Background: Addressing persistent cancer screening disparities between privileged groups and underserved populations remains an important national research priority and constitutes a larger social justice issue in the United States. This study was part of a broader and ongoing multi-state research program aimed at increasing participation in colorectal cancer (CRC) screening through the delivery of tailored interventions. The interdisciplinary research team combined the Health Belief Model with the Transtheoretical model to develop and test tailored messages for use with populations with private health insurance. Although the interventions have been used with English speaking Hispanic groups, this study ventured to refine interventions for use with Latino subgroups. Despite low screening rates in Hispanic populations, population specific interventions to increase CRC screening are relatively underdeveloped.

Purpose: To refine existing tailored interventions by understanding beliefs and knowledge about CRC and screening among a community based sample of Hispanic and Caucasian women and men.

Methods and Theoretical Framework: Using the Health Belief Model to frame the interview guide, focus groups were conducted to elicit beliefs in perceived susceptibility, benefits, barriers, and patient provider communication issues. Hispanic (3) and Caucasian (2) focus groups were recruited from the local community. Spanish and English speaking moderators facilitated the audio recorded group discussions, assisted with content analysis of transcripts, and worked with the research team to identify cultural and linguistic nuances relevant to the translation of the interview guide and the transcripts.

Results: Primary barriers to screening among Hispanic women were embarrassment, communication problems with doctors, and fear. Caucasian women reported embarrassment, painful experiences, cost, and no symptoms. Hispanic men thought CRC screening was covered under a physical exam, felt ‘invaded', joked about the screening procedure's impact on ‘machismo' and were generally fatalistic about cancer. Caucasian men preferred not to find out about a long term illness, had other health problems which took precedence, and disliked the preparation. There was consensus among all the groups that communication with providers was a major deterrent when doctors did not listen, explain tests well, or recommend screening.

Implications: Despite subtle cultural differences, similarities in CRC screening beliefs warrant the adaptation of our existing tailored intervention for Hispanics--provided adjustments are made for cultural and linguistic relevance. Refinements in our tailored interventions demonstrate the importance of culturally and linguistically relevant interventions with traditionally underserved populations.

Supported by the Huntsman Cancer Institute - NIH P30 CA42014