Cognitive Response Testing to Inform the Use of Culture in Cancer Communication and Intervention

Background: Colorectal cancer (CRC) is the third most common cancer among African American men and women, and the third most common cause of cancer death among African Americans. CRC disparity may be partly attributable to differences in African Americans' screening utilization, which remain below the national objective of 50% established by Healthy People 2010. Aim: To use cognitive response testing to develop a refined set of socio-cultural constructs and obtain information on African American question interpretation and judgment formation related to the socio-cultural constructs and CRC screening items. Methods: A community sample of 51 African Americans, age 50 to 75, engaged in one-on-one, retrospective think-aloud interviews; which assessed comprehension, interpretation, and judgments about how to respond to items and constructs. Results: A belief in God was central to spirituality and religiosity; only religious items and a belief in God were perceived to affect decisions about health. Trust of the medical profession and issues of discrimination were based on the interplay between insurance, socio-economic status and race, which participants related to the care they received and not their own health behaviors. Participants responded negatively to items that queried fatalism, as well as inaccurate cancer beliefs perceived as commonly held in the African American community. They were concerned about cancer misinformation. Participants had great difficulty with items that addressed complex constructs such as prevention and spirituality. Conclusion: Researchers should carefully word items and communications related to prevention and distinguish between cultural constructs perceived as relevant to health behavior versus healthcare delivery.