Sociocultural Differences and Colorectal Cancer Screening Among African American Men and Women

Kelly Brittain

Carol Loveland-Cherry

Laurel Northouse

Cleopatra H. Caldwell

Jacquelyn Y. Taylor

African American, colorectal cancer
ONF 2011, 39(1), 100-107. DOI: 10.1188/12.ONF.100-107

Purpose/Objectives: To examine sociocultural factors that influence an informed decision about colorectal cancer (CRC) screening among African American men and women.

Design: Descriptive, cross-sectional.

Setting: A medical center, a National Cancer Institute-designated comprehensive cancer center, and various social organizations and barbershops in a midwestern city of the United States.

Sample: A purposive sample of African American women (n = 65) and African American men (n = 64) aged 50 years and older.

Methods: Participants completed a self-administered survey.

Main Research Variables: Cultural identity, CRC beliefs, family support, and informed decision.

Findings: Family support was positively related to CRC beliefs among participants, and CRC beliefs were positively related to an informed decision. However, among men, family support positively related to an informed decision about CRC screening. In addition, t-test results indicated that the men and women were significantly different. Family support predicted CRC beliefs among men (p < 0.01) and women (p < 0.01). CRC beliefs predicted CRC screening informed decisions among men (p < 0.01) and women (p < 0.05). However, the accounted variance was dissimilar, suggesting a difference in the impact of the predictors among the men and women.

Conclusions: Family support has a significant impact on CRC beliefs about CRC screening among African Americans. However, how men and women relate to the variables differs.

Implications for Nursing: To improve CRC screening rates, informed decision-making interventions for African Americans should differ for men and women and address family support, CRC beliefs, and elements of cultural identity.

Jump to a section


    American Cancer Society. (2011). Colorectal cancer facts and figures 2011-2013. Atlanta, GA: Author.
    Becker, G., Gates, R. J., & Newsom, E. (2004). Self-care among chronically ill African Americans: Culture, health disparities, and health insurance status. American Journal of Public Health, 94, 2066-2073. doi:10.2105/AJPH.94.12.2066
    Billingsley, A., & Caldwell, C. H. (1991). Socialization forces affecting the education of African American youth in the 1990s. Journal of Negro Education, 60, 427-440. doi:10.2307/2295494
    Brenes, G. A., & Paskett, E. D. (2000). Predictors of stage of adoption for colorectal cancer screening. Preventive Medicine, 31, 410-416. doi:10.1006/pmed.2000.0729
    Briss, P., Rimer, B., Reilley, B., Coates, R. C., Lee, N. C., Mullen, P., … Lawrence, R. (2004). Promoting informed decisions about cancer screening in communities and healthcare systems. American Journal of Preventive Medicine, 26(1), 67-80. doi:10.1016/j.amepre.2003.09.012
    Brittain, K., Taylor, J. Y., & Wu, C. Y. (2010). Family adaptability and cohesion and high blood pressure among urban African American women. Journal for Nurse Practitioners, 6, 786-793. doi:10.1016/j.nurpra.2010.02.005
    Brown, M. L. (2001). The effects of environmental tobacco smoke on children: Information and implications for PNPs. Journal of Pediatric Health Care, 15, 280-286. doi:10.1067/mph.2001.116492
    Courtenay, W. H. (2000). Engendering health: A social constructionist examination of men's health beliefs and behaviors. Psychology of Men and Masculinity, 1(1), 4-15. doi:10.1037/1524-9220.1.1.4
    Courtenay, W. H. (2003). Key determinants of the health and the well-being of men and boys. International Journal of Men's Health, 2(1), 1-27.
    Dolan, J. G., & Frisina, S. (2002). Randomized controlled trial of a patient decision aid for colorectal cancer screening. Medical Decision Making, 22, 125-139. doi:10.1177/0272989X0202200210
    Erdfelder, E., Faul, F., & Buchner, A. (1996). GPOWER: A general power analysis program. Behavior Research Methods, Instruments, and Computers, 28, 1-11. doi:10.3758/BF03203630
    Galdas, P. M., Cheater, F., & Marshall, P. (2005). Men and health help-seeking behaviour: Literature review. Journal of Advanced Nursing, 49, 616-623. doi:10.1111/j.1365-2648.2004.03331.x
    Green, P. M., & Kelly, B. A. (2004). Colorectal cancer knowledge, perceptions, and behaviors in African Americans. Cancer Nursing, 27, 206-215. doi:10.1097/00002820-200405000-0004
    James, A. S., Campbell, M. K., & Hudson, M. A. (2002). Perceived barriers and benefits to colon cancer screening among African Americans in North Carolina: How does perception relate to screening behavior? Cancer Epidemiology, Biomarkers and Prevention, 11, 529-534.
    Jernigan, J. C., Trauth, J. M., Neal-Ferguson, D., & Cartier-Ulrich, C. (2001). Factors that influence cancer screening in older African American men and women: Focus group findings. Family and Community Health, 24(3), 27-33.
    Kim-Goodwin, Y. S. (2004). Family roles. In P. J. Bomar (Ed.), Promoting health in families: Applying family research and theory to nursing practice (pp. 117-141). Philadelphia, PA: Saunders.
    Kinney, A. Y., Bloor, L. E., Martin, C., & Sandler, R. S. (2005). Social ties and colorectal cancer screening among Blacks and Whites in North Carolina. Cancer Epidemiology, Biomarkers and Prevention, 14, 182-189.
    Leard, L. E., Savides, T. J., & Ganiats, T. G. (1997). Patient preferences for colorectal cancer screening. Journal of Family Practice, 45, 211-218.
    Ling, B. S., Moskowitz, M. A., Wachs, D., Pearson, B., & Schroy, P. C. (2001). Attitudes toward colorectal cancer screening tests. Journal of General Internal Medicine, 16, 822-830.
    Loveland-Cherry, C. J. (2005). Alcohol, children, and adolescents. In J. S. Stevenson & M. S. Sommers (Eds.), Annual review of nursing research: Alcohol use, misuse, abuse, and dependence (vol. 23, pp. 135-177). New York, NY: Springer.
    Lukwago, S. N., Kreuter, M. W., Bucholtz, D. C., Holt, C. L., & Clark, E. M. (2001). Development and validation of brief scales to measures collectivism, religiosity, racial pride, and time orientation in urban African American women. Family and Community Health, 24(3), 63-71.
    Marteau, T. M., Dormandy, E., & Michie, S. (2001). A measure of informed choice. Health Expectations, 4, 99-108. doi:10.1046/j.1369-6513.2001.00140.x
    Meissner, H. I., Breen, N., Klabunde, C. N., & Vernon, S. W. (2006). Patterns of colorectal cancer screening uptake among men and women in the United States. Cancer Epidemiology, Biomarkers and Prevention, 15, 389-394. doi:10.1158/1055-9965.EPI-05-0678
    Myers, R. E. (2005). Decision counseling in cancer prevention and control. Health Psychology, 24(4, Suppl.), S71-S77.
    Myers, R. E., Daskalakis, C., Cocroft, J., Kunkel, E. J., Delmoor, E., Liberatore, M., … Powell, R. L. (2005). Preparing African American men in community primary care practices to decide whether or not to have prostate cancer screening. Journal of the National Medical Association, 97, 1143-1154.
    Myers, R. E., Vernon, S. W., Tilley, B. C., Lu, M., & Watts, B. G. (1998). Intention to screen for colorectal cancer among white male employees. Preventive Medicine, 27, 279-287. doi:10.1006/pmed.1998.0264
    Novilla, M. L., Barnes, M. D., De La Cruz, N. G., Williams, P. N., & Rogers, J. (2006). Public health perspectives on the family: An ecological approach to promoting health in the family and community. Family and Community Health, 29(1), 28-42.
    Powe, B. D., Faulkenberry, R., & Harmond, L. (2010). A review of intervention studies that seek to increase colorectal cancer screening among African Americans. American Journal of Health Promotion, 25, 92-99. doi:10.4278/ajhp.080826-LIT-162
    Rimer, B. K., Briss, P. A., Zeller, P. K., Chan, E. C., & Woolf, S. H. (2004). Informed decision making: What is its role in cancer screening? Cancer, 101(5, Suppl.), 1214-1228. doi:10.1002/cncr.20512
    Russell, K. M., Perkins, S. M., Zollinger, T. W., & Champion, V. L. (2006). Sociocultural context of mammography screening use. Oncology Nursing Forum, 33, 105-112. doi:10.1188/06.ONF-112
    Sandman, D., Simantov, E., & An, C. (2000). Out of touch: American men and the healthcare system. New York, NY: Commonwealth Fund.
    Seeff, L. C., Nadel, M. R., Klabunde, C. N., Thompson, T., Shapiro, J. A., Vernon, S. W., & Coates, R. J. (2004). Patterns and predictors of colorectal cancer test use in the adult U. S. population. Cancer, 100, 2093-2103. doi:10.1002/cncr.20276
    Sherbourne, C. D., & Stewart, A. L. (1991). The MOS Social Support Survey. Social Science and Medicine, 32, 705-714. doi:10.1016/0277-9536(91)90150-B
    Stone, E. G., Morton, S. C., Hulscher, M. E., Maglione, M. A., Roth, E. A., Grimshaw, J. M., … Shekelle, P. G. (2002). Interventions that increase use of adult immunization and cancer screening services: A meta-analysis. Annals of Internal Medicine, 136, 641-651.
    Underwood, S. M., Powe, B., Canales, M., Meade, C. D., & Im, E. (2004). Cancer in U. S. ethnic and racial minority populations. In A. M. Villarruel & C. P. Porter (Eds.), Annual review of nursing research: Eliminating health disparities among racial and ethnic minorities in the United States (vol. 22, pp. 217-263). New York, NY: Springer.
    U. S. Census Bureau. (2005-2009). American Community Survey 5-year estimates. Retrieved from
    Ward, B. W., Barnes, P. M., Freeman, G., & Schiller, J. S. (2011). Early release of selected estimates based on data from the 2010 National Health Interview Survey. Retrieved from
    Wolf, A. M., & Schorling, J. B. (2000). Does informed consent alter elderly patients' preferences for colorectal cancer screening? Results of a randomized trial. Journal of General Internal Medicine, 15, 24-30. doi:10.1046/j.1525-1497.2000.01079.x
    Wolf, R. L., Zybert, P., Brouse, C. H., Neugut, A. I., Shea, S., Gibson, G., … Basch, C. E. (2001). Knowledge, beliefs, and barriers relevant to colorectal cancer screening in an urban population: A pilot study. Family and Community Health, 24(3), 34-47.