Hongmei Wang1, Shreya Roy2, Jungyoon Kim3, Paraskevi A Farazi4, Mohammad Siahpush5, Dejun Su6. 1. Department of Health Services Research and Administration, University of Nebraska Medical Center College of Public Health, 984350 Nebraska Medical Center, Omaha, NE 68198-4350, USA hongmeiwang@unmc.edu. 2. Department of Health Services Research and Administration, University of Nebraska Medical Center College of Public Health, 984350 Nebraska Medical Center, Omaha, NE 68198-4350, USA shreya.roy@unmc.edu. 3. Department of Health Services Research and Administration, University of Nebraska Medical Center College of Public Health, Omaha, NE 68198-4350, USA jungyoon.kim@unmc.edu. 4. Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, USA evi.farazi@unmc.edu. 5. Department of Health Promotion, University of Nebraska Medical Center, College of Public Health, 984365 Nebraska Medical Center, Omaha, NE 68198-4365, USA msiahpush@unmc.edu. 6. Center for Reducing Health Disparities, Department of Health Promotion, University of Nebraska Medical Center, College of Public Health, 984340 Nebraska Medical Center, Omaha, NE 68198-4340, USA dejun.su@unmc.edu.
Abstract
INTRODUCTION: Colorectal cancer (CRC) screening rates are lower in rural areas in the USA. To guide the design of interventions to improve CRC screening, a systematic review was conducted to identify CRC screening barriers for rural populations. METHODS: A search was conducted in four literature databases - Medline, CINAHL, Embase, and Scopus - for articles from 1998 to 2017 that examine CRC screening barriers in rural areas. This review included a total of 27 articles reporting perceived CRC screening barriers by rural residents or providers or examining factors associated with CRC screening of rural populations in the USA. RESULTS: The most frequently reported barriers were high screening cost and lack of insurance coverage, embarrassment or discomfort undergoing screening, lack of knowledge or perceived need on CRC screening, and lack of physician recommendation. These barriers were confirmed in quantitative studies examining their association with CRC screening status. Age, marital status, and race/ethnicity were the most frequently reported factors associated with CRC screening in rural areas. Lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities were reported as rural-specific barriers for CRC screening. CONCLUSIONS: Main barriers for CRC screening at both the individual and healthcare system level are identified in rural areas and they are in line with those found in urban areas in general. In particular, lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities disproportionately hamper CRC screening for rural Americans.
INTRODUCTION:Colorectal cancer (CRC) screening rates are lower in rural areas in the USA. To guide the design of interventions to improve CRC screening, a systematic review was conducted to identify CRC screening barriers for rural populations. METHODS: A search was conducted in four literature databases - Medline, CINAHL, Embase, and Scopus - for articles from 1998 to 2017 that examine CRC screening barriers in rural areas. This review included a total of 27 articles reporting perceived CRC screening barriers by rural residents or providers or examining factors associated with CRC screening of rural populations in the USA. RESULTS: The most frequently reported barriers were high screening cost and lack of insurance coverage, embarrassment or discomfort undergoing screening, lack of knowledge or perceived need on CRC screening, and lack of physician recommendation. These barriers were confirmed in quantitative studies examining their association with CRC screening status. Age, marital status, and race/ethnicity were the most frequently reported factors associated with CRC screening in rural areas. Lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities were reported as rural-specific barriers for CRC screening. CONCLUSIONS: Main barriers for CRC screening at both the individual and healthcare system level are identified in rural areas and they are in line with those found in urban areas in general. In particular, lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities disproportionately hamper CRC screening for rural Americans.
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