title: Risk and reluctance: understanding impediments to colorectal cancer screening.
abstract: OBJECTIVE
  Screening to detect and prevent colorectal cancer (CRC) is well below optimal, contributing to needless CRC-related morbidity and mortality. Little detailed information exists explaining why screening technologies are underutilized and why screening adherence rates are low. Prior to the design of an intervention study, we assessed knowledge about CRC among adult women and men with access to health care. We also investigated patterns of perceived risk for CRC, barriers and facilitators to screening, and experience and intentions with regard to both fecal occult blood testing and flexible sigmoidoscopy.
  
  
  METHODS
  We analyzed data from semistructured focus group interviews with a small, nonrepresentative sample (n = 39) of community-dwelling adult men and women ages 50 to 64 and 65 plus.
  
  
  RESULTS
  CRC-related knowledge is low, and misperceptions are common. Provider practices reinforce low levels of perceived risk. Multiple barriers to screening exist, of which many are remediable.
  
  
  CONCLUSIONS
  We are at an early stage in the diffusion of information about CRC. Screening utilization may be improved through development of appropriate public health awareness campaigns and by addressing service factors. Recommendations are provided.
authors.affiliation: Department of Health & Social Behavior, Harvard School of Public Health, 1633 Tremont Street, Boston, Massachusetts 02120, USA. eweitzma@hsph.harvard.edu
authors.forename: E R
authors.initials: ER
authors.lastname: Weitzman
authors.forename: J
authors.initials: J
authors.lastname: Zapka
authors.forename: B
authors.initials: B
authors.lastname: Estabrook
authors.forename: K V
authors.initials: KV
authors.lastname: Goins
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D012812:Sigmoidoscopy / Q000706:statistics & numerical data*; D014481:United States