# Understanding Barriers to Colon Cancer Screening Among Individuals Experiencing Housing Insecurity in Los Angeles

## TL;DR

This study explores why people without stable housing in Los Angeles avoid colon cancer screening and finds that having health insurance and a primary care provider helps increase screening rates.

## Contribution

The study identifies barriers to CRC screening among unhoused individuals and evaluates the impact of a brief educational intervention.

## Key findings

- Fewer than 50% of respondents aged 45 or older had a primary care provider or underwent CRC screening.
- Patients with health insurance and a PCP were more likely to have completed CRC screening.
- A brief educational intervention improved CRC screening knowledge and self-efficacy.

## Abstract

Background: Cancer is a leading cause of death among unhoused people, and the limited prior studies on colorectal cancer (CRC) screening in this group have shown low rates of screening compared to the general population.

Methods: Physicians administered surveys to patients at the University of California, Los Angeles Mobile Clinic who were experiencing homelessness or housing insecurity to determine rates of prior CRC screening, establish a baseline understanding of CRC screening, and elucidate barriers to screening. Physicians also administered a brief educational intervention about CRC screening and then administered a post-intervention survey to assess changes in participants’ understanding and preferences related to CRC screening.

Results: A total of 44 patients completed both the pre- and post-surveys and the educational intervention. Fewer than 50% of respondents aged 45 or older had a primary care provider (PCP) (n = 21) or had undergone CRC screening (n = 13). Patients who had health insurance - and particularly those who had a PCP - were more likely to have been offered and to have completed screening. CRC screening knowledge and self-efficacy increased after the brief educational intervention.

Conclusion: Helping unhoused patients obtain health insurance and establish care with a PCP may create opportunities to discuss preventive care and improve CRC screening rates.