Association of Healthcare Barriers With Prostate-specific Antigen Screening Among African-American and Afro-Caribbean Men

Abstract

To evaluate the association between the barriers to healthcare access and prostate-specific antigen (PSA) screening practices among African-American and Afro-Caribbean men. Stratified cluster sampling of census tracts in Brooklyn, New York yielded 533 men, aged 45-70 years. The men were classified into the following groups: U.S.-born white, U.S.-born African-American, Jamaican, and Trinidadian/Tobagonian. The subjects completed a written 6-item survey assessing the healthcare barriers. Overall, 27% of men reported never having had a PSA test and 28% reported that they had received annual PSA screening. On multivariate analysis, those who viewed the healthcare system as convenient were more likely to report an initial PSA test (odds ratio 1.8, P < .05). Those who perceived difficulty in accessing reliable care were less likely to ever have had a PSA test (odds ratio 0.6, P < .05). Subjects who had not had a comprehensive discussion with their physician about prostate cancer were less likely to have had an initial PSA test and more likely to have maintained annual PSA screening (odds ratio 0.3 and 1.7, respectively, P < .05). We identified 2 novel perceived barriers to prostate cancer screening: men who experience the healthcare system as inconvenient were less likely to initiate PSA testing, and those who found it difficult to obtain quality care were less likely to ever have had a PSA test. The perceived system barriers were more closely linked to PSA screening behavior than were the measures assessing perceptions of self-efficacy. Our results suggest that a broader discussion by physicians that addresses the perceptions regarding the healthcare system might enhance the understanding of, and increase the use of, prostate cancer screening among higher risk minority men.