Abstract C71: Discrepancies in perceptions of colorectal cancer screening and willingness to screen among Federally Qualified Health Centers staff and Latino community members
Authors: Alpert Elizabeth N. , Nuhaily Sumayah , Torre Carolina López De la , Haughton Jessica , Gupta Samir , Nodora Jesse , Bharti Balambal , Ramers Christian , Garcia Felipe , Clark Tatianna , Carrizosa Claudia , Arredondo Elva M. , Wells Kristen J. 
Published: February 2019

Abstract
Background: With colorectal cancer (CRC) persisting as the second leading cause of cancer deaths in the US, it is imperative that screening perceptions and behaviors among underserved populations be investigated and better understood. Latinos have exhibited lower rates of maintaining consistent and timely screening measures for CRC: while nearly 61% of non-Hispanic whites are screening regularly for CRC, Latinos fall behind at just below 45%.
Federally Qualified Health Centers (FQHCs) attempt to address this disparity by providing outreach and screening services to medically underserved patients. In 2014, approximately 13% of FQHC patients nationwide self-identified as Latino; this underscores this population's need for affordable and tailored care. As the passing of the Affordable Care Act has gradually increased access to health care among Americans who had previously been uninsured, FQHCs have a unique opportunity to implement interventions that target populations and individuals who now have access to regular care.
Objective: The purpose of the present study was to identify discrepancies in perceptions of CRC screening and willingness to screen among FQHCs staff and Latino community members living in San Diego, California. In-depth interviews (n=17) were held with health care providers and staff at local FQHCs (mean age: 38.8 years; 64.7% female; 88.2% Latino) and five focus groups (n=39) were conducted with community members who reside in neighborhoods served by FQHCs (mean age: 59.4 years; 79.5% female; 97.4% Latino).
Method: Using standardized interview and focus group guides based on Social Ecological Model (SEM), FQHCs staff and community members were asked to describe their experience with CRC screening. Beliefs, attitudes, and perceptions regarding CRC screening and related referrals were also discussed. Interviews and focus groups were audio recorded and transcribed, and content analysis was used to create a codebook based on SEM. Two coders independently reviewed transcripts and applied codes, meeting to resolve inconsistent coding via consensus. Data were summarized according to two themes: 1) patient-level facilitators and barriers to CRC screening and 2) organizational barriers to CRC screening.
Results: While patients often reported feeling that they had access to medical information and had a grasp of the basic tenets of preventive health care, FQHCs staff consistently reported a lack of CRC-specific knowledge among patients in their clinics. Community members' reported willingness to screen for CRC was higher than FQHCs staffs' perception of it. FQHCs patients were viewed by staff as being afraid or embarrassed to screen, while community members generally reported feeling comfortable with CRC screening methods. FQHCs staff identified organizational barriers, such as the fragmentation of the referral process and a lack of knowledge of appropriate screening procedures. Organizational facilitators at FQHCs were also identified, including the option of mailing completed fecal immunochemical tests (FIT) to labs as well as the overall cohesion and organizational capacities of the FQHCs' Electronic Health Record systems. Additionally, FQHCs staff reported having implemented a pilot program that sought to aid patients in understanding the importance and processes of using the FIT kit as well as facilitating the completion and return of FIT tests.
Discussion: The present study's findings suggest FQHCs staff may lack confidence in their patients' abilities and knowledge in obtaining CRC screening. Several discrepancies were noted with regard to patients' willingness and ability to obtain CRC screening. Interventions that work to improve communication between FQHC staff and patients would be beneficial to the Latino populations living in this region.
Citation Format: Elizabeth N. Alpert, Sumayah Nuhaily, Carolina López De la Torre, Jessica Haughton, Samir Gupta, Jesse Nodora, Balambal Bharti, Christian Ramers, Felipe Garcia, Tatianna Clark, Claudia Carrizosa, Elva M. Arredondo, Kristen J. Wells. Discrepancies in perceptions of colorectal cancer screening and willingness to screen among Federally Qualified Health Centers staff and Latino community members [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C71.