While recent rates of colorectal cancer (CRC) screening have improved in Appalachian Kentucky due to public health efforts, they remain lower compared to both KY as a whole, and the USA. Suboptimal screening rates represent a missed opportunity to engage in early detection and prevention. The purpose of this study is to determine the impact that lack of knowledge has on psychological barriers (e.g., fear and embarrassment) to CRC screening as well as the potential effect of a psychosocial intervention to reduce these barriers. Participants were recruited through faith-based organizations and other community sites. After randomizing participants to either an early or delayed group, a faith-based group education and motivational interviewing intervention was administered. Existing and pilot tested instruments were used to assess knowledge and potential psychological barriers. Data were analyzed using paired t tests and linear regression. We hypothesized that (1) psychological barriers are associated with inadequate knowledge and (2) the intervention, by improving knowledge, could reduce these barriers and increase screening rates. There was a small but significant reduction in psychological barriers (−0.11, p value = 0.015) and moderate increases in CRC knowledge scores (+0.17, p value = 0.06). There was no evidence that the intervention affected these measures (+0.10, p value = 0.58). The relationship between lower barrier scores and increased knowledge was significant at follow up (−0.05, 95% CI (−0.09, −0.00)). An increase in CRC knowledge was correlated with a small but significant decrease in psychological barriers, although there was no evidence that these changes were associated with one another. Future cognitive-based interventions may be effective in increasing CRC knowledge and reducing barriers, but new intervention approaches should be considered.

Original languageEnglish
Pages (from-to)325-332
Number of pages8
JournalJournal of Cancer Education
Issue number1
StatePublished - Feb 2023

Bibliographical note

Funding Information:
Support for this research was provided by National Institutes of Health/National Center on Minority Health and Health Disparities for “Faith Moves Mountains: A CBPR Appalachian Wellness & Cancer Prevention Program.” (Schoenberg R24 MD002757). Support was also provided by the Markey Cancer Center’s Appalachian Career Training in Oncology Program (R25 CA221765).

Publisher Copyright:
© 2022, The Author(s) under exclusive licence to American Association for Cancer Education.


  • Barriers
  • Colorectal cancer
  • Rural Appalachia
  • Screening

ASJC Scopus subject areas

  • Oncology
  • Public Health, Environmental and Occupational Health


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