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

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.