Attitudes Toward Colorectal Cancer Screening in the Digital Age: A Survey of Practices and Attitudes among Screening-Eligible Alabamians

Objectives: To ascertain barriers to colorectal cancer screening in an environment of changing recommendations, payment structures, and information access, and to develop strategies for overcoming these barriers by undertaking a population survey of colorectal cancer (CRC) screening knowledge and attitudes in Alabama. Methods: An 80-item questionnaire focused on cancer screening, specifically CRC screening, was developed and pretested. A random sample of Alabama residents was generated using random-digit dial methods and interviews of 615 participants aged 50 and older were conducted in March 2012 and April 2012. Screened and unscreened groups were compared using chi(2) statistics. Results: Sixty-one percent of Alabamians who participated in this survey reported being screened for CRC, the majority (95%) of these by colonoscopy. Both screened and unscreened participants reported using the Internet for health information more often if they were younger than 65 years. Those screened often reported feeling well informed regarding the guidelines, often to have discussed CRC screening with their family physician, and often to have had other cancer screenings. All of the respondents, screened and unscreened, reported financial considerations to be the most significant barriers to screening. Conclusions: Although educating the general population could be helpful, a physician championing screening is key. Home stool testing is underused in Alabama in part because physicians are not fully aware of its utility. As financial barriers diminish, it is important to offer multiple effective modalities when available, and insurance reform, which includes payment for preventive care, may improve screening rates.