Why Wait Until Our Community Gets Cancer?: Exploring CRC Screening Barriers and Facilitators in the Spanish-Speaking Community in North Carolina.
Colorectal cancer (CRC) is a leading cause of death among Hispanics in the United States. Despite the benefits of CRC screening, many Hispanics are not being screened. Using a combined methodology of focus groups and discrete choice experiment (DCE) surveys, the objectives for this research were as follows: (1) to improve understanding of preferences regarding potential CRC screening program characteristics, and (2) to improve understanding of the barriers and facilitators around CRC screening with the Hispanic, immigrant community in North Carolina. Four gender-stratified focus groups were conducted and DCE surveys were administered to 38 Spanish-speaking individuals across four counties in North Carolina. In-depth content analysis was used to examine the focus group data; descriptive analyses and mean attribute importance scores for cost of screening and follow-up care, travel time, and test options were calculated from DCE data. Data analyses showed that this population has a strong interest in CRC screening but experience barriers such as lack of access to resources, cost uncertainty, and stigma. Some of these barriers are unique to their cultural experiences in the United States, such as an expressed lack of tailored CRC information. Based on the DCE, cost variables were more important than testing options or travel time. This study suggests that Hispanics may have a general awareness of and interest in CRC screening, but multiple barriers prevent them from getting screened. Special attention should be given to designing culturally and linguistically appropriate programs to improve access to healthcare resources, insurance, and associated costs among Hispanics.
University of North Carolina Lineberger Comprehensive Cancer Center, Campus Box 7295, Chapel Hill, NC, 27599, USA. christa_martens@med.unc.edu.
Christa E
CE
Martens
University of North Carolina Lineberger Comprehensive Cancer Center, Campus Box 7295, Chapel Hill, NC, 27599, USA.|Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA.|Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA.
Trisha M
TM
Crutchfield
North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, 212 Brinkhous-Bullitt Building, 160 N. Medical Dr., Chapel Hill, NC, 27599, USA.
Jane L
JL
Laping
North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, 212 Brinkhous-Bullitt Building, 160 N. Medical Dr., Chapel Hill, NC, 27599, USA.
Lexie
L
Perreras
University of North Carolina Lineberger Comprehensive Cancer Center, Campus Box 7295, Chapel Hill, NC, 27599, USA.|North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, 212 Brinkhous-Bullitt Building, 160 N. Medical Dr., Chapel Hill, NC, 27599, USA.|Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA.|Division of General Internal Medicine, University of North Carolina School of Medicine, Campus Box 7110, Chapel Hill, NC, 27599, USA.
Daniel S
DS
Reuland
North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, 212 Brinkhous-Bullitt Building, 160 N. Medical Dr., Chapel Hill, NC, 27599, USA.|Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA.
Laura
L
Cubillos
University of North Carolina Lineberger Comprehensive Cancer Center, Campus Box 7295, Chapel Hill, NC, 27599, USA.|Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA.|Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA.|Division of General Internal Medicine, University of North Carolina School of Medicine, Campus Box 7110, Chapel Hill, NC, 27599, USA.
Michael P
MP
Pignone
University of North Carolina Lineberger Comprehensive Cancer Center, Campus Box 7295, Chapel Hill, NC, 27599, USA.|Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA.|Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC, 27599, USA.|Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
Stephanie B
SB
Wheeler
D000368:Aged; D002755:Choice Behavior; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D035862:Vulnerable Populations
Colorectal cancer; Discrete choice experiment; Focus groups; Hispanics; Screening