title: Persons Who Failed to Obtain Colorectal Cancer Screening Despite Participation in an Evidence-Based Intervention.
abstract: In a previous report, we demonstrated the efficacy of an educational intervention focused on increasing colorectal cancer screening rates among African Americans. Despite participating in the intervention, however, nearly two-thirds of participants did not seek and receive screening. Participants were African-Americans over age 49 (N = 257) who had not been screened for colorectal cancer according to guidelines. At baseline, participants completed tests measuring fatalism, perceived stress, self-esteem, attitudes/benefits/barriers, social support, and social network diversity. Those who completed the educational intervention were followed up by telephone to learn if they had been screened. We compared the scores on the psychometric tests of the participants who had been screened against the scores of those who had not. Only the mean scores on the attitudes, benefits, and barriers scale distinguished participants who had been screened from those who had not (p = 0.0816 on bivariate testing and p = 0.0276 in the logistic regression model). Social interaction among participants or social cognitive learning may have played a role in determining which participants were screened, but we were not able to demonstrate this. The major factor distinguishing participants who were not screened was their attitude toward screening at baseline. There is a subset of African Americans who are persistently resistant to screening, and their perspective in this regard must be addressed if colorectal cancer disparities are to be reduced.
authors.affiliation: Institute of Public and Preventive Health, Augusta University, CJ-2318 1120 15TH Street, Augusta, GA, 30912, USA. sesmith@augusta.edu.|Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA. sesmith@augusta.edu.
authors.forename: Selina A
authors.initials: SA
authors.lastname: Smith
authors.affiliation: Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
authors.forename: Ernest
authors.initials: E
authors.lastname: Alema-Mensah
authors.affiliation: Institute of Public and Preventive Health, Augusta University, CJ-2318 1120 15TH Street, Augusta, GA, 30912, USA.|Dental College of Georgia, Augusta University, Augusta, GA, USA.
authors.forename: Wonsuk
authors.initials: W
authors.lastname: Yoo
authors.affiliation: Institute of Public and Preventive Health, Augusta University, CJ-2318 1120 15TH Street, Augusta, GA, 30912, USA.
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Ansa
authors.affiliation: Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA.|American College of Preventive Medicine, Washington, DC, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Blumenthal
mesh_terms: D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D001294:Attitude to Health; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000523:psychology / Q000706:statistics & numerical data*; D006266:Health Education / Q000379:methods; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011581:Psychological Tests; D011795:Surveys and Questionnaires
keywords: Colorectal cancer; Community-based participatory research; Health disparities; Screening; Social cognitive theory