News & Commentary

Poor Face Barriers To Colorectal Care


There are four barriers to improving colorectal cancer screening for people of lower socioeconomic status, according to research published in Diseases of the Colon & Rectum. Those four barriers are: limited resources, whether patients understand colo­rectal symptoms and physicians correctly diagnose them, beliefs about health and illness such as self-care, and patients’ reaction to illness.

Data were collected at Lyndon B. Johnson General Hospital, a safety net hospital in Houston. There were 30 participants with stage III or IV colorectal cancer (CRC), most of whom were Hispanic. The data were collected throughout 2014.

The researchers used interviews with the participants to substantiate analytic findings. “Face-to-face semistructured interviews were conducted with patients in their language of choice by native or bilingual speakers during participants’ scheduled colorectal clinical appointments,” the research paper states.

Participants were interviewed two times, and the responses focused on the four themes. “Together these themes form an overarching thematic framework, a different frame of reference, in which participants report preventive screenings and medical check-ups as foreign,” the study states.

Some of the interview responses make up the more poignant parts of the research. For instance, patients said that they lacked insurance or adequate funds to pay for the needed care.

As one respondent put it: “I didn’t know what to do and the doctor told me, ‘Don’t worry, you have cancer, but make a $50,000–$60,000 deposit to the bank and I will recommend a good doctor.’ It is very difficult when you don’t have health insurance.”

Respondents were not prone to access the health care system unless they were sick, and for the most part did not see the need for preventive health. “The social norm shared within participants’ communities was reliance on healing through faith, self-care, and folk or natural remedies, such as changing the diet, rather than professional medical care,” the research paper states.

Ideas of masculinity also presented a hurdle to getting care. As one respondent put it: “I knew there was something wrong, but you kinda say that whole male egotistical thing … you know, you’re the male, you’re the provider….” Another respondent: “And it was going to embarrass me to go to the doctor because it’s down there (points to genital/anal area and looks embarrassed).”

Although most of the participants were Hispanic, the researchers said that “regardless of race or ethnicity, participants exhausted alternative medical options before turning to professional care; this finding is consistent with other studies on lower-SES populations.”