Trust and Faith: An assessment of barriers and facilitators of colorectal cancer screening in Blacks

Background: Despite evidence that early detection of colorectal cancer (CRC) effectively prevents premature deaths, racial disparities in CRC persist. Underutilization of cancer screening services result in late stage diagnosis and higher mortality rates, especially among Blacks. Unfortunately, behavioral interventions to increase CRC screening have produced mixed results; presenting a challenge and opportunity to improve interventions. We need to better understand psychosocial/cultural factors (e.g., religiousness, trust, social support, risk perception) contributing to cancer health disparities. This study seeks to elucidate how these factors influence colorectal cancer screening behavior. Methods: This community-based study used qualitative research methods (focus groups and in-depth interviews) to assess participants' (age 50-74 years) attitudes, beliefs, and knowledge of CRC screening and their willingness to participate in research. Data was collected from three types of groups: those (1) screened for CRC, (2) unscreened for CRC, and (3) cancer survivors. Results: A total of 6 focus groups and 14 in-depth interviews (n=59) were conducted. Preliminary results show respondents were: male (36%), employed (44%), and high school graduates (40%). Additionally, 38% earned less than $25,000 annually. Common themes emerged including: 1) the importance of faith and the black church; 2) the importance of trust in physicians; 3) fear of participation in clinical research; and 4) lack of knowledge regarding risks of developing cancer and cancer etiology. Conclusion: Trust and faith appear to influence individual health behavior. A better understanding of these psychosocial/cultural factors will inform the design of culturally-tailored interventions that promote CRC screening and participation in research among blacks.