JMIR Publications

ABSTRACT

Background:

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the US. Early detection via routine CRC screening of visual or stool-based testing can significantly lower risks for morbidity and mortality of CRC at the population level. Public health initiatives to promote CRC screening utilization between 2000-2015 produced CRC screening rates that nearly doubled for some US adults. However, rates of CRC screening remain lowest for adults ages 45-49 (20%), patients of safety-net healthcare facilities (42%), adults without insurance (44%) and various other subgroups when compared to national averages (72%). Given the evolving landscape of digital healthcare and growing trends in online health information seeking behaviors, leveraging existing online medical record (OMR) systems within healthcare settings may be an underutilized resource to facilitate CRC screening promotion and patient utilization. Examining patterns of behavior of OMR use and CRC screening utilization may provide insight for design and development of digital, CRC interventions to address remaining disparities.

Objective:

This study was designed to examine the association of accessing an OMR with CRC screening utilization and corresponding sociodemographic characteristics of US adults.

Methods:

In 2023, we conducted a secondary data analysis using a pooled, weighted sample from HINTS 5 Cycles, 2, 3, and 4 (2018-2020). We analyzed the association between sociodemographic characteristics (e.g. age, income, race/ethnic identity), medical conditions (e.g. diabetes), OMR access, and CRC screening behaviors via logistic regression.

Results:

The sample included adults aged 45-75 years. Mean age was 59 years (SD: 8) for those who reported CRC screening and 52 years (SD: 6) for those never screened. Nearly 70% of participants reported CRC screening and 52% reported OMR access in the past year. Adjusted odds of CRC screening were higher among non-Hispanic African American/Black adults compared to non-Hispanic White adults (OR: 1.76, 95% CI: 1.22 - 2.53), adults who accessed an OMR (OR: 1.89, 95% CI: 1.45 - 2.46), older individuals (OR: 1.18, 95% CI: 1.16 - 1.21), the insured (OR: 3.69, 95% CI: 2.34 - 5.82), and those with a professional or graduate degree vs those with a high school diploma or less (OR: 2.65, 95% CI: 1.28 - 5.47).

Conclusions:

Promoting access to OMRs — especially among the most disadvantaged Americans — may assist in reaching national screening goals. Emphasis can and should be made on the mutability of OMR use, as compared to most other statistically significant associations with CRC screening behaviors above. OMR access provides an intervenable means of promoting CRC education and screening, especially among those who experience structural barriers and inequities to cancer diagnoses and systems of care. Future research should center tailored and technologically accessible interventions that educate and expand on OMR access.