Reasons for CRC screening non-adherence among African Americans in primary care

Background: Low colorectal cancer (CRC) screening rates among African Americans (AAs) contribute to disparities in CRC mortality and survival. As part of a randomized controlled trial that compared the impact of tailored navigation and a mailed intervention on screening adherence among AA patients in primary care, we identified reasons for non-adherence.

Methods: 764 participants were randomized either to a Tailored Navigation Intervention (TNI) Group (n=384) or a Standard Intervention (SI) Group (n=380). An endpoint telephone survey was administered to 519 (68%) participants. Respondents who had not screened at 6 months were asked to report a primary reason for non-adherence.

Results: 388 endpoint survey respondents indicated that that they had not completed a screening test. Of this number, 243 (63%) reported a primary reason for why they did not screen.  Primary reasons for non-adherence were distributed as follows: low perceived importance of CRC screening (28%), lack of transportation or time needed to attend a screening appointment (17%), fear of screening or results (11%), dislike of screening  procedures (11%), lack of insurance coverage or limited capacity to pay for screening and follow-up (10%), confusion about the screening process (10%), existence of a health condition that precluded screening (8%), and other reasons (5%).

Conclusions: CRC screening non-adherence among AAs was influenced by negative perceptions and confusion related to screening, lack of access to testing, concerns about cost, and health limitations. Initiatives seeking to maximize screening rates among AAs should be designed to identify and address both perceptual and logistical barriers to screening.