Attitudes and beliefs regarding colorectal cancer screening among African American patients of community health centers in North-Central Florida and stakeholder perspectives: a qualitative study

BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer mortality in the US with African Americans continuing to experience CRC health disparities due to numerous factors. While colonoscopy remains the most utilized test for CRC screening, stool-blood tests are cost-effective and offered by community health centers (CHC) serving un- and underinsured patients. Qualitative research has identified multilevel barriers to CRC screening and can potentially inform the development of tailored interventions to promote stool-based screening. METHODS: In this qualitative study, we explored the CHC context for delivering CRC screening services and patient education by interviewing six stakeholders of two north Florida CHCs and conducted six focus groups among African American patients of the two CHCs who had recently completed a CRC screening. CHC stakeholders were identified for interviews by their organizational roles delivering CRC screening services and focus group participants were recruited from our previous CRC screening behavioral clinical trial study group participant pool. RESULTS: CHC stakeholders assessed their organizations' delivery of CRC screening services, which included stool-based tests and colonoscopy referrals, and discussed trends in the screening rates achieved by their organizations. CHC stakeholders spoke about their patient education and outreach within the community and offered ideas about how community-based CRC screening education could be improved. CHCs highly valued the community-academic partnership, identifying numerous mutually beneficial aspects and embraced the ongoing partnership as a way to increase CRC screening adherence among their patients. The focus group discussions can be grouped into three main themes. The first theme is healthcare attitudes and relationships with providers. This theme covered perceptions of seeking healthcare and communication and trust with providers. The second theme is CRC knowledge and prevention. This theme covered patients' knowledge about CRC, what symptoms to monitor, knowing their family history of cancer, and the different screening tests. The third theme is technological and systematic issues in healthcare. These discussions focused on health insurance and accessing the patient portal. CONCLUSIONS: This study demonstrated the value of community-engaged qualitative research on CRC screening delivery and completion in partnership with CHC stakeholders.