Colorectal cancer knowledge and screening adherence among low-income Hispanic employees

Abstract Hispanics have the lowest colorectal cancer (CRC) screening rates of all racial/ethnic groups and comprise the largest proportion of low-income manual laborers in the nation. We partnered with businesses to implement a community health worker (CHW)-led intervention among Hispanic workers in service-related and manual labor occupations, which often pay low wages and do not provide health insurance. CHWs measured knowledge, screening adherence and perceptions of CRC risk before and after educational interventions via interview. CHWs provided fecal immunochemical tests (FITs) to participants aged ≥50 years. Chi-square tests and logistic regression identified pre-intervention predictors of CRC knowledge of all participants and adherence among eligible participants. Adherence among participants increased from 40% (n = 307) pre-intervention to 66% post-intervention. Knowledge about CRC was associated with age ≥50 years (OR = 8.90 [95% CI = 2.61–30.35]; ref = 18–30) and perceived personal risk for CRC (Likely, OR = 3.06 [95% CI = 1.40–6.67]; ref = Not likely). Insurance status was associated with screening adherence pre-intervention (OR = 3.00 [95% CI 1.10–8.12]; ref = No insurance). Improvement in adherence post-intervention was associated with income between $25 000 and ≥$55 000 (OR = 8.49 [95% CI 1.49–48.32]; ref = $5000–<$10 000). Community-based health programs can improve CRC screening adherence among Hispanic workers in service-related and manual labor positions, but lowest-income workers may need additional support.

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Pacific Islander Organization’s Approach towards Increasing Community Colorectal Cancer Knowledge and Beliefs

Californian Journal of Health Promotion ◽

10.32398/cjhp.v11i2.1527 ◽

2013 ◽

Vol 11 (2) ◽

pp. 12-20 ◽

Cited By ~ 1

Author(s):

Roger Sur ◽

Ruth Peters ◽

Leah Leilani Beck ◽

Melevesi Fifita ◽

Maria Gonzalez ◽

...

Keyword(s):

Colorectal Cancer ◽

Knowledge Score ◽

Female Gender ◽

Positive Change ◽

Cancer Knowledge ◽

Chi Square ◽

Logistic Regression Models ◽

Crc Screening ◽

Knowledge And Beliefs ◽

Post Test

Purpose: Evaluate the educational intervention and determine if changes in knowledge and beliefs are associated with positive intentions to screen among Pacific Islanders (PIs). Design: Pre- and post-test surveys were utilized to evaluate the intervention. Educational materials included an in-language presentation, educational videos, and bookmarks with screening re-enforcement messages for communitybased PI groups. Methods: One hundred and ninety-six PIs aged 50 years and older residing in Orange County completed the educational workshop. The dependent variable is intention and the independent variables are demographic, enabling, and predisposing characteristics. Statistical analyses included paired samples t-tests, chi-square tests, and two logistic regression models. Results: Knowledge and belief scores increased pre- to post-test. A majority intended to (1) talk to a doctor about colorectal cancer (CRC) screening (74.5%), and (2) participate in CRC screening (73.5%). Positive change in knowledge score was a significant predictor for intending to talk to a doctor about CRC screening; female gender and positive change in knowledge score were significant predictors for intending to participate in screening. Conclusion: The study highlighted the effectiveness of tailored education in addressing cultural and linguistic needs of the community. Moreover, it demonstrated the education’s potential for moving participants with limited CRC screening knowledge to intend to screen.

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Effect of Neighborhood and Individual-Level Socioeconomic Factors on Colorectal Cancer Screening Adherence

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094398 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4398

Author(s):

Kiara N. Mayhand ◽

Elizabeth A. Handorf ◽

Angel G. Ortiz ◽

Evelyn T. Gonzalez ◽

Amie Devlin ◽

...

Keyword(s):

Colorectal Cancer ◽

Study Participant ◽

Socioeconomic Indicators ◽

Cross Sectional ◽

Mixed Effect ◽

Total Study Population ◽

Screening Guidelines ◽

Individual Level ◽

Crc Screening ◽

Screening Adherence

Despite the effectiveness of screenings in reducing colorectal cancer (CRC) mortality, ~25% of US adults do not adhere to screening guidelines. Prior studies associate socioeconomic status (SES) with low screening adherence and suggest that neighborhood deprivation can influence CRC outcomes. We comprehensively investigated the effect of neighborhood SES circumstances (nSES), individual SES, and race/ethnicity on adherence to CRC screening in a multiethnic cross-sectional study. Participant surveys assessing 32 individual-level socioeconomic and healthcare access measures were administered from 2017 to 2018. Participant data were joined with nine nSES measures from the US Census at the census tract level. Univariate, LASSO, and multivariable mixed-effect logistic regression models were used for variable reduction and evaluation of associations. The total study population included 526 participants aged 50–85; 29% of participants were non-adherent. In the final multivariable model, age (p = 0.02) and Non-Hispanic Black race (p = 0.02) were associated with higher odds of adherence. Factors associated with lower adherence were home rental (vs. ownership) (p = 0.003), perception of low healthcare quality (p = 0.006), no routine checkup within two years (p = 0.002), perceived discrimination (p = 0.02), and nSES deprivation (p = 0.02). After comprehensive variable methods were applied, socioeconomic indicators at the neighborhood and individual level were found to contribute to low CRC screening adherence.

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The Impact of Socioeconomic Status on Perceived Barriers to Colorectal Cancer Testing

American Journal of Health Promotion ◽

10.4278/ajhp.07041938 ◽

2008 ◽

Vol 23 (2) ◽

pp. 97-100 ◽

Cited By ~ 15

Author(s):

Aimee S. James ◽

Sandra Hall ◽

K. Allen Greiner ◽

Dan Buckles ◽

Wendi K. Born ◽

...

Keyword(s):

Colorectal Cancer ◽

Socioeconomic Status ◽

Low Income ◽

Fecal Occult Blood ◽

Low Ses ◽

National Guidelines ◽

Convenience Sample ◽

Crc Screening ◽

Screening Barriers ◽

The Impact

Purpose. Colorectal cancer (CRC) screening is effective, but only one-half of age-eligible adults adhere to national guidelines. Lower socioeconomic status (SES) groups are less likely to be screened. Methods. Baseline data from a prospective study were used to examine the associations among CRC screening screening barriers, and SES. A convenience sample of adults (N = 291) aged 40 years and older was recruited from a federally qualified health center. Questionnaires were administered orally and included demographics, health, health behavior, and screening barriers. Results. In logistic regression, having health insurance was associated with greater odds of screening. Bivariate analyses detected few differences in fecal occult blood test (FOBT) barriers, but several endoscopy barriers were more common among the lowest SES groups. For example, fear of injury from endoscopy was more likely among low-income and uninsured participants. Discussion. The impact of SES on cancer screening is complex, but low-SES participants more often reported certain barriers than their higher-SES counterparts. This was more evident for endoscopy than for FOBT. Programs targeted at low-SES patients may need to focus on barriers that are not fully addressed in traditional promotion efforts.

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Assessing Colorectal Cancer Screening Adherence of Medicare Fee-for-Service Beneficiaries Age 76 to 95 Years

Journal of Oncology Practice ◽

10.1200/jop.2015.009118 ◽

2016 ◽

Vol 12 (6) ◽

pp. e670-e680 ◽

Cited By ~ 5

Author(s):

John Bian ◽

Charles Bennett ◽

Gregory Cooper ◽

Alessandra D'Alfonso ◽

Deborah Fisher ◽

...

Keyword(s):

Colorectal Cancer ◽

Odds Ratio ◽

Patient Adherence ◽

Adherence Rate ◽

Average Risk ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Crc Screening ◽

The Status ◽

Screening Adherence

Introduction: There are concerns about potential overuse of colorectal cancer (CRC) screening services among average-risk individuals older than age 75 years. Materials and Methods: Using a 5% random noncancer sample of Medicare beneficiaries who resided in the SEER areas, we examined rates of CRC screening adherence, defined by the Medicare coverage policy, among average-risk fee-for-service beneficiaries age 76 to 95 years from 2002 to 2010. The two outcomes are the status of overall CRC screening adherence, and the status of adherence to colonoscopy (v other modalities) conditional on patient adherence. Results: Overall CRC screening adherence rates of Medicare beneficiaries age 76 to 95 years increased from 13.0% to 21.4% from 2002 to 2010. In 2002, 2.2% of beneficiaries were adherent to colonoscopy, and 10.7%, by other modalities; the corresponding rates were 19.5% and 1.9%, respectively, in 2010. Specifically, rates of adherence to colonoscopy were 1.1% for those age 86 to 90 years and almost nil for those age 91 to 95 years in 2002, but the rates became 13.5% and 8.2%, respectively, in 2010. Compared with white beneficiaries, black beneficiaries age 76 to 95 years had a 7-percentage-point lower adherence rate. However, overall adherence rates among blacks increased by 168.6% from 2002 to 2010, whereas rates among whites increased by 63.0%. Logistic regressions showed that blacks age 86 to 95 years were less likely than whites to be adherent (odds ratio, 0.56; 95% CI, 0.47 to 0.59) but were more likely to be adherent to colonoscopy (odds ratio, 2.34; 95% CI, 1.47 to 3.91). Conclusion: High proportions of average-risk Medicare fee-for-service beneficiaries screened by colonoscopy may represent opportunities for improving appropriateness and allocative efficiency of CRC screening by Medicare.

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Outreach and Inreach Strategies for Colorectal Cancer Screening Among Latinos at a Federally Qualified Health Center: A Randomized Controlled Trial, 2015–2018

American Journal of Public Health ◽

10.2105/ajph.2019.305524 ◽

2020 ◽

Vol 110 (4) ◽

pp. 587-594

Author(s):

Sheila F. Castañeda ◽

Balambal Bharti ◽

Marielena Rojas ◽

Silvia Mercado ◽

Adriana M. Bearse ◽

...

Keyword(s):

Colorectal Cancer ◽

Randomized Controlled Trial ◽

Usual Care ◽

Health Center ◽

Low Income ◽

Controlled Trial ◽

Crc Screening ◽

Randomized Controlled ◽

Federally Qualified Health Center ◽

Mexico Border

Objectives. To compare usual care, inreach consisting of one-on-one education, mailed outreach offering a fecal immunochemical test (FIT), and a combination of outreach and inreach for promoting colorectal cancer (CRC) screening. Methods. We conducted a 4-arm randomized controlled trial from 2015 to 2018 at a US federally qualified health center near the California–Mexico border primarily serving low-income Hispanics/Latinos. A total of 673 individuals aged 50 to 75 years not up to date with screening were assigned to 1 of the 4 intervention groups. The primary outcome was CRC screening through 6 months follow-up. Results. A total of 671 patients were included in intention-to-screen analyses. Their mean age was 59.9 years, 48.9% were male, and 86.3% were primarily Spanish-speaking. Screening was 27.5% for usual care (95% confidence interval [CI] = 0.21, 0.34), 52.7% for inreach (95% CI = 0.45, 0.60), 77.2% for outreach (95% CI = 0.71, 0.83), and 78.9% for combination of inreach and outreach (95% CI = 0.73, 0.85; P < .001 for all comparisons except P = .793 for outreach vs combination). Conclusions. Among individuals at high risk for noncompletion, inreach with one-on-one education nearly doubled, and outreach offering mailed FIT alone or in combination with inreach nearly tripled screening compared with usual care. Mailed FIT outreach was superior to inreach for promoting screening.

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Implementation of colorectal cancer screening interventions in low-income and middle-income countries: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2020-037520 ◽

2020 ◽

Vol 10 (6) ◽

pp. e037520

Author(s):

Désirée Schliemann ◽

Nicholas Matovu ◽

Kogila Ramanathan ◽

Paloma Muñoz-Aguirre ◽

Ciaran O'Neill ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Scoping Review ◽

Low Income ◽

Middle Income ◽

Crc Screening ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Scoping Reviews

IntroductionColorectal cancer (CRC) imposes a significant global burden of disease. CRC survival rates are much lower in low-income and middle-income countries (LMICs). Screening tends to lead to an improvement in cancer detection and the uptake of available treatments and, in turn, to better chances of cancer survival. Most evidence on CRC screening interventions comes from high-income countries. The objective of this scoping review is to map the available literature on the implementation of CRC screening interventions in LMICs.Methods and analysisWe will conduct a scoping review according to the framework proposed by Arksey and O’Malley (2005). We will search MEDLINE, EMBASE, Web of Science and Google Scholar using a combination of terms such as “colorectal cancer”, “screening” and “low-middle-income countries”. Studies of CRC screening interventions/programmes conducted in the general adult population in LMICs as well as policy reviews (of interventions in LMICs) and commentaries on challenges and opportunities of delivering CRC screening in LMICs, published in the English language before February 2020 will be included in this review. The title and abstract screen will be conducted by one reviewer and two reviewers will screen full-texts and extract data from included papers, independently, into a data charting template that will include criteria from an adapted template for intervention description and replication checklist and implementation considerations. The presentation of the scoping review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews guidance.Ethics and disseminationThere are no ethical concerns. The results will be used to inform colorectal screening interventions in LMICs. We will publish the findings in a peer-reviewed journal and present them at relevant conferences.

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Changes in colorectal cancer knowledge and screening intention among Ohio African American and Appalachian participants: The screen to save initiative

Cancer Causes & Control ◽

10.1007/s10552-021-01462-w ◽

2021 ◽

Author(s):

Andrew S. Boutsicaris ◽

James L. Fisher ◽

Darrell M. Gray ◽

Toyin Adeyanju ◽

Jacquelin S. Holland ◽

...

Keyword(s):

Colorectal Cancer ◽

African Americans ◽

Underserved Populations ◽

Educational Interventions ◽

Cancer Knowledge ◽

College Graduate ◽

Logistic Regression Models ◽

Incidence And Mortality ◽

Before And After ◽

Screening Intention

AbstractAfrican Americans and Appalachians experience greater incidence and mortality rates of colorectal cancer due to factors, such as reduced prevalence of screening. An educational session (the Screen to Save Initiative) was conducted to increase intent to screen for colorectal cancer among African Americans and Appalachians in Ohio. Using a community-based approach, from April to September 2017, 85 eligible participants were recruited in Franklin County and Appalachia Ohio. Participants completed a knowledge assessment on colorectal cancer before and after participating in either an educational PowerPoint session or a guided tour through an Inflatable Colon. Logistic regression models were used to determine what factors were associated with changes in colorectal cancer knowledge and intent to screen for colorectal cancer. The majority (71.79%) of participants gained knowledge about colorectal cancer after the intervention. Multivariate results showed that race (OR = 0.30; 95% CI: 0.11–0.80 for African Americans versus White participants) and intervention type (OR = 5.97; 95% CI: 1.94–18.43 for PowerPoint versus Inflatable Colon) were associated with a change in knowledge. The association between education and intent to screen was marginally statistically significant (OR = 0.42; 95% CI: 0.16–1.13 for college graduate versus not a college graduate). A change in colorectal cancer knowledge was not associated with intent to screen. Future educational interventions should be modified to increase intent to screen and screening for colorectal cancer. Further research with these modified interventions should aim to reduce disparities in CRC among underserved populations while listening to the voices of the communities.

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Misconceptions in colorectal cancer among a community-based population and CRC screening adherence.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.15_suppl.6578 ◽

2014 ◽

Vol 32 (15_suppl) ◽

pp. 6578-6578

Author(s):

Thomas Guerrero ◽

Mobeen Rehman ◽

Mary Roberts ◽

Joseph Diaz

Keyword(s):

Colorectal Cancer ◽

Community Based ◽

Crc Screening ◽

Screening Adherence

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#CRCFREE: Using Social Media to Reduce Colorectal Cancer Risk in Rural Adults

American Journal of Health Behavior ◽

10.5993/ajhb.44.3.8 ◽

2020 ◽

Vol 44 (3) ◽

pp. 353-363

Author(s):

Kaitlin Voigts Key ◽

Adebola Adegboyega ◽

Heather Bush ◽

Mollie E. Aleshire ◽

Omar A. Contreras ◽

...

Keyword(s):

Physical Activity ◽

Colorectal Cancer ◽

Focus Group ◽

Preliminary Evidence ◽

Healthy Eating Index ◽

Post Intervention ◽

Crc Screening ◽

Inflammatory Index ◽

Intervention Acceptability ◽

Predominantly Female

Objectives: In this study, we pilot-tested #CRCFree, a Facebook-based intervention aimed at reducing colorectal cancer (CRC) risk in rural Appalachian adults at risk for CRC. Methods: Participants were 56 rural Appalachian adults aged > 50 years. Daily #CRCFree Facebook posts addressed diet, physical activity, and CRC screening. Participants' sociodemographics, diet, body mass index, physical activity, and CRC screening status were measured pre- and post-intervention. The Healthy Eating Index (HEI) and the Dietary Inflammatory Index (DII) assessed dietary patterns. Facebook engagement was measured throughout the intervention. A post-intervention focus group evaluated intervention acceptability. Results: Participants were Caucasian, aged 58 ± 6 years, and predominantly female (66%). Post-intervention, HEI scores increased (49.9 ± 9.9 vs 58.6 ± 12.1, p = <.001), and DII scores decreased from baseline (2.8 ± 1.1 vs 1.6 ± 1.7, p = .002). There was no change in physical activity, BMI, or CRC screening status. Focus group participants found the intervention to be educational and motivating. Conclusions: These results provide preliminary evidence to support using Facebook to address CRC risk in this population. Participants were responsive to this intervention, and Facebook is a novel and accessible modality for health promotion.

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Impact of Tailored Interventions on Receipt of a Preference-Concordant Colorectal Cancer Screening Test

Medical Decision Making ◽

10.1177/0272989x19890603 ◽

2019 ◽

Vol 40 (1) ◽

pp. 29-41

Author(s):

Shannon M. Christy ◽

Patrick O. Monahan ◽

Timothy E. Stump ◽

Susan M. Rawl ◽

Victoria L. Champion

Keyword(s):

Colorectal Cancer ◽

Screening Test ◽

Intervention Group ◽

Health Belief ◽

Average Risk ◽

Post Intervention ◽

Specific Test ◽

Care Experience ◽

Crc Screening ◽

Test Preference

Background. Individuals at average risk for colorectal cancer (CRC) have multiple test options. Preference for a specific test modality may affect decision making about CRC screening. The current study examined 1) the sociodemographic and health belief characteristics of average-risk participants with a test preference for stool blood test (SBT) versus those with a preference of colonoscopy, and following receipt of a tailored CRC screening intervention, 2) the percentage of participants who completed a preference-concordant CRC screening test, and 3) the sociodemographic, health care experience, and health belief characteristics and intervention group(s) associated with completion of a preference-concordant screening test. Methods. Participants ( N = 603) were female, aged 50 to 75 years, at average CRC risk, not currently up-to-date with CRC screening recommendations, had Internet access, and were randomized to receive 1 of 3 tailored CRC screening promotion interventions. Multivariable logistic regression analyses were conducted. Results. Most women (64%) preferred SBT, whereas 36% preferred colonoscopy. There were significant differences in test preference by age, stage of change for the specific tests, perceived benefits of CRC screening, perceived barriers to both tests, and self-efficacy for colonoscopy. Two hundred thirty participants completed CRC screening at 6 months post-intervention. Of those, most (84%) completed a test concordant with their preference. Multivariable analyses revealed that compared with participants completing a preference-discordant test, those completing a preference-concordant test were older ( P = 0.01), had health insurance ( P < 0.05), and were in the phone counseling–only group ( P < 0.01). Conclusions. High levels of completion of preference-concordant CRC screening can be achieved by educating average-risk patients about the multiple screening test options, soliciting their preferences, and offering testing that is concordant with their preference.

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