Perceptions of and Barriers to Colorectal Cancer Screening Uptake in Underserved Baltimore and Eastern Shore Populations

Colorectal cancer (CRC) remains a leading cause of preventable cancer mortality, with persistent screening disparities in underserved communities. This qualitative study aimed to identify community-specific barriers to CRC screening among two distinct Maryland populations to inform the development of tailored educational materials. We conducted four in-person focus groups with 24 adults, consisting of residents from Baltimore City (BC) and the rural Maryland Eastern Shore (ES). Semi-structured guides explored CRC screening knowledge, perceived barriers, trusted information sources, and preferences for educational content. Discussions were audio-recorded, transcribed, and analyzed by two researchers using thematic analysis. There were significant differences between screening barriers in both populations. In the BC population, key barriers included lack of CRC symptom knowledge, stigma surrounding colorectal procedures, lack of recommendation for screening, and use of medical jargon during appointments. Participants emphasized the importance of plain language, visual aids, and community-specific references to increase CRC screening. In the ES population, key barriers included disengagement with healthcare, not pursuing medical care outside of emergencies, and significant logistical challenges. Participants emphasized the importance of incentives to encourage involvement with the healthcare system as well as using community health workers to help decrease logistic barriers to CRC screening. Within the state of Maryland, there are significantly different CRC screening barriers among BC and ES populations. This study elucidates the value of community-engaged approaches in developing CRC screening educational materials. These findings provide a foundation for future interventions and health education in similar underserved settings.