ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2021
A Multilevel Approach to Understand the Context and Potential Solutions for Low Colorectal Cancer (CRC) Screening Rates in Rural Appalachia Clinics.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 15 citations in OpenAlex.
- Video brochures in a mailed fecal immunochemical test outreach program provide cancer screening information in a user-friendly format for rural Appalachian community members.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2024Trial
- Knowledge, Symptom Awareness, and Referral Practices of Primary Care Providers in Early-Onset Colorectal Cancer.Population health management · 2026Article
- Evaluation of colorectal cancer screening practices in Rhode Island, 2011-2021.Cancer causes & control : CCC · 2026Article
- Cancer Screening in Appalachia: A Common-Sense Approach.International journal of behavioral medicine · 2025Article
- A socioecological taxonomy of determinants to colorectal cancer screening in black men: Insights from a mixed-methods systematic review.Preventive medicine reports · 2025Review
- Reach and effectiveness of a centralized navigation program for patients with positive fecal immunochemical tests requiring follow-up colonoscopy.Preventive medicine reports · 2023Article
- A "sludge audit" for health system colorectal cancer screening services.The American journal of managed care · 2023Article
- Cancer Screening Among Rural and Urban Clinics During COVID-19: A Multistate Qualitative Study.JCO oncology practice · 2022Article
- Perspectives of cancer prevention and control resources from stakeholders in rural southern Illinois.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2022Article
- Advancing engagement and capacity for rural cancer control: a mixed-methods case study of a Community-Academic Advisory Board in the Appalachia region of Southwest Virginia.Research involvement and engagement · 2021Article
- The potential feasibility of tobacco-focused medication therapy management in pharmacies affiliated with Federally Qualified Health Centers: Perspectives of pharmacists.Journal of the American Pharmacists Association : JAPhAArticle
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
purposeTo explore system/staff- and patient-level opportunities to improve colorectal cancer (CRC) screening within an 11-clinic Federally Qualified Health Center (FQHC) in rural Appalachia with CRC screening rates around 22%-30%.
methodsUsing a convergent parallel mixed-methods design, staff (n = 26) and patients (n = 60, age 50-75, 67% female, 83% <college, 47% Medicare, 23% Medicaid) were interviewed about CRC-related screening practices. Staff and patient interviews were guided by the Consolidated Framework for Implementation Research and Health Belief Model, respectively, and analyzed using a hybrid inductive-deductive approach.
resultsAmong staff, inner setting factors that could promote CRC screening included high workplace satisfaction, experiences tracking other cancer screenings, and a highly active Performance Improvement Committee. Inner setting hindering factors included electronic medical record inefficiencies and requiring patients to physically return fecal tests to the clinic. Outer setting CRC screening promoting factors included increased Medicaid access, support from outside organizations, and reporting requirements to external regulators, while hindering factors included poor social determinants of health, inadequate colonoscopy access, and lack of patient compliance. Among patients, perceived screening benefits were rated relatively higher than barriers. Top barriers included cost, no symptoms, fear, and transportation. Patients reported high likelihood of getting a stool-based test and colonoscopy if recommended, yet self-efficacy to prevent CRC was considerably lower.
conclusionsContextualized perceptions of barriers and practical opportunities to improve CRC screening rates were identified among staff and patients. To optimize multilevel CRC screening interventions in rural Appalachia clinics, future quality improvement, research, and policy efforts are needed to address identified challenges.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.