Population considerations:

  • Cost of screening. Without health insurance, the cost of screening becomes an issue for lower-income populations (Ward, 2008). Sometimes people who live on a limited budget are forced to choose between being screened and other necessities like food or medicine (Green, et al. 2008). Lower income populations will not be screened if the cost of the test and treatment is beyond their means (Natale-Periera, 2008).
  • Transportation. Sometimes lower income individuals without their own vehicle have to take two or three buses at one time to access health care services (Natale-Periera, 2008) or rely on others to take them to and from the screening (Green, 2008).  
  • Fear.  Fear has been found to be a common barrier among lower-income populations. They often express fear of pain from the preparation of the procedure itself as well as fear of a cancer diagnosis (Green et al, 2008).
  • Lack of provider recommendation. Lower income populations have reported a lack of physician recommendation for colorectal cancer screening as a reason that they do not seek screening. In addition, lower income individuals have said that they view the importance of the test by whether or not their physician recommends it to them (Green et al, 2008).
  • Hours of availability for medical visits. Some lower income people are not able to make doctor appointments scheduled during regular working hours because their jobs do not provide the benefit of paid time off for sick or other leave.

  Strategies to address these considerations:

  • Arrange for transportation. Helping to arrange an escort or providing shuttle service to and from the screening site could decrease transportation barriers to screening (Green, 2008).
  • Provide affordable tests. People will not undergo screening if the test is not affordable, so it is critical to provide tests and treatment options free of charge or at low cost. Arranging for free or more affordable access to screening preparation medication could decrease barriers to screening (Green, 2008). People must also know how to access affordable treatment if they receive a positive result (Natale-Pereira, 2008).
  • Improve provider recommendations. It is important to train health care providers to recommend screenings to all eligible and at-risk patients. Providers must also be able recommend low-cost or free resources to lower income communities.
  • Increase knowledge. In order to decrease fear and misunderstanding, it is important to educate lower income populations about colorectal cancer prevention and screenings. 
  • Flexible hours for screenings. Work with health care providers to offer evening or weekend appointments.

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