Perceptions of colorectal cancer screening in African Americans: Differences by gender and screening status

African Americans have higher colorectal cancer (CRC) morbidity and mortality, yet have the lowest rates of CRC screening. Few studies have explored the barriers African Americans have to CRC screening, or elucidated the differences between gender and screening status. This qualitative focus group study involved 34 patients 50 years of age and older from a general internal medicine clinic in a large, inner city hospital. Patients were stratified by gender and CRC screening status. Focus groups focused on attitudes about different types of CRC screening methods, barriers to screening and needs for information. Focus group transcripts were analyzed using an iterative coding process with consensus and triangulation to develop thematic categories. Results identified key findings, many of which differed by gender and screening status. In those who had not been screened, fear of the doctor and reluctance to undergo screening because of sexual connotations were important to un-screened men while women indicated a belief that they were not at risk or would not want to know they had CRC. In those who had been screened, men noted that once they had been screened, fear and reluctance were reduced. Women felt that they underwent screening because their doctors wanted them to and would again. Implications of the gender specific and screening status findings for the development of messages targeted to specific subgroups will be discussed. This is important for African American populations as screening barriers are unique and mortality due to CRC is high.