Unwillingness to Participate in Colorectal Cancer Screening: Examining Fears, Attitudes, and Medical Mistrust in an Ethnically Diverse Sample of Adults 50 Years and Older

Abstract

Purpose. Identify the influence of medical mistrust, fears, attitudes, and sociodemographic characteristics on unwillingness to participate in colorectal cancer (CRC) screening. Design. Cross-sectional, disproportionally allocated, stratified, random-digit-dial telephone questionnaire of noninstitutionalized households. Setting. New York City, New York; Baltimore, Maryland; San Juan, Puerto Rico. Subjects. Ethnically diverse sample of 454 adults ≥50 years of age. Measures. Health status, cancer screening effectiveness, psychosocial factors (e.g., perceptions of pain, fear, trust), and CRC screening intentions using the Cancer Screening Questionnaire, which addresses a range of issues related to willingness of minorities to participate in cancer screening. Analysis. Multivariate logistic regression was used to model the probability of reporting unwillingness to participate in CRC screening. Results. Fear of embarrassment during screening (odds ratio [OR] = 10.72; 95% confidence interval [CI], 2.15–53.39), fear of getting AIDS (OR = 8.75; 95% CI, 2.48–30.86), fear that exam might be painful (OR = 3.43; 95% CI, 1.03–11.35), and older age (OR = 1.10; 95% CI, 1.04–1.17) were positively associated with unwillingness to participate in CRC screening. Fear of developing cancer (OR = .12; 95% CI, .03–.57) and medical mistrust (OR = .19; 95% CI, .06–.60) were negatively associated with unwillingness to screen. Conclusions. Findings suggest that CRC health initiatives should focus on increasing knowledge, addressing fears and mistrust, and normalizing CRC screening as a beneficial preventive practice, and should increase focus on older adults.