Colorectal cancer screening knowledge in Appalachian Kentucky

Background: Appalachian Kentucky is recognized for poor socioeconomic conditions, geographic isolation, and poor health outcomes, particularly for colorectal cancer (CRC), the second leading cause of cancer-related mortality among men and women. Assessment of CRC screening knowledge is needed among this population to target CRC educational efforts. Methods: CRC screening knowledge among a sample of Appalachian Kentucky men and women age 45 and older (N=35) was explored using in-depth, semi-structured interviews. Interviews focused on participants' knowledge, comprehension, understanding of CRC terminology, anatomy, and commonly used screening procedures. Interviews were audio-recorded and transcribed verbatim. Analysis of the interview transcripts was an iterative process performed by all three authors. Results: Participants were predominantly female (n=27, 77.1%) and Caucasian (94.3%, n=33). The average age was 58 (n=34, SD=10.03) and over half of the sample reported having some college or more (n=22, 62.7 %). The majority reported earning less than $60,000 annually (n=28, 84.8%); most participants reported having health insurance (n=27, 77.1%). Thematic results suggest: 1) lack of understanding about colon and rectal cancer and colorectal cancer; 2) lack of knowledge about how CRC develops; and 3) discrepancy between having heard of a CRC screening-related term or screening test and accurate knowledge of term or procedure. Conclusions: Findings suggest this sample of Appalachian Kentucky adults had limited understanding of CRC and its related screening procedures, highlighting the need for increased patient-provider communication and attention to CRC health literacy. Improving CRC screening knowledge and patient-provider communication in Appalachian Kentucky may improve CRC disparities in the region.