Psychosocial determinants of colorectal Cancer screening uptake among African-American men: understanding the role of masculine role norms, medical mistrust, and normative support.

OBJECTIVES: Despite having the highest colorectal cancer (CRC) incidence and mortality across all major racial/ethnic groups, African-American men consistently have poor CRC screening rates. Gendered and racialized beliefs and norms have been associated with African-American men's lower medical assistance-seeking rates, but how these notions influence African-American men's CRC screening practices merits further investigation. The purpose of this study was to examine the influence of psychosocial determinants of men's health on CRC screening uptake among African-American men in three states. DESIGN: Participants were recruited via CuttingCRC.com and through culturally-tailored flyers, newspaper ads, and snowball sampling, among other methods. From April 2019-August 2019, 11 focus groups were conducted with English-speaking Black/African-American men who (a) were between ages 45-75, (b) were born in the United States, (c) had a working telephone, and (d) lived in Minnesota, Ohio, or Utah. Multiple-cycle coding, Hatch's 9-step approach, and constant comparative data analysis was employed for de-identified transcript data. RESULTS: Eighty-four African-American men met inclusion criteria and participated. Their mean age was 59.34 ± 7.43. In regards to CRC screening status, Ohio had the most previously screened participants (85%), followed by Minnesota (84%) and Utah (76%). Two major CRC screening barriers (masculine role norms and medical mistrust) - both encompassed 3-5 subthemes, and one major facilitator (normative support from family members or social networks) emerged. CONCLUSIONS: Despite CRC screening's life-saving potential, African-American men have had the lowest 5-year relative survival for more than 40 years. When developing interventions and health promotion programs aiming to eliminate the racial disparity in CRC outcomes, addressing both masculine role norms and medical mistrust barriers to CRC screening completion among African-American men is warranted.

Barriers to and Facilitators of Recruitment of Adult African American Men for Colorectal Cancer Research: An Instrumental Exploratory Case Study.

PURPOSE: Racial and ethnic minorities remain underrepresented in research and clinical trials. Better understanding of the components of effective minority recruitment into research studies is critical to understanding and reducing health disparities. Research on recruitment strategies for cancer-specific research-including colorectal cancer (CRC)-among African American men is particularly limited. We present an instrumental exploratory case study examining successful and unsuccessful strategies for recruiting African American men into focus groups centered on identifying barriers to and facilitators of CRC screening completion. METHODS: The parent qualitative study was designed to explore the social determinants of CRC screening uptake among African American men 45-75 years of age. Recruitment procedures made use of community-based participatory research strategies combined with built community relationships, including the use of trusted community members, culturally tailored marketing materials, and incentives. RESULTS: Community involvement and culturally tailored marketing materials facilitated recruitment. Barriers to recruitment included limited access to public spaces, transportation difficulties, and medical mistrust leading to reluctance to participate. CONCLUSION: The use of strategies such as prioritizing community relationship building, partnering with community leaders and gatekeepers, and using culturally tailored marketing materials can successfully overcome barriers to the recruitment of African American men into medical research studies. To improve participation and recruitment rates among racial and ethnic minorities in cancer-focused research studies, future researchers and clinical trial investigators should aim to broaden recruitment, strengthen community ties, offer incentives, and use multifaceted approaches to address specific deterrents such as medical mistrust and economic barriers.

Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis.

BACKGROUND: African-American men have the lowest 5-year survival rate in the U.S. for colorectal cancer (CRC) of any racial group, which may partly stem from low screening adherence. It is imperative to synthesize the literature evaluating the effectiveness of interventions on CRC screening uptake in this population. MATERIALS AND METHODS: In this systematic review and meta-analysis, Medline, CINAHL, Embase, and Cochrane CENTRAL were searched for U.S.-based interventions that: were published after 1998-January 2020; included African-American men; and evaluated CRC screening uptake explicitly. Checklist by Cochrane Collaboration and Joanna Brigg were utilized to assess risk of bias, and meta-regression and sensitivity analyses were employed to identify the most effective interventions. RESULTS: Our final sample comprised 41 studies with 2 focused exclusively on African-American men. The most frequently adopted interventions were educational materials (39%), stool-based screening kits (14%), and patient navigation (11%). Most randomized controlled trials failed to provide details about the blinding of the participant recruitment method, allocation concealment method, and/or the outcome assessment. Due to high heterogeneity, meta-analysis was conducted among 17 eligible studies. Interventions utilizing stool-based kits or patient navigation were most effective at increasing CRC screening completion, with odds ratios of 9.60 (95% CI 2.89-31.82, p = 0.0002) and 2.84 (95% CI 1.23-6.49, p = 0.01). No evidence of publication bias was present for this study registered with the International Prospective Registry of Systematic Reviews (PROSPERO 2019 CRD42019119510). CONCLUSIONS: Additional research is warranted to uncover effective, affordable interventions focused on increasing CRC screening completion among African-American men. When designing and implementing future multicomponent interventions, employing 4 or fewer interventions types may reduce bias risk. Since only 5% of the interventions solely focused on African-American men, future theory-driven interventions should consider recruiting samples comprised solely of this population.