Table 4.

Knowledge, attitudes, and beliefs about CRC and CRC screening

Theme/sub-theme	Example quote
CRC knowledge, attitudes, and beliefs
Symptoms	I think usually of bleeding – blood in the stool is usually maybe a possible indicator. – Male participant, FG 1 I’ve heard of pain, stomach pains, and blood in the stool. – Female participant, FG 5 I’ve heard that, you know, having gastrointestinal issues as well as blood in the stool is a symptom. So, that’s, you know, my understanding of that. – Female participant, FG 5
Lack of knowledge	I’ve never really heard of colon cancer until recently. One of my brothers-in-law, he was telling me that he had colon cancer. But that’s about it. – Female participant, FG 6
More prevalent in men	I don’t know if it’s rumors or if it’s truth to it – that it’s very hard to be diagnosed in women … But even in me seeing patients throughout the hospital, I’ve seen more men with the diagnosis than I have women. – Female participant, FG 1 I heard that black men – it was higher in black men than other races. – Male participant, FG 1
Etiology of cancer	And I know lots of people in the African American community who are working two jobs. They’re working extra hours. And so, we have to talk about self-care in terms of exercise, taking a few, you know, like three days a week or something to de-stress … As well as the diet, encouraging you know those two things, stress, and diet. – Female participant, FG 7 Environmental. Because I know people working at different areas of healthcare field. I mean the whole county. It’s one thing that I noticed that we was [sic] focusing on one time. Nine time out of ten if you look at the population of people that are think about this disease, either their momma, their dad, their grandmomma or great grandmomma, somebody work in the tobacco field here. – Female participant, FG 4 I think that, first off was: African Americans – maybe their diet – I was raised on a lot of pork and fat. And every vegetable we had had to have seasoning in it. We didn’t have plain old sweet peas … So, I think maybe that fat got something to do with it. – Female participant, FG 3
Family history	If it runs in your family, I think you should get it earlier because my son had large polyps and he has a history of cancer. So, he had to get them removed. So, it just depends on your family history, as well as your age. – Female participant, FG 6
Ways to prevent cancer	You need to be careful with–we need to eat more green vegetables, basically. It’s important to make sure you’re eating foods where you’re having regular bowel movements. Because you need to be concerned if you’re going for, you know, days and days and days or even weeks and you’re having problems with your bowels. So, any diet high in fiber … I’ve heard that those are some of the positives to us. – Female participant, FG 5 Positive you know, lifestyle changes, whether it’s walking 30 min a day or eating more fruits and vegetables or adding fiber, to your diet, just healthier, making healthy food choices. – Female participant, FG 6
CRC screening knowledge, attitudes, and beliefs
Screening age	You’re not looking for colon cancer until you reach 50 because that’s the current age that they say, unless you have someone in the family who’s had it, or they’ve had polyp, then you don’t even start, the doctors don’t recommend you taking them until you’re 50. But, you know, you can get it at 45, even earlier. So, the sooner you detect it, the better off you will be, and the cure rate will be higher, if you had tested sooner. – Female participant, FG 7 If it’s suggested in African Americans that we start at age 45, what is the reason for our medical professionals not making the referrals for us to get those colon screenings, or mammograms and all that if the research suggests that we do it five years earlier? To me, again, if there are procedures and markers put in place, why aren’t the medical professionals making those recommendations at 45, 46, 47, you know? – Female participant, FG 4
Colonoscopy experience	I’ve had like two colonoscopies within the past, you know, couple years because my dad used to have polyps. So, people usually say if you have a relative who has had problems with polyps, that you should go and get tested. So that’s why I went and got it done. – Female participant, FG 7 Well, me, myself is working with the community. I’ve never heard so many men said, “Lord, I’ve been violated.” They don’t like the procedures. – Female participant, FG 4
Stool blood test	I don’t understand because it don’t bother me, but did them with other people. Some people have a problem with dealing with bowel. They can’t just – like for example, I had nieces that was nursing that had to put on a mask to help change the colostomy bag when I just go in there and do what I’ve got to do. – Female participant, FG 4 I just heard a cousin the other day make the statement, “I have one of those things to do, those stool samples. I can’t stand doing those things. Those things get on my nerves.” And so, my first thing, my statement to her was, “yeah, it is, it seems like it’s cumbersome sometimes but,” I said, “think about it, if they’re giving it to us to do, it is for a reason. They’re checking.” So, you know, I mean, I learn to even appreciate the fact that this is something I don’t like to do but I find it necessary. – Female participant, FG 5
Reasons for screening delay	And like I said, that’s when I turned 45 and then that’s when the COVID outbreak just hit. So, I know I need to go and get it done— the year’s almost over, whatever. So, you know, I still can get it done at the beginning next year, something like that. But it’s just all of those, factors or whatever. And it’s still early because, like, some of the studies say 45, some say 50, some say other ages. But I do believe that early detection is the best protection. And then for me, I don’t have any blood in my stool, and I don’t really have any stomach pains or anything kind of going wrong in that area. So, just those kind of things just helped me to keep kind of like pushing it back. – Female participant, FG 6 My insurance is through [blinded] Care just like this. They monthly send me information about have you done this, or have you done that. And they sent me the stool sample. I did that through that, and when I needed to – they wanted to setup a colonoscopy for me but they told me it was not time, so my insurance would keep me up to date, and they say something every month on information like this. – Female participant, FG 4