In light of the higher CRC mortality rates among African Americans, early detection by screening within recommended guidelines is vital for this vulnerable population. In this study, we found greater perception of CRC screening benefits among individuals who perceived high group susceptibility to CRC, regardless of the level of traditional cultural orientation or medical mistrust. Among individuals who perceived low group susceptibility to CRC, however, perceptions of the benefits of CRC screening were increased if they had a high versus a low traditional cultural orientation. Perception of benefits also increased if low perceivers of group susceptibility had low medical mistrust compared to those with high medical mistrust. Increased expressed intention to complete CRC screening was associated with perceiving high group CRC susceptibility while being more culturally traditional, and increased CRC screening intention was also associated with having an African American physician and low medical mistrust. These findings suggest that perceived benefit and intent to complete CRC screening is best among African Americans with high group susceptibility, high traditional cultural orientation, less mistrust of the medical system, and who report that their primary healthcare provider is an African American physician.
The results of this study suggest that African Americans who identify with a traditional cultural orientation only have lower perceived benefits to CRC screening if they have low perceived group susceptibility. Individuals with a more traditional cultural orientation have increased perceived benefit to CRC screening if they perceive high group susceptibility for CRC. Since many of the MASPAD items address fidelity to one’s racial/ethnic identity as a person of African descent and adherence to cultural norms, it is possible that the traditional acculturative strategy was a proxy for a positive racial identity in this study. This may explain why results from this study differ from studies that report a negative association between traditional cultural orientation (e.g., low acculturation) and colorectal cancer screening in other ethnic groups (Maxwell et al. 2000
, Tang et al. 2001
, Honda 2004
, Honda et al. 2005
, Shah et al. 2006
,). There is some evidence that the protective nature of positive racial identity leads to less risky health behaviors (Caldwell et al. 2002
, Beadnell et al. 2003
, Caldwell et al. 2004
). This implies that behavioral interventions seeking to increase screening among this population might successfully incorporate traditional African American values (e.g., group solidarity, striving despite obstacles, and reliance on others within the group) and risk messages focused at the level of the African American community rather than exclusively at the individual level. Interventions that use existing social networks (e.g., churches, social and fraternal organizations, extended families) as motivational and venues for message delivery may prove especially effective at increasing CRC screening rates.
In contrast to individuals with high traditional cultural orientation and perceived high group susceptibility, study participants who perceived low group susceptibility and who were also highly mistrustful of healthcare professionals and the healthcare system perceived fewer benefits of CRC screening. The relationship of mistrust with less perception of benefits is consistent with previous research in which African Americans are more likely to express mistrust of the medical system and concerns about quality of care when contemplating CRC screening (Holmes-Rovner et al. 2002
, Greiner et al. 2005
). However, the concept of group susceptibility has not received as much attention in the literature. It is possible that one way to overcome CRC screening barriers associated with medical mistrust is to focus cancer prevention and control communications at both the individual and group levels. There is evidence from previous research that African Americans are interested in receiving information regarding their racial group, as long as group-level risk information is closely paired with concrete behavioral recommendations for cancer screening (Sanders Thompson et al. 2007
Having an African American physician appeared to have buffered the impact of mistrust on intention to be screened. While several studies have noted the impact of racial concordance on health care utilization and perceptions of quality of care (LaVeist and Nuru-Jeter 2002
, Cooper et al. 2003
, LaVeist et al. 2003
), more information is needed about the effect of having a same-race physician on CRC screening completion. African American physicians and other health providers may be particularly important as spokespersons to communicate CRC risk and prevention messages to African Americans.
While we believe that this study offers important new information that could improve behavioral interventions aimed at increasing CRC among African Americans, there are several limitations that must be noted. First, this study was exploratory in nature and therefore did not proceed from a priori hypotheses regarding the relationships under study. The participants in this study were a convenience sample of African Americans from two large Midwestern cities, who may differ from African Americans in other communities. The participants included in this study also had a relatively high socioeconomic status, and rates of physician recommendation for CRC screening and CRC screening completion were above the rates reported nationally. Also while gender was not a significant correlate of the outcomes addressed in this study, a majority of study participants was female and more information may be necessary before drawing conclusions regarding African American men.
In conclusion, the results of this study suggest that among African Americans, traditional cultural orientation, group susceptibility of CRC, medical mistrust, and physician ethnicity play a significant role in perceived benefits to CRC screening and intention to complete CRC screening. These factors should be considered when developing new behavioral interventions to increase CRC screening among African Americans. The development of new prevention and control strategies will potentially reduce the disparities associated with CRC and race.