title: Factors associated with colorectal cancer screening among a low-income, multiethnic, highly insured population: does provider's understanding of the patient's social context matter?
abstract: The primary aim of this paper was to explore whether provider's understanding of patient's social context is associated with screening uptake, independent of provider's recommendation. Baseline data were collected in 2004-2005 from a cluster randomized control trial in 12 low-income housing sites. Participants included 695 low-income, multiethnic adults aged 50 years and over who were primarily insured (97%). Provider's recommendation was significantly associated with current adherence to colorectal cancer (CRC) screening. Provider's understanding of patient's social context, as operationalized by how well participants felt that their provider knew (a) their responsibilities at work, home, or school; (b) their worries about health; and (c) them as a person and their values and beliefs, was also significantly associated with current adherence to screening, independent of provider's recommendation. Participants who reported that their provider knew them well on two or three items were significantly more likely to be current with CRC screening compared to those who reported their provider knew them well on only one or none of the items (odds ratio = 1.56; 95% confidence interval = 1.06, 2.29). Our findings indicate that provider's understanding of patient's social context, independent of provider's recommendation for CRC screening, contributed to adherence to CRC screening in this low-income, multiethnic population.
authors.affiliation: Center for Community-Based Research, Dana-Farber Cancer Institute, 44 Binney Street, LW 703, Boston, MA, 02115, USA. Maria_Dejesus@dfci.harvard.edu.|Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA. Maria_Dejesus@dfci.harvard.edu.
authors.forename: Maria
authors.initials: M
authors.lastname: De Jesus
authors.affiliation: Division of Biostatistics and Epidemiology, Department of Public Health, University of Massachusetts, Amherst, MA, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Puleo
authors.affiliation: Division of Cancer Prevention and Control, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Shelton
authors.affiliation: Department of Health Disparities Research, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Lorna H
authors.initials: LH
authors.lastname: McNeill
authors.affiliation: Center for Community-Based Research, Dana-Farber Cancer Institute, 44 Binney Street, LW 703, Boston, MA, 02115, USA.|Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Emmons
mesh_terms: D001900:Boston; D016000:Cluster Analysis; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D011203:Poverty; D011369:Professional-Patient Relations; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014505:Urban Population