title: Colorectal cancer screening barriers in persons with low income.
abstract: OBJECTIVE
  The purpose of this study was to provide insight into the modest success of a physician and patient education and reminder program that improved screening rates from 37% to 49% among rural Medicaid-eligible patients in western Michigan.
  
  
  METHODS
  The following four focus groups were conducted: African American men, African American women, White men, and White women, matched with moderators by gender and ethnicity. The sample was selected by contacting prior eligible screening refusers, completing groups with a convenience sample who had accepted screening. Twenty-one patients participated who were ages >50 years. The screening refusal rates were 19% for men and 9% for women. Open-ended questions guided the discussion of colorectal cancer (CRC) attitudes, beliefs, and practices.
  
  
  RESULTS
  All participants believed in the efficacy of cancer screening. White women were better informed about screening purposes and procedures. The major barriers to screening were quality of care (ie, the perceived lack of offering screening and the follow-up of test results) and the potential for pain from screening or treatment of CRC, should it be discovered.
  
  
  CONCLUSIONS
  Successful efforts to improve awareness of the importance and efficacy of screening must further address deeply held skepticism and fears about CRC screening in this population. A fruitful direction for this difficult problem appears to be improved communication (both negative and positive test results). Without feedback, patients with negative results may assume lack of provider follow-through.
authors.affiliation: Health Service Research, Michigan State University, East Lansing, Michigan 48824, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Holmes-Rovner
authors.forename: Gilbert A
authors.initials: GA
authors.lastname: Williams
authors.forename: Susan
authors.initials: S
authors.lastname: Hoppough
authors.forename: Lisa
authors.initials: L
authors.lastname: Quillan
authors.forename: Rishan
authors.initials: R
authors.lastname: Butler
authors.forename: C William
authors.initials: CW
authors.lastname: Given
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D010146:Pain; D010353:Patient Education as Topic; D011203:Poverty; D011787:Quality of Health Care; D017010:Reminder Systems; D012737:Sex Factors; D044465:White People; D001741:Black or African American