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Showing content from https://pubmed.ncbi.nlm.nih.gov/33026682/ below:

A Multilevel Approach to Understand the Context and Potential Solutions for Low Colorectal Cancer (CRC) Screening Rates in Rural Appalachia Clinics

. 2021 Jun;37(3):585-601. doi: 10.1111/jrh.12522. Epub 2020 Oct 7. A Multilevel Approach to Understand the Context and Potential Solutions for Low Colorectal Cancer (CRC) Screening Rates in Rural Appalachia Clinics

Affiliations

¹ Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia.
² Stone Mountain Health Services, Damascus, Virginia.
³ Tri-Area Community Health, Laurel Fork, Virginia.

PMID: 33026682
PMCID: PMC8238123
DOI: 10.1111/jrh.12522

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A Multilevel Approach to Understand the Context and Potential Solutions for Low Colorectal Cancer (CRC) Screening Rates in Rural Appalachia Clinics

Jamie Zoellner et al. J Rural Health. 2021 Jun.

. 2021 Jun;37(3):585-601. doi: 10.1111/jrh.12522. Epub 2020 Oct 7. Affiliations

¹ Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia.
² Stone Mountain Health Services, Damascus, Virginia.
³ Tri-Area Community Health, Laurel Fork, Virginia.

PMID: 33026682
PMCID: PMC8238123
DOI: 10.1111/jrh.12522

Item in Clipboard

Abstract

Purpose: To explore system/staff- and patient-level opportunities to improve colorectal cancer (CRC) screening within an 11-clinic Federally Qualified Health Center (FQHC) in rural Appalachia with CRC screening rates around 22%-30%.

Methods: Using a convergent parallel mixed-methods design, staff (n = 26) and patients (n = 60, age 50-75, 67% female, 83% <college, 47% Medicare, 23% Medicaid) were interviewed about CRC-related screening practices. Staff and patient interviews were guided by the Consolidated Framework for Implementation Research and Health Belief Model, respectively, and analyzed using a hybrid inductive-deductive approach.

Results: Among staff, inner setting factors that could promote CRC screening included high workplace satisfaction, experiences tracking other cancer screenings, and a highly active Performance Improvement Committee. Inner setting hindering factors included electronic medical record inefficiencies and requiring patients to physically return fecal tests to the clinic. Outer setting CRC screening promoting factors included increased Medicaid access, support from outside organizations, and reporting requirements to external regulators, while hindering factors included poor social determinants of health, inadequate colonoscopy access, and lack of patient compliance. Among patients, perceived screening benefits were rated relatively higher than barriers. Top barriers included cost, no symptoms, fear, and transportation. Patients reported high likelihood of getting a stool-based test and colonoscopy if recommended, yet self-efficacy to prevent CRC was considerably lower.

Conclusions: Contextualized perceptions of barriers and practical opportunities to improve CRC screening rates were identified among staff and patients. To optimize multilevel CRC screening interventions in rural Appalachia clinics, future quality improvement, research, and policy efforts are needed to address identified challenges.

Keywords: cancer early detection; colorectal cancer; community health centers; health status disparities; implementation science.

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