Barriers to Screening BCCEDP 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. 2

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 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

9 Pre Intervention Post Intervention YesNoYesNo 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 nurse27.0%  My doctor86.5%  My family17.2%  Telephone help/hotline1.9%  Magazine articles18.4%  Television9.4%  Public library2.2%  Radio1.1%  My pharmacist9.0%  Internet groups1.5%  Internet sources 19.1%  Health-related reading 20.6%  Other16.5% “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 11

12 Reasons which have/would keep you from being screened. Variables Pre- intervention Post- intervention Too young.7%.3% No time3.4%4.2% The cost of screening77.2%67.8% I do not have health insuranceNot asked46.4% My health insurance plan does not cover colorectal cancer screening25.8%16.6% My health insurance plan co-pay/deductible is too highNot asked19.7% Embarrassment9.4%8.7% Fear of finding cancer14.2%8.7% I have no family history of colorectal or colon cancer25.1%18.3% I currently do not have symptoms29.2%23.9% I do not know where to go to be screened5.6%7.6% No transportation available3.4%4.2% I didn't know that I needed to be screened11.6%5.9% A healthcare provider had never recommended one of the test21%15.6% I don't know how to do the test3.4%3.5% A previous screening test was unpleasant5.2%3.8% I am not interested in being screened for colorectal cancer6.7%6.6% “Want a screening but can't afford one”

 Are already knowledgeable/do not need more information at this time24.0%  Have already received information 18.4%  Will get information within the next month4.9%  Will get information within six months6.0%  Will get more information at some point in the future23.2%  Do not plan to get more information 3.4%  Don't know/am not sure 25.1% 13 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.”

14 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 ) PrePost %41.9% 2 9.3%10% %20.8% %7.6% %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.”

15 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 % % % White93.3% African American 2.6% Native American 1.5% Asian0.7% Other0.7% Alaska Native0% Age on last birthday? (N=260) Race (N=264) Ethnicity (N=235) Non-Hispanic91.9% Unknown6.0% Hispanic/Latino2.1%

“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.”