Research article

Colorectal cancer screening: Understanding the health literacy needs of hispanic rural residents

  • Received: 11 July 2018 Accepted: 15 November 2018 Published: 01 April 2019
  • Purpose: Hispanics residing in rural areas are among those who are least likely to be screened for colorectal cancer (CRC) and more likely to present with late stage CRC than other racial or ethnic groups. We conducted a pilot study utilizing a mixed-method approach to explore perceptions of CRC and CRC screening among Hispanic adults residing in South Texas rural communities and to identify health literacy needs associated with CRC screening uptake. Methods: A convenience sample of 58 participants, aged 35–65, were recruited to complete questionnaires and participate in focus groups, ranging in size from 4 to 13 participants. Six focus groups were conducted across 3 adjacent rural counties. A semi-structured moderator’s guide was designed to elicit discussion about participants’ experiences, knowledge, and perceptions of CRC and CRC screening. Findings: Lack of knowledge of CRC and CRC screening as cancer prevention was a common theme across focus groups. A majority, 59%, reported never been screened. Thirty-nine percent reported they had been screened for colon cancer and 5% reported they did not know if they had been screened. Participants with lower educational levels perceived themselves at high risk for developing CRC polyps, would not want to know if they had CRC, and if they did have CRC, would not want to know until the very end. Limited information about CRC and CRC screening, a lack of specialized providers, limited transportation assistance, and compromised personal privacy in small-town medical facilities were perceived to be barriers to CRC screening. Conclusions: Low screening rates persist among rural Hispanics. Improving CRC screening literacy and addressing factors unique to rural Hispanics may be a beneficial strategy for reducing screening disparities in this at-risk population.

    Citation: Angelina R. Wittich, L. Aubree Shay, Belinda Flores, Elisabeth M. De La Rosa, Taylor Mackay, Melissa A. Valerio. Colorectal cancer screening: Understanding the health literacy needs of hispanic rural residents[J]. AIMS Public Health, 2019, 6(2): 107-120. doi: 10.3934/publichealth.2019.2.107

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  • Purpose: Hispanics residing in rural areas are among those who are least likely to be screened for colorectal cancer (CRC) and more likely to present with late stage CRC than other racial or ethnic groups. We conducted a pilot study utilizing a mixed-method approach to explore perceptions of CRC and CRC screening among Hispanic adults residing in South Texas rural communities and to identify health literacy needs associated with CRC screening uptake. Methods: A convenience sample of 58 participants, aged 35–65, were recruited to complete questionnaires and participate in focus groups, ranging in size from 4 to 13 participants. Six focus groups were conducted across 3 adjacent rural counties. A semi-structured moderator’s guide was designed to elicit discussion about participants’ experiences, knowledge, and perceptions of CRC and CRC screening. Findings: Lack of knowledge of CRC and CRC screening as cancer prevention was a common theme across focus groups. A majority, 59%, reported never been screened. Thirty-nine percent reported they had been screened for colon cancer and 5% reported they did not know if they had been screened. Participants with lower educational levels perceived themselves at high risk for developing CRC polyps, would not want to know if they had CRC, and if they did have CRC, would not want to know until the very end. Limited information about CRC and CRC screening, a lack of specialized providers, limited transportation assistance, and compromised personal privacy in small-town medical facilities were perceived to be barriers to CRC screening. Conclusions: Low screening rates persist among rural Hispanics. Improving CRC screening literacy and addressing factors unique to rural Hispanics may be a beneficial strategy for reducing screening disparities in this at-risk population.


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    Acknowledgments



    The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR001120. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
    Dr. Shay was supported through a Postdoctoral Fellowship at the UTHealth School of Public Health Cancer Education and Career Development Program–National Cancer Institute/NIH Grant (R25 CA57712).

    Conflict of interest



    All authors declare no conflicts of interest in this paper.

    [1] American Cancer Society (2015) Cancer facts & figures for Hispanics/Latinos 2015–2017. Am Cancer Soc.
    [2] American Cancer Society (2017) Cancer facts & figures 2017. Am Cancer Soc.
    [3] Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, et al. (2009) Evaluating test strategies for colorectal cancer Screening-Age to begin, age to stop, and timing of screening intervals: A decision analysis of colorectal cancer screening for the U.S. preventive services task force from the cancer intervention and surveillance modeling network (CISNET).
    [4] Khajuria H (2015) QuickStats: Colorectal cancer screening among adults aged 50–75 years, by race and hispanic origin-national health interview survey, united states, 2000–2013. MMWR Morb Mortal Wkly Rep 64: 834. doi: 10.15585/mmwr.mm6430a6
    [5] Bennett KJ, Probst JC, Bellinger JD (2012) Receipt of cancer screening services: surprising results for some rural minorities. J Rural Health 28: 63–72. doi: 10.1111/j.1748-0361.2011.00365.x
    [6] Maxwell AE, Hannon PA, Escoffery C, et al. (2014) Promotion and provision of colorectal cancer screening: A comparison of colorectal cancer control program grantees and nongrantees, 2011–2012. Prev Chronic Dis 11: E170.
    [7] Shokar NK, Carlson CA, Weller SC (2008) Factors associated with racial/ethnic differences in colorectal cancer screening. J Am Board Fam Med 21: 414–426. doi: 10.3122/jabfm.2008.05.070266
    [8] Liss D, Baker DW (2014) Understanding current racial/ethnic disparities in colorectal cancer screening in the United States: The contribution of socioeconomic status and access to car. Am J Prev Med 46: 228–236. doi: 10.1016/j.amepre.2013.10.023
    [9] Mehta SJ, Jensen CD, Quinn VP, et al. (2016) Race/ethnicity and adoption of a population health management approach to colorectal cancer screening in a community-based healthcare system. J Gen Intern Med 31: 1323–1330. doi: 10.1007/s11606-016-3792-1
    [10] Burnett-Hartman AN, Mehta SJ, Zheng Y, et al. (2016) Racial/ethnic disparities in colorectal cancer screening across healthcare systems. J Gen Intern Med 51: 107–115.
    [11] Centers for Disease Control and Prevention (2016) QuickStats: colorectal cancer screening among adults aged 50–75 years, by race/ethnicity-national health interview survey, United States, 2000–2015. MMWR Morb Mortal Wkly Rep 65: 1042. doi: 10.15585/mmwr.mm6538a6
    [12] National Center for Health Statistic (2015) Health, United States, 2014: With special feature on adults aged 55–64. Hyattsville, MD.
    [13] Texas Department of State Health Services. Texas BRFSS 2014, summary table, health service region 11. Available from: http://dshs.texas.gov/chs/brfss/query/brfss_form.shtm.
    [14] Decker KM, Singh H (2014) Reducing inequities in colorectal cancer screening in North America. J Carcinog 13: 12. doi: 10.4103/1477-3163.144576
    [15] Cole AM, Jackson JE, Doescher M (2013) Colorectal cancer screening disparities for rural minorities in the United States. J Prim Care Community Health 4: 106–111. doi: 10.1177/2150131912463244
    [16] Smith SK, Trevena L, Simpson JM, et al. (2010) A decision aid to support informed choices about bowel cancer screening among adults with low education: Randomised controlled trial. BMJ 341: c5370. doi: 10.1136/bmj.c5370
    [17] Fernandez ME, Savas LS, Carmack CC, et al. (2015) A randomized controlled trial of two interventions to increase colorectal cancer screening among Hispanics on the Texas-Mexico border. Cancer Causes Control 26: 1–10. doi: 10.1007/s10552-014-0472-5
    [18] Enard KR, Nevarez L, Hernandez M, et al. (2015) Patient navigation to increase colorectal cancer screening among Latino Medicare enrollees: A randomized controlled trial. Cancer Causes Control 26: 1351–1359. doi: 10.1007/s10552-015-0620-6
    [19] Gordon NP, Green BB (2015) Factors associated with use and non-use of the fecal immunochemical test (FIT) kit for colorectal cancer screening in response to a 2012 outreach screening program: A survey study. BMC public health 15: 546. doi: 10.1186/s12889-015-1908-x
    [20] Gonzales M, Qeadan F, Mishra SI, et al. (2017) Racial-ethnic disparities in late-stage colorectal cancer among Hispanics and non-Hispanic whites of New Mexico. Hisp Health Care Int 15: 180–188. doi: 10.1177/1540415317746317
    [21] Vernon SW, Myers RE, Tilley BC (1997) Development and validation of an instrument to measure factors related to colorectal cancer screening adherence. Cancer Epidemiol Biomarkers Prev 6: 825–832.
    [22] McCaffery K, Wardle J, Waller J (2003) Knowledge, attitudes, and behavioral intentions in relation to the early detection of colorectal cancer in the United Kingdom. Prev Med 36: 525–535. doi: 10.1016/S0091-7435(03)00016-1
    [23] Strauss A, Corbin J (1998) Basics of qualitative research: Techniques and procedures for developing grounded theory, 2nd ed. Thousand Oaks, CA: Sage Publications.
    [24] Miles MB, Huberman M (1994) Qualitative data analysis: An expanded sourcebook. 2nd ed. Thousand Oaks: Sage Publications: 55–69.
    [25] Centers for Disease Control and Prevention (CDC) (2013) Vital signs: Colorectal cancer screening test use-United States, 2012. MMWR Morb Mortal Wkly Rep 62: 881–888.
    [26] Texas population, 2015 (projections), population data projections for Texas counties, 2015. Texas Department of State Health Statistics. Available from: http://www.dshs.state.tx.us/chs/popdat/ST2015.shtm.
    [27] Shelton RC, Jandorf L, Ellison J, et al. (2011) The influence of sociocultural factors on colonoscopy and FOBT screening adherence among low-income Hispanics. J Health Care Poor Underserved 22: 925–944. doi: 10.1353/hpu.2011.0074
    [28] Morris NS, Field TS, Wagner JL, et al. (2013) The association between health literacy and cancer-related attitudes, behaviors, and knowledge. J Health Commun 18: 223–241.
    [29] Dolan NC, Ferreira MR, Davis TC, et al. (2004) Colorectal cancer screening knowledge, attitudes, and beliefs among veterans: Does literacy make a difference? J Clin Oncol 22: 2617–2622. doi: 10.1200/jco.2004.22.14_suppl.2617
    [30] Scott TL, Gazmararian JA, Williams MV, et al. (2002) Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care 40: 395–404. doi: 10.1097/00005650-200205000-00005
    [31] Wang J, Moehring J, Stuhr S, et al. (2013) Barriers to colorectal cancer screening in Hispanics in the united states: An integrative review. Appl Nurs Res 26: 218–224. doi: 10.1016/j.apnr.2013.08.005
    [32] Fernandez ME, Savas LS, Wilson KM, et al. (2015) Colorectal cancer screening among Latinos in three communities on the Texas-Mexico border. Health Educ Behav 42: 16–25. doi: 10.1177/1090198114529592
    [33] Wee CC, McCarthy EP, Phillips RS (2005) Factors associated with colon cancer screening: The role of patient factors and physician counseling. Prev Med 41: 23–29. doi: 10.1016/j.ypmed.2004.11.004
    [34] Guerra CE, Dominguez F, Shea JA, et al. (2005) Literacy and knowledge, attitudes, and behavior about colorectal cancer screening. J Health Commun 10: 651–663. doi: 10.1080/10810730500267720
    [35] Zauber AG (2015) The impact of screening on colorectal cancer mortality and incidence: has it really made a difference? Dig Dis Sci 60: 681–691. doi: 10.1007/s10620-015-3600-5
    [36] Hirai K, Ishikawa Y, Fukuyoshi J, et al. (2016) Tailored message interventions versus typical messages for increasing participation in colorectal cancer screening among a non-adherent population: A randomized controlled trial. BMC Public Health 16: 431. doi: 10.1186/s12889-016-3069-y
    [37] Lairson DR, DiCarlo M, Myers RE, et al. (2008) Cost-effectiveness of targeted and tailored interventions on colorectal cancer screening use. Cancer 112: 779–788. doi: 10.1002/cncr.23232
    [38] Myers RE, Sifri R, Hyslop T, et al. (2007) A randomized controlled trial of the impact of targeted and tailored interventions on colorectal cancer screening. Cancer 110: 2083–2091. doi: 10.1002/cncr.23022
    [39] Manne SL, Coups EJ, Markowitz A, et al. (2009) A randomized trial of generic versus tailored interventions to increase colorectal cancer screening among intermediate risk siblings. Ann Behav Med 37: 207–217. doi: 10.1007/s12160-009-9103-x
    [40] Anderson AE, Henry KA, Samadder NJ, et al. (2013) Rural vs urban residence affects risk-appropriate colorectal cancer screening. Clin Gastroenterol Hepatol 11: 526–533. doi: 10.1016/j.cgh.2012.11.025
    [41] Liang PS, Mayer JD, Wakefield J, et al. (2016) Temporal trends in geographic and sociodemographic disparities in colorectal cancer among Medicare patients, 1973–2010. J Rural Health.
    [42] American College of Gastroenterology. Find a gastroenterologist. Available from: http://patients.gi.org/find-a-gastroenterologist/.
    [43] Baxter NN, Warren JL, Barrett MJ, et al. (2012) Association between colonoscopy and colorectal cancer mortality in a US cohort according to site of cancer and colonoscopist specialty. J Clin Oncol 30: 2664–2669. doi: 10.1200/JCO.2011.40.4772
    [44] U.S. Census Bureau. 2013–2017 American community survey 5-year estimates. Available from: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_17_5YR_DP02&prodType=table
    [45] Baier M, Calonge N, Cutter G, et al. (2000) Validity of self-reported colorectal cancer screening behavior. Cancer Epidemiol Biomarkers Prev 9: 229–232.
    [46] Partin MR, Grill J, Noorbaloochi S, et al. (2008) Validation of self-reported colorectal cancer screening behavior from a mixed-mode survey of veterans. Cancer Epidemiol Biomarkers Prev 17: 768–776. doi: 10.1158/1055-9965.EPI-07-0759
    [47] Dodou D, de Winter JC (2015) Agreement between self-reported and registered colorectal cancer screening: A meta-analysis. Eur J Cancer Care (Engl) 24: 286–298. doi: 10.1111/ecc.12204
    [48] Atkinson TM, Salz T, Touza KK, et al. (2015) Does colorectal cancer risk perception predict screening behavior? A systematic review and meta-analysis. J Behav Med 38: 837–850.
    [49] Miller DP, Brownlee CD, McCoy TP, et al. (2007) The effect of health literacy on knowledge and receipt of colorectal cancer screening: A survey study. BMC family practice 8: 1–7. doi: 10.1186/1471-2296-8-1
    [50] Arnold CL, Rademaker A, Bailey SC, et al. (2012) Literacy barriers to colorectal cancer screening in community clinics. J Health Commun 17: 252–264. doi: 10.1080/10810730.2012.713441
    [51] Winterich JA, Quandt SA, Grzywacz JG, et al. (2011) Men's knowledge and beliefs about colorectal cancer and 3 screenings: Education, race, and screening status. Am J Health Behav 35: 525–534.
    [52] Anderson JC, Fortinsky RH, Kleppinger A, et al. (2011) Predictors of compliance with free endoscopic colorectal cancer screening in uninsured adults. J Gen Intern Med 26: 875–880. doi: 10.1007/s11606-011-1716-7
    [53] Golboni F, Nadrian H, Najafi S, et al. (2017) Urban-rural differences in health literacy and its determinants in iran: A community-based study. Aust J Rural Health26: 98–105.
    [54] Shelton RC, Jandorf L, Ellison J, et al. (2011) The influence of sociocultural factors on colonoscopy and FOBT screening adherence among low-income Hispanics. J Health Care Poor Underserved 22: 925–944. doi: 10.1353/hpu.2011.0074
    [55] Gonzalez P, Castaneda SF, Mills PJ, et al. (2012) Determinants of breast, cervical and colorectal cancer screening adherence in Mexican-American women. J Community Health 37: 421–433. doi: 10.1007/s10900-011-9459-2
    [56] Walsh JM, Kaplan CP, Nguyen B, et al. (2004) Barriers to colorectal cancer screening in Latino and Vietnamese Americans. Compared with non-Latino white Americans. J Gen Intern Med 19: 156–166.
    [57] Thompson B, Coronado G, Neuhouser M, et al. (2005) Colorectal carcinoma screening among Hispanics and non-Hispanics whites in a rural settings. Cancer 103: 2491–2498. doi: 10.1002/cncr.21124
    [58] Hunleth JM, Steinmetz EK, McQueen A, et al. (2015) Beyond adherence: Health care disparities and the struggle to get screened for colon cancer. Qual Health Res 26: 17–31.
    [59] Cooper CP, Gelb CA, Hawkins NA (2014) How many "Get screened" messages does it take? Evidence from colorectal cancer screening promotion in the United States, 2012. Prev Med 60: 27–32.
    [60] LoConte NK, Weeth-Feinstein L, Conlon A, et al. (2013) Engaging health systems to increase colorectal cancer screening: Community-clinical outreach in underserved areas of Wisconsin. Prev Chronic Dis 10: E192.
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