Barriers and Facilitators of Colorectal Cancer Screening in a Federally Qualified Health Center (FQHC)

Article Figures & Data

Table 1.

Patient Characteristics of Total Sample and by FIT Return Status, n = 875

	Total (n = 875)	FIT Return (n = 440)	FIT Non-Return (n = 435)	P
Sex, n (%)				.33
Male	322 (36.8)	155 (35.2)	167 (38.4)
Female	553 (63.2)	285 (64.8)	268 (61.6)
Age, n (%)				.19
50 to 59 years	478 (54.6)	227 (51.6)	251 (57.7)
60 to 69 years	327 (37.4)	176 (40.0)	151 (34.7)
70 years and older	70 (8.0)	37 (8.4)	33 (7.6)
Race/Ethnicity, n (%)				.02
Hispanic or Latino	392 (44.8)	213 (48.4)	179 (41.2)
Non-Hispanic white	259 (29.6)	133 (30.2)	126 (29.0)
Non-Hispanic black	213 (24.3)	91 (20.7)	122 (28.1)
Non-Hispanic other	11 (1.3)	3 (0.7)	8 (1.8)
Insurance Status, n (%)				.07
Private	246 (28.1)	131 (29.8)	115 (26.4)
Public	214 (24.5)	93 (21.1)	121 (27.8)
Self-pay	415 (47.4)	216 (49.1)	199 (45.8)
Body mass index, n (%)				.74
Underweight or normal (<25 kg/m²)	154 (17.6)	75 (17.1)	79 (18.2)
Overweight (≥25 and <30kg/m²)	239 (27.3)	125 (28.4)	114 (26.2)
Obese (≥30 kg/m²)	482 (55.1)	240 (54.6)	242 (55.6)
Smoking status, n (%)				.003
Never	466 (53.3)	255 (58.0)	211 (48.5)
Former	215 (24.6)	107 (24.3)	108 (24.8)
Current	194 (22.2)	78 (17.7)	116 (26.7)

FIT, fecal immunochemical test.
P values compare participants who returned and did not return FIT. P values were generated from χ² tests for categorical variables and bold font indicates statistical significance at the two-sided α = 0.05 level.

Table 2.

Bivariate and Multivariate Risk Ratios (RR [95% CI]) to Evaluate the Association Between Patient Characteristics and FIT Non-Return, n = 875

CI, confidence interval; FIT, fecal immunochemical test; RR, risk ratio.
Bivariate and multivariate log-binomial regression models the risk of FIT non-return. Multivariate model includes all variables in the table. Risk ratios greater than one indicate the patient characteristic is a risk factor for failing to return the FIT and risk ratios less than one indicate a beneficial characteristic for FIT return. Bold font indicates statistical significance at the two-sided α = 0.05 level.

Table 3.

Barriers and Facilitators of FIT Return for Patients and Clinicians

	Patients, n (%) (n = 121)	Clinicians, n (%) (n = 31)
Barriers
Cost of test	22 (18)	3 (10)
Poor/confusing test instructions	33 (27)	17 (55)
Transportation to return site	23 (19)	13 (42)
Time to complete test	26 (21)	1 (3)
Limited return sites	13 (11)	0 (0)
Return site hours of operation	3 (2)	2 (6)
Fear of abnormal findings	24 (20)	7 (23)
Fear of embarrassment	38 (31)	17 (55)
Lack of motivation	62 (51)	25 (81)
Forgetfulness	74 (61)	19 (61)
Facilitators
Pre-paid postage w/ return address	93 (77)	22 (71)
More drop-off sites	63 (52)	6 (19)
Live call reminders	88 (73)	16 (52)
Text message reminders	72 (60)	8 (26)
Email reminders	34 (28)	11 (35)
Mailed reminders	51 (42)	4 (13)
Better test instructions	33 (27)	14 (45)
More educational materials	64 (53)	4 (13)
More time with clinician	61 (50)	9 (29)
Automatic messaging by EPIC	n/a	4 (13)

FIT, fecal immunochemical test.
Patients self-reported barriers and facilitators by telephone survey and clinicians reported perceived patient barriers and facilitators by online survey. Both patients and clinicians could select as many barriers and facilitators as they deemed appropriate.

Table 4.

Reported Barriers and Facilitators of FIT Return by Patient Race/Ethnicity

	Hispanic or Latino, n (%) (n = 48)	Non-Hispanic Black, n (%) (n = 28)	Non-Hispanic White, n (%) (n = 45)	P
Barriers
Cost of test	6 (13)	6 (21)	10 (22)	.39
Poor/confusing test instructions	26 (54)	4 (14)	3 (7)	<.001
Transportation to return site	12 (25)	4 (14)	7 (16)	.42
Time to complete test	11 (23)	6 (21)	9 (20)	.96
Limited return sites	3 (6)	2 (7)	8 (18)	.18
Return site hours of operation	1 (2)	0 (0)	2 (4)	.61
Fear of abnormal findings	10 (21)	7 (25)	7 (16)	.56
Fear of embarrassment	27 (56)	5 (18)	6 (13)	<.001
Lack of motivation	32 (67)	14 (50)	16 (36)	.03
Forgetfulness	35 (73)	19 (68)	20 (44)	.02
Facilitators
Pre-paid postage w/ return address	40 (83)	16 (57)	37 (82)	.05
More drop-off sites	31 (65)	16 (57)	16 (36)	.02
Live call reminders	40 (83)	19 (68)	29 (64)	.13
Text message reminders	29 (60)	17 (61)	26 (58)	.84
Email reminders	12 (25)	9 (32)	13 (29)	.57
Mailed reminders	23 (48)	12 (43)	16 (36)	.49
Better test instructions	26 (54)	4 (14)	3 (7)	<.001
More educational materials	36 (75)	14 (50)	14 (31)	<.001
More time with clinician	34 (71)	13 (46)	14 (31)	<.001

FIT, fecal immunochemical test.
P values generated from χ² tests. Bold font indicates statistical significance at the two-sided α = 0.05 level.

Table 5.

Reported Barriers and Facilitators of FIT Return by Patient Language

	Spanish, n (%) (n = 27)	English, n (%) (n = 94)	P
Barriers
Cost of test	4 (15)	18 (19)	.78
Poor/confusing test instructions	22 (81)	11 (12)	<.001
Transportation to return site	8 (30)	15 (16)	.16
Time to complete test	9 (33)	17 (18)	.12
Limited return sites	1 (4)	12 (13)	.29
Return site hours of operation	0 (0)	3 (3)	.99
Fear of abnormal findings	5 (19)	19 (20)	.79
Fear of embarrassment	22 (81)	16 (17)	<.001
Lack of motivation	26 (96)	36 (38)	<.001
Forgetfulness	26 (96)	48 (51)	<.001
Facilitators, n (%)
Pre-paid postage w/ return address	26 (96)	67 (71)	<.001
More drop-off sites	23 (85)	40 (43)	<.001
Live call reminders	26 (96)	62 (66)	<.001
Text message reminders	17 (63)	55 (59)	.82
Email reminders	3 (11)	31 (33)	.06
Mailed reminders	11 (41)	40 (43)	.99
Better test instructions	22 (81)	11 (12)	<.001
More educational materials	26 (96)	38 (40)	<.001
More time with clinician	23 (85)	38 (40)	<.001