Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Sarah Wackerbarth

Committee Member

Dr. Jennifer Redmond Knight

Committee Member

Dr. Robin Vanderpool


In eastern Kentucky, some communities experience colorectal cancer (CRC) mortality rates as high as 25.9 deaths per 100,000 people as compared to the national rate of 14.8 deaths per 100,000 people (NCI, 2018; Kentucky Cancer Registry, 2018). Innovative screening mechanisms, coupled with patient navigation services, may be the key to increasing screening rates and preventing unnecessary deaths in the region. The current study focuses on the accounts of patient navigators (n = 9) to identify the essential ingredients for addressing barriers to CRC screening cited by Appalachian Kentucky patients. Using the core tenants of effective patient navigation programs (Freeman & Rodriguez, 2011) and uncertainty and communication privacy management theories (Brashers, 2001; Petronio, 2002), data were analyzed using a qualitative framework analysis methodology (Ritchie & Spencer, 1994). Six primary themes were discovered including (a) common (and seemingly insurmountable) barriers to navigation; (b) facilitating navigation through the system using relational capital; (c) managing uncertainty using education, social support, and emotional appeals; (d) countering uncertainty and privacy concerns with stories and help from friends and family; (e) accommodating and supporting patients to manage privacy concerns; and (e) honest advice for future navigators. Findings from this study may be used to inform future patient navigation programs in regions similar to Appalachia and catalyze future research efforts.

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