Barriers to screening colonoscopy for low-income Latino and white patients in an urban community health center.
BACKGROUND
Colonoscopy is a screening modality for the early detection of colonic polyps and cancers but is underutilized, particularly among minorities.


OBJECTIVE
To identify potential barriers to screening colonoscopy among low income Latino and white non-Latino patients in an urban community health center. DESIGN, PARTICIPANTS, AND APPROACH: We conducted semistructured interviews with a convenience sample of patients 53 to 70 years old, eligible for colorectal cancer screening that spoke English or Spanish. Open-ended questions explored knowledge, beliefs, and experience with or reasons for not having screening colonoscopy. We performed content analysis of transcripts using established qualitative techniques.


RESULTS
Of 40 participants recruited, 57% were women, 55% Latino, 20% had private health insurance, and 40% had a prior colonoscopy. Participants described a wide range of barriers categorized into 5 major themes: (1) System barriers including scheduling, financial, transportation, and language difficulties; (2) Fear of pain or complications of colonoscopy and fear of diagnosis (cancer); (3) Lack of desire or motivation, including "laziness" and "procrastination"; (4) Dissuasion by others influencing participants' decision regarding colonoscopy; and (5) Lack of provider recommendation including not hearing about colonoscopy or not understanding the preparation instructions.


CONCLUSIONS
Understanding of the range of barriers to colorectal cancer screening can help develop multimodal interventions to increase colonoscopy rates for all patients including low-income Latinos. Interventions including systems improvements and navigator programs could address barriers by assisting patients with scheduling, insurance issues, and transportation and providing interpretation, education, emotional support, and motivational interviewing.
Green
Alexander R
AR
The Disparities Solutions Center at the Institute for Health Policy, Massachusetts General Hospital, Boston, MA 02114, USA. argreen@partners.org
Peters-Lewis
Angelleen
A
Percac-Lima
Sanja
S
Betancourt
Joseph R
JR
Richter
James M
JM
Janairo
Maria-Pamela R
MP
Gamba
Gloria B
GB
Atlas
Steven J
SJ
D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D003113:Colonoscopy; D054521:Cultural Competency; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011204:Poverty Areas; D014505:Urban Population; D044465:White People