Jesse Tran

Date of Award

January 2017

Document Type


Degree Name

Doctor of Philosophy (PhD)


Teaching & Learning

First Advisor

Steven LeMire


Background. Colorectal cancer (CRC) is the third most commonly diagnosed type of cancer in North Dakota. It also ranks second in late-stage diagnosis among all cancers. High quality screening tests such as colonoscopy have shown to reduce CRC incidence significantly, but screening rates in North Dakota remain low. The literature is consistent in that a recommendation by a healthcare provider is the most influential factor in a patient’s decision to screen.

Purpose. The purpose of this dissertation was to understand how healthcare providers perceive the barriers and facilitators that affect their decision to make CRC screening recommendations to patients. Identifying educational concepts and strategies that can be used to address needs and gaps uncovered in this study is also a priority.

Sample. A total of 43 out of 55 clinics that provide primary care services in North Dakota was invited to participate in the survey. The sample was one of convenience as the survey was distributed to the 201 healthcare providers practicing at these clinics. There was a total of 74 completed responses for a response rate of 37 percent.

Method. A survey was used to collect data from participants on their perceptions of patient-, provider-, and systems-level barriers and facilitators. Descriptive statistics were used to analyze perceptions of providers on individual items. Directional t-tests were used to test for an effect between the independent variable of whether the provider had completed a CRC screening test or not and the dependent variables of the six constructs

of patient-, provider-, and systems-level barriers and facilitators. Linear regression was used to test for a correlation between providers’ attitudes on the efficacy of CRC screening tests and the six constructs.

Results. No statistical significance was found in the analysis using t-tests. Significance was found using linear regression between the independent variable of the provider’s attitude on the efficacy of immunochemical fecal occult blood test/fecal immunochemical test (iFOBT/FIT) and the constructs of systems barriers, provider facilitators, and systems facilitators. The descriptive analysis did reveal practical insight that can be used to address needs and gaps as well as enhance current practice.

Keywords: barriers, cancer, colorectal, education, facilitators, healthcare providers, screening, tests