198397 Colonoscopy screening? Not without health insurance. What people say about iFOBT

Tuesday, November 10, 2009: 10:30 AM

Elizabeth Harden, MPH , University of North Carolina at Chapel Hill, Chapel Hill, NC
Alexis A. Moore, MPH , Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
Cathy L. Melvin, PhD , Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, Chapel Hill, NC
Background: Despite wide acceptance of colonoscopy as a highly accurate screening test for colorectal cancer (CRC), annual immunochemical fecal occult blood test (iFOBT) screening may narrow socio-economic and ethnic disparities in early detection and CRC morbidity and mortality. Methods: Formative research for a CRC screening intervention included implementation of four focus groups (n=28) to determine whether iFOBT screening is acceptable to individuals in an under/uninsured, predominantly African American, population. Diffusion of Innovations theory was used to inform the discussion guide and organize presentation of results. Focus group data were transcribed and subjected to content and thematic analysis. Participants completed a demographic questionnaire. Results: Perceptions and attitudes about iFOBT (innovation) characteristics fell into three categories: compatibility with individual beliefs and values; test complexity; and relative advantage of iFOBT compared to no screening and to other tests. Individual characteristics perceived as likely to influence iFOBT initiation included CRC awareness, literacy level, and knowledge and attitudes about local health services. A prominent barrier to iFOBT screening is shared with colonoscopy: cost. Study participants indicated that adoption of free or low-cost iFOBT is unlikely without assured access to affordable diagnostic follow-up. Discussion: Use of iFOBT in community-based screening programs may increase CRC screening in under/uninsured among African Americans who have not been screened or are not up-to-date. Important program components include patient education on correct use of iFOBT, minor redesigns of some iFOBT kit features, and assurance of diagnostic follow up for positive screens.

Learning Objectives:
Describe individual, environmental and innovation-level characteristics that influence the spread of new technologies in populations, according to Diffusion of Innovations theory. Identify barriers to initiating colorectal cancer screening for average-risk adults, 50 years and older. Discuss the perceptions of African American focus group participants about the pros and cons of screening colonoscopy versus Fecal Occult Blood Test screening.

Keywords: Cancer Screening, Evidence Based Practice

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: To understand barriers and facilitators to using FOBT, the Beckman Coulter

Qualified on the content I am responsible for because: MPH in health behavior and health education. Project Director for the NCI-funded Dissemination Research Core at UNC Lineberger Comprehensive Cancer Center and the for the joint CDC/NCI-funded Cancer Prevention and Control Research Collaborative at UNC-Chapel Hill. Directly supervised the planning and implementation of this study and presentation of its results.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.