Strategies to Address Colorectal Cancer Screening Disparities Developed Through Community Based Participatory Design: A Mixed Methods Study

INTRODUCTION: Colorectal cancer (CRC) screening rates remain below recommended clinical guidelines, especially among people of color. This study aimed to assess CRC screening rates, identify barriers, and develop improvement strategies in racially diverse communities using community-based participatory design, engaging Community Health Action Teams (CHATs). METHODS: This mixed-methods study employed surveys and focus groups, with data collection instruments co-designed with community members to ensure relevance and accuracy. A random sample of households with screen-eligible residents received a survey, focusing on assessing screening rates and identifying facilitators and barriers to CRC screening. Focus groups used snowball sampling in the same communities to deepen understanding through qualitative insights. RESULTS: Of 1,798 survey respondents, 81% reported participating in CRC screening, with 69% being up to date. Awareness of CRC's preventable and treatable nature, when detected early, (b = 0.647, p < 0.001, OR = 1.91); understanding its asymptomatic potential (b = 0.345, p < 0.001, OR = 1.42); and recognition of its ranking as the second most deadly cancer (b = 0.354, p = 0.007, OR = 1.42) were significant predictors of screening adherence. Knowledge of at-home tests increased compliance with screening (b = 0.752, p < 0.001, OR = 2.12). Barriers reported by unscreened respondents included a lack of symptoms (19%), absence of motivation (19%), being asymptomatic (20%), and for insured individuals, a lack of physician orders for screening (19%). Insights from focus groups, including 65 participants, revealed multi-level barriers, echoing survey findings where relationships with medical providers emerged as the strongest predictor of screening participation. CONCLUSIONS: The study informed the creation of six key outreach messages and two strategies co-led by CHATs, emphasizing CRC screening importance, test options, and cost considerations. Suggested strategies include organizing community events to raise awareness and enhancing direct provider-to-patient communication to encourage screening uptake.