Review Article
Barriers of colorectal cancer screening in rural USA: a systematic review
AUTHORS
Hongmei Wang1 PhD, Associate Professor *
Shreya Roy2 MS, PhD
Jungyoon Kim3 PhD 
Paraskevi A Farazi4 PhD
Mohammad Siahpush5 PhD
Dejun Su6 PhD
AFFILIATIONS
1, 2 Department of Health Services Research and Administration, University of Nebraska Medical Center College of Public Health, 984350 Nebraska Medical Center, Omaha, NE 68198-4350, USA
3 Department of Health Services Research and Administration, University of Nebraska Medical Center College of Public Health, Omaha, NE 68198-4350, USA
4 Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, USA
5 Department of Health Promotion, University of Nebraska Medical Center, College of Public Health, 984365 Nebraska Medical Center, Omaha, NE 68198-4365, USA
6 Center for Reducing Health Disparities, Department of Health Promotion, University of Nebraska Medical Center, College of Public Health, 984340 Nebraska Medical Center, Omaha, NE 68198-4340, USA
ACCEPTED: 29 April 2019
early abstract:
Introduction: Colorectal cancer (CRC) screening rates are lower in rural areas in the United States. To guide the design of interventions to improve CRC screening, we conducted a systematic review to identify CRC screening barriers for rural populations.
Methods: A search was conducted in four literature databases MEDLINE, CINAHL, EMBASE, and SCOPUS for articles from 1998-2017 that examine CRC screening barriers in rural areas. This review included a total of 27 articles reporting perceived CRC screening barriers by rural residents or providers or examining factors associated with CRC screening of rural populations in the U.S.
Results: The most frequently reported barriers were high screening cost and lack of insurance coverage, embarrassment or discomfort undergoing screening, lack of knowledge or perceived need on CRC screening, and lack of physician recommendation. These barriers were confirmed in quantitative studies examining their association with CRC screening status. Age, marital status, and race/ethnicity were the most frequently reported factors associated with CRC screening in rural areas. Lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities were reported as rural-specific barriers for CRC screening.
Discussion and Conclusions: Main barriers for CRC screening at both the individual and health care system level are identified in rural areas and they are in line with those found in urban areas in general. In particular, lack of prevention attitude toward cancer, perceived lack of privacy, shortage of specialists, and distance to test facilities disproportionately hamper CRC screening for rural Americans.