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

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

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Free PMC article

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

Jean M Hunleth et al. Qual Health Res. .
Free PMC article

Abstract

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.

Conflict of interest statement

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Anna took this photograph to illustrate the number of bills she receives and the limited money she has to pay them. She paired this photograph with another photo of medication to represent the difficulty of paying for medical bills.
Figure 2
Figure 2
Lillian photographed a bookshelf in a local public library to show the lack of readily available information on CRC and CRC screening.
Figure 3
Figure 3
Esther took this photograph of a gun to represent the feeling that cancer can take life away “like a bolt of lightening” and also the fear she faced when going for CRC screening.

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