James Cook University ISSN 1445-6354
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.