Barriers of Colorectal Cancer Screening in Rural USA: A Systematic Review

Authors

Hongmei Wang, University of Nebraska Medical CenterFollow
Shreya Roy, University of Nebraska Medical CenterFollow
Jungyoon Kim, University of Nebraska Medical CenterFollow
Evi A. Farazi, University of Nebraska Medical CenterFollow
Mohammad Siahpush, University of Nebraska Medical CenterFollow
Dejun Su, University of Nebraska Medical CenterFollow

Document Type

Article

Journal Title

Rural and Remote Health

Publication Date

2019

Volume

19

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.

DOI Link

10.22605/RRH5181

ISSN

1445-6354

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Recommended Citation

Wang, Hongmei; Roy, Shreya; Kim, Jungyoon; Farazi, Evi A.; Siahpush, Mohammad; and Su, Dejun, "Barriers of Colorectal Cancer Screening in Rural USA: A Systematic Review" (2019). Journal Articles: Epidemiology. 63.
https://digitalcommons.unmc.edu/coph_epidem_articles/63