Background: Colorectal cancer (CRC) is a leading cause of cancer-related mortality among African Americans. Understanding how health beliefs affect health behaviors is essential to improving CRC screening adherence.

Methods: This observational study examined the relationship between health beliefs and CRC screening adherence within the context of a community-based CRC screening program BEAT Cancer (Black-Equity-Access and-Treatment for-Cancer). The primary outcome was the fecal immunochemical test (FIT) return rate. Independent variables included socio-demographics (age, gender, income), healthcare access (insurance, primary care access), health behavior (smoking status), and health beliefs related to CRC screening (perceived benefits, barriers, susceptibility, self-efficacy, and social influence). Multivariable logistic regression with backward selection was used to generate adjusted odds ratios (AORs) between health beliefs and screening adherence (FIT return).

Results: The study included 471 African American participants aged 45-75 who received a FIT kit between 10/1/2023 and 2/1/2025. The overall FIT return rate was 34.8%. Bivariate analyses showed that participants who returned their FIT kits were older (59.0 vs. 57.0 years; p=0.01), more likely to be non-smokers (73.0% vs. 62.4%; p=0.02), and had higher beliefs in CRC screening benefits (3.6 vs. 3.5; p=0.006), self-efficacy (3.3 vs. 3.2; p=0.02), and social influence (3.1 vs. 2.9; p=0.003). After adjusting for age and smoking status, social influence (AOR: 1.60; CI: 1.11-2.32) and self-efficacy (AOR: 1.53; CI: 1.01-2.32) remained significantly associated with FIT return.

Conclusion: Self-efficacy and social influence were positively associated with CRC screening adherence, highlighting the potential of community partnerships and advocacy efforts to improve screening rates among African Americans.