Barriers to ScreeningBCCEDP CRC Project

Iowa Breast and Cervical Cancer Early Detection Program Colon Cancer Education Pilot Project

Goal: Increase awareness about the importance of colon cancer screening among IA BCCEDP participants and providers.

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Activities

11 IA counties selected that have a higher rate of late-stage colon cancer than the rest of the state (Adair, Buena Vista, Pocahontas, Cedar, Cerro Gordo, Franklin, Fayette, Floyd, Hamilton, Kossuth, & Scott)

Obtain baseline status of colon cancer screening among BCCEDP participants

Activities

February, 2008 – 663 surveys mailed to BCCEDP eligible women aged 50-64

o Pre/663 questionnaires mailed; 12 returned/address; 267 returned

41% response rate

Activities

Develop and disseminate public education materials and maps indicating where BCCEDP participants could receive free or low cost CRC screening.

March, 2008 – Cover letter, CDC brochure “Colon Cancer Screening Saves Lives” & free/low cost CRC screening map mailed to 663 participants

Free/Low Cost CRC Screening Locations

Activities

Develop and disseminate provider education materials to also include the map of free screening programs

March, 2008 – “How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician’s Evidence-Base Toolbox and Guide” and the free/low cost CRC map were mailed to 171 providers.

Activities

o May, 2008 – Conduct a post intervention survey to assess status on colon cancer screening among BCCEDP participants

Post/664 questionnaires mailed; 20 returned/address; 288 returned

45% response rate

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Pre Intervention

Post Intervention

Yes No Yes No

Have you ever had a fecal occult blood test? 52.6%

47.4%

Not asked

Have you had the fecal occult blood test in the past 12 months?

30.5%

69.5%

28.4%

70.6%

Have you ever had a colonoscopy? 39% 61% Not asked

Have you had a colonoscopy in the past ten year? 67.2%

32.8%

67.2%

32.8%

Have you ever had a sigmoidoscopy? 8.6%

91.4%

Not asked

Have you had a sigmoidoscopy in the last five years? 7.4%

92.6%

7.4% 92.6%

Have you ever had a double-contrast barium enema? 11.2%

88.8%

Not asked

Have you had a double-contrast barium enema (DCBE) within the last five years?

2.6%

97.5%

2.6% 97.5%

Where do you prefer to get your health information?

My doctor's nurse 27.0% My doctor 86.5% My family 17.2% Telephone help/hotline 1.9% Magazine articles 18.4% Television 9.4% Public library 2.2% Radio 1.1% My pharmacist 9.0% Internet groups 1.5% Internet sources 19.1% Health-related reading 20.6% Other 16.5%

“Friends say test was unpleasant”

Do you have a health clinic or doctor’s office in which you receive primary health care?

93% responded YES

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Reasons which have/would keep you from being screened.

VariablesPre-intervention

Post-intervention

Too young .7% .3%

No time 3.4% 4.2%

The cost of screening 77.2% 67.8%

I do not have health insurance Not asked 46.4%

My health insurance plan does not cover colorectal cancer screening 25.8% 16.6%

My health insurance plan co-pay/deductible is too high Not asked 19.7%

Embarrassment 9.4% 8.7%

Fear of finding cancer 14.2% 8.7%

I have no family history of colorectal or colon cancer 25.1% 18.3%

I currently do not have symptoms 29.2% 23.9%

I do not know where to go to be screened 5.6% 7.6%

No transportation available 3.4% 4.2%

I didn't know that I needed to be screened 11.6% 5.9%

A healthcare provider had never recommended one of the test 21% 15.6%

I don't know how to do the test 3.4% 3.5%

A previous screening test was unpleasant 5.2% 3.8%

I am not interested in being screened for colorectal cancer 6.7% 6.6%

“Want a screening but can't afford one”

Are already knowledgeable/do not need more information at this time 24.0%

Have already received information 18.4% Will get information within the next month

4.9% Will get information within six months 6.0% Will get more information at some point in the

future 23.2% Do not plan to get more information 3.4% Don't know/am not sure 25.1%

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PRE Q only: In regard to receiving information about colorectal cancer screening, would you say…

“When I got the first mailing I did everything it ended up I did have a pre-cancer.”

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If your doctor suggested that you get a colorectal cancer screening test, how likely would you be to get one? (1 = I would absolutely get the screening test to 5 = I would not get the screening test )

Pre Post1 42.8% 41.9%2 9.3% 10%3 22.2% 20.8%4 13.2% 7.6%5 12.5% 12.1%

“My big disappointment was that I took the test with the card that was sent in the mail and I never received a report back.”

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POST ONLY - Did you receive the CRC information? (n=282)

Yes: 65.7% No: 11.1%I do not remember receiving the information: 20.8%

POST ONLY - If indicated received, did you read the materials (n=200)Yes, read everything: 63% No: 6.2%

Demographic Information

40-49 0%

50-59 68.3%

60-69 31.7% White 93.3%

African American

2.6%

Native American

1.5%

Asian 0.7%

Other 0.7%

Alaska Native

0%

Age on last birthday? (N=260)

Race (N=264)

Ethnicity (N=235)

Non-Hispanic 91.9%

Unknown 6.0%

Hispanic/Latino

2.1%

“Right with the co-pay I would have to pay $2500 along with it. I can't afford to get a screening. it's all out my pocket in every way.”

What were women telling us?“If I could afford it I would do so. Thank you for caring.”

“Fear”

“I didn't know the other 2 tests existed.”

“The place I would have to go are far away. I am the only person that works, can't afford fuel to get there. I can't afford to take off work.”