community-engaged research method, Photovoice, to examine how people from medically under-served areas experienced and gave meaning to CRC screening. In our analysis, we first discuss ways in which participants recounted screening as a struggle. Second, we highlight a category that participants suggested was key to successful screening: social connections. Finally, we identify screening as an emotionally laden process that is underpinned by feelings of uncertainty, guilt, fear, and relief. We discuss the importance of these findings to research and practice.

Keywords: America, North; adherence, compliance; aging, older people; cancer, screening, and prevention; health care disparities; health, lived experience; photography/photovoice; prevention, illness, and disease.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Colonic Neoplasms / diagnosis*
  • Colonic Neoplasms / mortality
  • Colonic Neoplasms / prevention & control
  • Colonic Neoplasms / psychology*
  • Colonoscopy / economics
  • Colonoscopy / psychology*
  • Early Detection of Cancer / methods
  • Early Detection of Cancer / psychology*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Healthcare Disparities
  • Humans
  • Insurance, Health / economics
  • Male
  • Middle Aged
  • Missouri / epidemiology
  • Patient Compliance / psychology*
  • Photography
  • Social Support
  • Socioeconomic Factors