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Beyond Access: Language, Knowledge, and Psychosocial Barriers to Colorectal Cancer Screening in a South Asian Community Cohort

Despite high healthcare access, South Asian adults in a New York metropolitan cohort demonstrated significantly lower colorectal cancer knowledge and higher psychosocial barriers compared to a clinic-based group, with English language preference strongly associated with awareness while cultural factors like modesty and cancer taboos remained critical obstacles requiring culturally responsive interventions.

Original authors: Abrahim Mahmood, Aimaloghi Eromosele, Blanca Sckell, Elizabeth Brondolo, Constantine Fisher

Published 2026-08-12

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Abrahim Mahmood, Aimaloghi Eromosele, Blanca Sckell, Elizabeth Brondolo, Constantine Fisher

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine the human body as a bustling city, and the colon (the large intestine) as the city's main waste-processing plant. Sometimes, tiny, unwanted weeds called polyps start growing in this plant. If left alone, these weeds can turn into a big, dangerous mess known as colorectal cancer. The good news is that we have a "weed-whacker" called screening. This is a check-up that finds and removes the weeds before they cause trouble, keeping the city safe. Scientists have known for a long time that this check-up works wonders, but not everyone in the city gets the invitation to come in for a cleaning.

In this story, we are looking at a specific neighborhood: the South Asian community in the New York area. Researchers wanted to know why some people in this neighborhood weren't getting their "weed-whacking" check-ups, even though they seemed to have everything they needed to get there. They were looking for three main things: Knowledge (do you know the weeds exist?), Psychosocial Barriers (are you scared, embarrassed, or think it's a bad topic to talk about?), and Access (do you have a ticket to the clinic?). The big question was: Is the problem that people can't get to the clinic, or is it that they don't know they should go, or maybe they just feel too shy to talk about it?

The Great Screening Mystery: A Tale of Two Groups

Think of this study as a detective story where the investigators are trying to solve a mystery about why a specific group of people isn't getting a life-saving health check-up. The detectives gathered two groups of people to compare notes. One group was a Community Cohort, recruited from places like a senior center and a mosque in Queens and Long Island. The other was a Clinic Cohort, recruited from the waiting room of an internal medicine doctor's office in Queens.

The researchers asked everyone the same questions, like a giant, anonymous quiz. They wanted to see if the community group knew less about the "weed-whacker" (screening) and if they felt more awkward or scared about it than the people already sitting in the doctor's office.

What the Clues Revealed

The results were like finding a hidden map that showed exactly where the roadblocks were.

1. The Knowledge Gap
The community group was significantly less likely to have heard of colorectal cancer compared to the clinic group. Only about 59.7% of the community folks had heard of it, while 76.0% of the clinic folks had. Even more surprising was a specific misconception: the community group was much less likely to know that women can get this cancer. Only 39.8% of the community group got this right, compared to 65.5% of the clinic group. It's as if the community group thought the "weed-whacker" was only for men, which is a big misunderstanding!

2. The "Shy" Factor (Psychosocial Barriers)
This is where the story gets interesting. Even though both groups said they had health insurance and a regular doctor (so they could get to the clinic), the community group felt much more uncomfortable.

Cancer Taboo: The community group gave higher scores to the idea that cancer is a "forbidden" or taboo topic.
Modesty: They also scored higher on "modesty concerns." Imagine feeling like you have to take your clothes off to talk about your bathroom habits; for this group, that feeling was much stronger than for the clinic group.
Fatalism: Some in the community group felt a bit more like, "If it's meant to happen, it will happen," rather than believing they could do something to change it.

3. The "Religion" Red Herring
The researchers wondered if religion was the main villain here. They asked, "Does your religion say you can't get screened?" The answer? No. Very few people (only about 4%) said religion was a direct objection. So, the idea that "faith stops them from getting checked" was ruled out. The real barriers were more about culture, shyness, and not knowing the facts, not about religious rules.

4. The Language Key
The biggest clue of all was language. The study found that people who preferred to speak only English were much more likely to know about the cancer and the screening. In fact, speaking only English was linked to being nearly 4 times more likely to have heard of the cancer and 3.7 times more likely to know about the screening tests. This suggests that language is a huge key to unlocking knowledge, but it's not the only key.

What This Means for the Future

The study suggests that simply building more clinics or giving people insurance isn't enough. The community group already had those things! The problem is a mix of not knowing the facts (especially that women are at risk) and feeling too shy or embarrassed to talk about it.

The researchers found that the strongest thing that could get people to go for a check-up was a doctor personally telling them to do it. In both groups, when a doctor said, "You need this," people were much more likely to listen.

So, the solution isn't just translating a brochure into another language. It's about having doctors who are willing to have open, gentle conversations that respect people's modesty, explain clearly that women need this check-up too, and actively invite them in. It's about turning a scary, taboo topic into a normal, manageable part of staying healthy. The paper suggests that if we can bridge the gap in knowledge and make people feel less shy, we can help more people in this community get their "weed-whacking" check-ups and keep their city safe.

Technical Summary: Beyond Access: Language, Knowledge, and Psychosocial Barriers to Colorectal Cancer Screening in a South Asian Community Cohort

Problem Statement
Colorectal cancer (CRC) screening uptake remains uneven across immigrant and language-minority populations, particularly among South Asian subgroups in the United States. While prior literature identifies barriers such as limited awareness, low health literacy, and cultural stigma, many studies aggregate diverse Asian subgroups or fail to distinguish structural access barriers from knowledge and psychosocial factors. Furthermore, the specific role of direct religious objection versus broader cultural taboos and modesty concerns remains under-explored in local, heterogeneous metropolitan settings like the New York area. This study addresses the gap in understanding whether disparities in CRC screening readiness persist among South Asian adults despite high reported access to healthcare, and seeks to identify the specific interplay of language, knowledge, and psychosocial factors driving these disparities.

Methodology
The researchers conducted an anonymous, cross-sectional survey between September 2025 and April 2026 in the New York metropolitan area. The study utilized a convenience sampling strategy to recruit two distinct cohorts:

South Asian Community Cohort ( $n=126$ ): Recruited from a senior center and a mosque-based community site in Queens and Long Island.
Internal Medicine (IM) Clinic Cohort ( $n=97$ ): Recruited from an outpatient internal medicine clinic in Queens.

Both groups completed the same survey instrument before any educational intervention was provided. The study population consisted of adults aged 18 and older. A total of 223 respondents were included in the primary analysis after excluding 31 surveys from a mixed-population church site.

Key Measures and Analysis

Primary Outcomes: CRC knowledge metrics, specifically: (1) having heard of CRC, (2) awareness of CRC screening tests, and (3) correctly answering that women can develop CRC.
Psychosocial Barriers: Assessed via 1–5 Likert-scale items measuring cancer taboo, modesty concerns, embarrassment, fatalism (general, CRC-specific, and regarding the ability of action to change outcomes), and perceived conflict with religion.
Access and Facilitators: Self-reported health insurance, primary care provider (PCP) status, and physician recommendation for screening.
Statistical Approach: Descriptive statistics were used for baseline characteristics. Between-group comparisons utilized Welch's t-tests for continuous variables and chi-square or Fisher's exact tests for categorical variables. Multivariable logistic regression models were constructed to identify factors associated with the three primary knowledge outcomes, adjusting for cohort assignment, age, sex, and English-only language preference. Sensitivity analyses were performed to isolate the effects of access (insurance/PCP) and to exclude South Asian-origin respondents from the clinic cohort.

Key Results

Demographics: The South Asian community cohort was slightly older (mean age 64.8 vs. 60.9) and significantly more likely to prefer non-English or mixed languages (71.4% vs. 29.9%) compared to the clinic cohort. However, reported health insurance coverage and PCP access were high and statistically similar between both groups (>90%).
Knowledge Gaps: The South Asian community cohort demonstrated significantly lower CRC knowledge:
- Awareness of CRC: 59.7% vs. 76.0% ( $p=0.011$ ).
- Knowledge that women can develop CRC: 39.8% vs. 65.5% ( $p<0.001$ ).
- Awareness of screening tests: Numerically lower (68.3% vs. 74.0%), though not statistically significant ( $p=0.360$ ).
Psychosocial Barriers: The community cohort reported significantly higher scores for cancer taboo (2.7 vs. 2.0, $p<0.001$ ) and modesty concerns (3.2 vs. 2.5, $p<0.001$ ). Direct religious objection to screening was rare in both groups (~4%) and did not differ significantly.
Screening Engagement (Age 45–75): Among age-eligible respondents, the community cohort reported numerically lower physician recommendations (46.8% vs. 60.3%) and prior screening (38.3% vs. 54.8%), though these differences did not reach statistical significance. However, the community cohort significantly more frequently cited inadequate knowledge (52.8% vs. 34.8%) and lack of physician recommendation (43.4% vs. 19.7%) as barriers.
Multivariable Regression: After adjusting for age, sex, and cohort, English-only language preference remained the strongest independent predictor of all three knowledge outcomes (Adjusted Odds Ratios ranging from 2.93 to 3.91). In contrast, the independent association of South Asian community cohort membership with knowledge outcomes was largely attenuated; the cohort was not significantly associated with having heard of CRC or awareness of screening tests. The cohort remained associated with lower odds of correctly answering that women can develop CRC, though this finding did not reach statistical significance in the primary model (aOR 0.55, $p=0.063$ ).
Site-Based Heterogeneity: Within the South Asian cohort, respondents at the mosque-based site reported higher fatalism and scheduling difficulties compared to the senior center, though knowledge and modesty scores were similar across sites.

Significance and Claims
The paper claims that despite high reported structural access to healthcare (insurance and PCPs), significant disparities in CRC knowledge and psychosocial barriers persist within South Asian communities. The study posits that these disparities are driven less by access alone and more by the intersection of language preference, communication gaps, and culturally shaped psychosocial barriers such as modesty and cancer-related taboo.

Key contributions include:

Refining the Barrier Landscape: The study challenges the assumption that direct religious objection is a primary barrier, finding instead that broader cultural taboos and modesty concerns are more prevalent and significant.
The Role of Language: While English-only preference is strongly associated with higher knowledge, the authors caution against viewing language concordance as a sole solution. They argue that interventions must pair linguistically responsive education with culturally responsive, modesty-sensitive counseling.
Clinician Engagement: The findings reinforce that physician recommendation is a critical, modifiable facilitator. The study suggests that clinicians should not assume that insured, PCP-connected South Asian patients have received adequate screening counseling, particularly regarding the risk of CRC in women.
Nuanced Interventions: The authors advocate for interventions that explicitly address the misconception that CRC primarily affects men, utilize trusted community settings for outreach, and tailor approaches to specific sub-sites within the community (e.g., addressing fatalism in faith-based settings).

The paper concludes that addressing CRC screening disparities in South Asian populations requires a multifaceted approach that moves beyond simple access metrics to address the specific psychosocial and communicative nuances of the community.

The Great Screening Mystery: A Tale of Two Groups

What the Clues Revealed

What This Means for the Future

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