Improving colorectal cancer screening strategies for low-literacy African Americans: Using risk-benefit segmentation to define a typology of patients and mapping perceptions to design targeted decision aids

Mortality from colorectal cancer (CRC) is high among African Americans (AA) while screening rates are low, particularly for those with low levels of education. We report on an NCI funded project to develop CRC screening decision aids for this population. Perceived risks and benefits of CRC screening (derived from patient focus groups) were used to develop a survey administered to 102 AA patients aged 50-75. A segmentation (cluster) analysis provided a typology of 3 distinct clusters: Ready Screeners (50%), Fearful Avoiders (30.4%), and Cautious Screeners (19.6%). Ready Screeners were favorably disposed to going to the doctor, doing screening tests, following doctor's advice, and believe that screening helps keep them healthy. Fearful Avoiders trust their body to tell them of problems, dislike testing, don't want to know if they have cancer, and believe if they get sick it is God's will. Additional analyses showed that 65% of Ready Screeners and 57.6% of the Cautious Screeners had a colonoscopy in the past, compared to 24.3% of Fearful Avoiders. Perceptual mapping was used to create maps showing how each type perceives the CRC risks-benefits. Based on the maps, vector message design analyses identified optimal message strategies to appeal to each type. The combination of methodologies used to define the types and develop the message strategies represents a powerful approach to health campaign design that could improve CRC screening rates. The methods described can be applied to a variety of health issues.