Barriers, Facilitators, and Preferred Interventions of Colorectal Cancer Screening Among Older Asian Americans: A Gender- and Age-Stratified Focus Group Study

Background and Purpose: Regular colorectal cancer (CRC) screening accounts for approximately 50% reduction for CRC incidence and mortality since 1975 among Americans. However, for Korean Americans (KAs), CRC incidence and mortality have increased and persisted over the past two decades. Furthermore, KAs have consistently reported lower rates (25-50%) of CRC screening than the national target (70.5%) set by Healthy People 2020, thereby CRC becoming the second most commonly diagnosed cancer and the leading cause of death. While studies have investigated factors predicting CRC screening, little is known about culture-specific experiences and meanings of CRC for KAs. This study sought to understand CRC screening among older KAs within the cultural context by answering the following research questions: 1) what are barriers, facilitators, and preferred interventions of CRC screening for KAs? and 2) how do they differ by age (50-64 vs. 65-80) and gender (male vs. female)? The findings added to a body of social work knowledge and practice by filling the gaps existing in the literature.  

Methods: We conducted a series (2-3 sessions, 60-90 minutes per session) of four focus groups with 25 KAs aged 50 to 80 in the Atlanta metropolitan area and a separate focus group with five health professionals (i.e., two nurses, a physician, and two medical interpreters) working with KAs in local healthcare settings. We performed age- and gender-stratified purposive sampling to better understand differences in CRC screening among KAs. We conducted semi-structured focus group interviews with open-ended questions about knowledge, beliefs, and attitudes regarding CRC screening and their preferred interventions for CRC screening. We transcribed the interviews verbatim and implemented grounded and interpretive analyses.

Results: All focus groups indicated poor English proficiency and mistrust of the American healthcare system as barriers to access of CRC screening. Females demonstrated a lack of CRC knowledge and feeling ashamed during CRC screening tests. Males stated fatalism pertinent to CRC, modesty and no perceived need for screening as barriers. As facilitators, all focus groups stated doctor’s recommendations for CRC screening positively influence their decision to receive CRC screening. Interventions differed by age and gender. Older females suggested CRC-related education led by Korean health professionals within KA community (e.g., churches, laundry stores), whereas older males preferred newspapers to obtain CRC screening information. Younger females and males recommended public advertisement, seminars, and mailed leaflets from publicly-recognized health institutes. The health professional focus group triangulated and expanded the results and suggested transportation services to assist older adults in accessing screenings as well as community outreach for screening events to increase KAs’ screenings.

Conclusions and Implications: The findings furthered understanding of barriers, facilitators, and interventions regarding CRC screening in KAs and provided implications for age- and gender-specific approaches to increase CRC screening. Social workers and healthcare providers can build trusting relationships with KAs and help to bridge gaps, coordinate services, minimize mistrust, especially for females. KA males could benefit from prevention interventions using empowerment strategies. Understanding and targeting gender- and age-specific barriers and facilitators for KAs can increase CRC screening among this population.