Community-Based Recommendations to Improve Colorectal Cancer Screening: Utilizing the Theory of Planned Behavior to Understand Patient and Provider Perceptions – A Mixed Methods Study in North Dakota

Abstract

Purpose

This study examines community and provider perceptions of colorectal cancer (CRC) screening using the Theory of Planned Behavior (TPB) to identify barriers and interventions for improving screening rates.

Approach or Design

A mixed methods research design using focus groups with community members and semi-structured interviews with health care providers in counties with the highest and lowest CRC mortality-to-incidence ratios (MIRs). Data analysis was guided by the TPB.

Setting

North Dakota counties with the highest and lowest CRC MIRs, covering urban and rural populations.

Participants

Twenty community members aged 50+ (18 women, 2 men) participated in 5 in-person and 3 virtual focus groups. Eight health care providers, including physicians and nurse practitioners, were interviewed virtually.

Method

Focus groups and interviews were conducted between summer and fall 2023. Discussions were transcribed, coded, and thematically analyzed using Dedoose, guided by the TPB.

Results

Top barriers included access to screening (total codes, n = 183), fear/stigma (n = 126), provider communication (n = 80), cost (n = 67), and travel (n = 58). Community members relied on social networks over providers for screening decisions. No significant differences emerged between high- and low-MIR counties, nor between rural and urban, indicating systemic rather than geographic barriers.

Conclusion

Findings suggest improving provider communication, leveraging trusted social networks, addressing stigma, and reducing barriers to screening (eg, cost, transportation). Future interventions should prioritize community-informed health promotion efforts to increase CRC screening rates and improve health equity.