Table 3.

Barriers to Colorectal Screening Residents Perceived Among African Americans

Lack of awareness and knowledge	Lack of awareness of need for screening  “It’s part of a belief system and how it is used. You only come when you’re sick.”  “I don’t think they understand that it is a good screening tool. They don’t understand the benefit of finding the cancer early.”  “They don’t recognize the need for preventative care because they feel well.”
	Lack of knowledge of colorectal cancer risk  “A lot of people don’t understand the disease the way an average health care practitioner does—don’t understand how preventable it is or how much at risk they are for developing colorectal cancer.”
Fears	Fear of outcomes  “I think the biggest reasons are that they’re scared to find out” [if they have cancer].  “Fear of finding something that they would’ve preferred to pretend they didn’t have.”  “Fear of the unknown. The thinking is ‘I’m fine. Why go looking for something that may alter my life?’“
	Fear of colonoscopy procedure  “More fear of the procedure than fear of the diagnosis.”  “I think mostly they are afraid of the prep. They are afraid of the invasive procedure. They are worried it is going to be painful.”
Colonoscopy procedure	Psychological-emotional  “I guess that a lot of them just seem uncomfortable with the idea of someone ‘going there’ whether it’s a flex sig or colonoscopy. I think they’re just uncomfortable with the idea of someone doing that to them.”  “There is a lot of stigma attached to having the anal area examined.”  “We always say we’re going through the rectum looking with a camera. I think there’s a sexual connotation for some.”  “People get caught up on how a colonoscopy is performed - an invasive procedure.”
	Time and complexity of colonoscopy  “Logistics are a big deterrent - first day is the prep, second day is the procedure…”  “I think the process is a little bit more complicated than simply getting a mammogram. They need to do the bowel prep, they need to make another appointment with another doctor, they need a referral.”
Personal/social circumstances	“Often they have personal circumstances, social circumstances that make it hard. They often don’t see it as a priority….no substitute for any duties that they have (child care, elder care, etc).” “They come here to the hospital with serious illnesses. They don’t come here to be screened.”
Distrust related to experimentation	“I think there’s a distrust of medicine. They’ve gotten the impression that we’re here to experiment on them.”