title: Barriers and facilitators of colorectal cancer screening among Mid-Atlantic Latinos: focus group findings.
abstract: OBJECTIVE
  To examine patient and provider barriers and facilitators of colorectal cancer (CRC) screening among mid-Atlantic Latinos seeking care at urban primary care clinics and describe implications for the design of interventions in primary care.
  
  
  METHODS
  Nine focus groups were conducted with 70 Latino patients and 27 primary care providers. Content analysis of focus group transcripts was performed using established qualitative techniques.
  
  
  RESULTS
  Comments on CRC screening fell into 10 content areas: primary care site or provider characteristics (25% patient/21% provider comments); knowledge (18% patient/12% provider comments); cost/insurance coverage (10%/25%); attitudes (14%/7%); ordering of priorities (10%/11%); language (12%/7%); procedural issues regarding screenings (8%/10%); discrimination (2%/1%); and issues related to being a new immigrant (.2%/6%). Patient lack of understanding of the screening test procedures, inadequate knowledge about colorectal cancer, inadequate numbers of Spanish-speaking providers, and the cost of screening were most often cited as barriers by patients. Both providers and patients repeatedly mentioned the lack of funding and referral sources for colonoscopy as a key barrier to performing screening, even with lower-cost fecal occult blood tests, as colonoscopy follow-up would not be available. Patients favored receiving CRC screening recommendations from their usual continuity physician, but were open to receiving information on test procedures and indications from a Spanish-speaking health educator.
  
  
  CONCLUSIONS
  Efforts to improve funding and availability of colonoscopy for low-income persons could proceed in tandem with linguistically and culturally appropriate clinic-based efforts to improve CRC screening among Latinos.
authors.affiliation: Latin American Cancer Research Coalition, Lombardi Comprehensive Cancer Center, USA. mjg46@georgetown.edu
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Goodman
authors.forename: Alexis
authors.initials: A
authors.lastname: Ogdie
authors.forename: Mariano J
authors.initials: MJ
authors.lastname: Kanamori
authors.forename: Janet
authors.initials: J
authors.lastname: Cañar
authors.forename: Ann S
authors.initials: AS
authors.lastname: O'Malley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D017144:Focus Groups; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008873:Mid-Atlantic Region; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011320:Primary Health Care / Q000706:statistics & numerical data*