TY - JOUR
T1 - An examination of socioeconomic and racial/ethnic disparities in the awareness, knowledge and utilization of three colorectal cancer screening modalities
AU - Zhu, Xuan
AU - Parks, Philip D.
AU - Weiser, Emily
AU - Griffin, Joan M.
AU - Limburg, Paul J.
AU - Finney Rutten, Lila J.
N1 - Funding Information:
This work was funded by Exact Sciences Corporation. The funding agreement ensured author independence when developing the survey questions, interpreting and analyzing the data, and writing and submitting the publication.
Funding Information:
These findings demonstrate a need to improve awareness, knowledge, and access to various CRC screening modalities among certain populations as defined by race/ethnicity or SES indicators. Education efforts to improve CRC screening awareness and knowledge among racial/ethnic minorities and lower SES populations should consider tailoring content and implementation strategies to the needs and social-cultural context of specific communities. Example intervention strategies that have been shown to be effective at reducing CRC screening disparities include disseminating culturally tailored educational materials through culturally appropriate venues, training community health workers to deliver education, navigate patients through screening and follow-up, and provide social support, and reducing access barriers through mailed stool-based tests with as-needed patient navigation (Issaka, Avila, Whitaker, Bent, & Somsouk, 2019; Luque et al., 2014; Mojica et al., 2018; Naylor et al., 2012; Roland et al., 2017). When choosing communication channels for outreach and education efforts, it is also important to take into account the complex and competitive nature of the information environment and the target audience's media use habits, values, and preferences. Innovative communication strategies and unconventional venues may be required to deliver messages to communities and sub-populations who are difficult to reach via traditional mass media channels. Additionally, efforts to improve CRC screening access among racial/ethnic minorities and lower SES populations should take into consideration the nature of different screening modalities. Screening modalities with lower demand on patient time, effort, skills, and/or money may be more likely to achieve widespread, equitable adoption, and therefore be more likely to reduce disparities in CRC-related health outcomes. Healthcare policies that address inequities in social and economic resources, such as expanding health insurance coverage, would facilitate more widespread, equitable CRC screening uptake as well. Additionally, policymakers may consider requiring state Medicaid agencies to track and measure CRC screening uptake by different screening modalities, as is currently required for commercial and Medicare plans.We thank Debra J. Jacobson, MS in the Division of Biomedical Statistics and Informatics at Mayo Clinic for statistical support. We also thank David K. Edwards V, PhD and William K. Johnson, PhD, at Exact Sciences Corporation for medical writing and editorial support and Jack Van Thomme at Exact Sciences Corporation for survey development support.
Publisher Copyright:
© 2021 The Authors
PY - 2021/6
Y1 - 2021/6
N2 - While colorectal cancer (CRC) mortality rates have been decreasing, disparities by socioeconomic status (SES) and race/ethnicity persist. CRC screening rates remain suboptimal among low SES and racial/ethnic minority populations, despite the availability of multiple screening modalities. Understanding awareness, knowledge, and utilization of common screening modalities within different racial/ethnic and SES groups is critical to inform efforts to improve population screening uptake and reduce disparities in CRC-related health outcomes. Through the theoretical lenses of diffusion of innovation and fundamental cause theory, we examined the associations of race/ethnicity and SES with awareness, knowledge, and utilization of three guideline recommended CRC screening strategies among individuals at average risk for CRC. Data were obtained from a survey of a nationally representative panel of US adults conducted in November 2019. The survey was completed by 31.3% of invited panelists (1595 of 5097). Analyses were focused on individuals at average risk for CRC, aged 45–75 for awareness and knowledge outcomes (n = 1062) and aged 50–75 for utilization outcomes (n = 858). Analyses revealed racial/ethnic and SES disparities among the three CRC screening modalities, with more racial/ethnic and SES differences observed in the awareness, knowledge, and utilization of screening colonoscopy and mt-sDNA than FIT/gFOBT. Patterns of disparities are consistent with previous research showing that inequities in social and economic resources are associated with an imbalanced adoption of medical innovations. Our findings demonstrate a need to increase awareness, knowledge, and access of various CRC screening modalities in specific populations defined by race/ethnicity or SES indicators. Efforts to increase CRC screening should be tailored to the needs and social-cultural context of populations. Interventions addressing inequalities in social and economic resources are also needed to achieve more equitable adoption of CRC screening modalities and reduce disparities in CRC-related health outcomes.
AB - While colorectal cancer (CRC) mortality rates have been decreasing, disparities by socioeconomic status (SES) and race/ethnicity persist. CRC screening rates remain suboptimal among low SES and racial/ethnic minority populations, despite the availability of multiple screening modalities. Understanding awareness, knowledge, and utilization of common screening modalities within different racial/ethnic and SES groups is critical to inform efforts to improve population screening uptake and reduce disparities in CRC-related health outcomes. Through the theoretical lenses of diffusion of innovation and fundamental cause theory, we examined the associations of race/ethnicity and SES with awareness, knowledge, and utilization of three guideline recommended CRC screening strategies among individuals at average risk for CRC. Data were obtained from a survey of a nationally representative panel of US adults conducted in November 2019. The survey was completed by 31.3% of invited panelists (1595 of 5097). Analyses were focused on individuals at average risk for CRC, aged 45–75 for awareness and knowledge outcomes (n = 1062) and aged 50–75 for utilization outcomes (n = 858). Analyses revealed racial/ethnic and SES disparities among the three CRC screening modalities, with more racial/ethnic and SES differences observed in the awareness, knowledge, and utilization of screening colonoscopy and mt-sDNA than FIT/gFOBT. Patterns of disparities are consistent with previous research showing that inequities in social and economic resources are associated with an imbalanced adoption of medical innovations. Our findings demonstrate a need to increase awareness, knowledge, and access of various CRC screening modalities in specific populations defined by race/ethnicity or SES indicators. Efforts to increase CRC screening should be tailored to the needs and social-cultural context of populations. Interventions addressing inequalities in social and economic resources are also needed to achieve more equitable adoption of CRC screening modalities and reduce disparities in CRC-related health outcomes.
KW - Colorectal cancer screening
KW - Diffusion of innovation
KW - Fundamental cause theory
KW - Health disparities
KW - Socioeconomic status
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U2 - 10.1016/j.ssmph.2021.100780
DO - 10.1016/j.ssmph.2021.100780
M3 - Article
AN - SCOPUS:85103613192
SN - 2352-8273
VL - 14
JO - SSM - Population Health
JF - SSM - Population Health
M1 - 100780
ER -