Abstract
<title>Abstract</title> <p>Background Colorectal cancer (CRC) screening remains uneven across immigrant and language-minority populations. South Asian adults may face knowledge, communication, and psychosocial barriers despite access to care. Aims To compare CRC knowledge and psychosocial barriers between a South Asian community cohort and an internal medicine clinic cohort and identify factors associated with CRC knowledge. Methods Adults aged 18 years or older completed an anonymous cross-sectional survey between September 2025 and April 2026 at South Asian-serving community sites or an internal medicine clinic in the New York metropolitan area. Primary outcomes were having heard of CRC, awareness of CRC screening tests, and correctly answering that women can develop CRC. Psychosocial barriers were assessed using 1–5 Likert-scale items. Multivariable logistic regression identified factors associated with CRC knowledge outcomes. Results The analysis included 223 respondents: 126 in the South Asian community cohort and 97 in the clinic cohort. The community cohort had lower CRC awareness (59.7% vs 76.0%; p = 0.011), lower knowledge that women can develop CRC (39.8% vs 65.5%; p < 0.001), and higher cancer taboo (2.7 vs 2.0; p < 0.001) and modesty scores (3.2 vs 2.5; p < 0.001). Direct religious objection was uncommon. English-only language preference was independently associated with having heard of CRC (adjusted odds ratio 3.91), awareness of screening tests (3.72), and knowledge that women can develop CRC (2.93), all p < 0.001. Conclusions CRC knowledge gaps and psychosocial barriers persisted despite high reported healthcare access. Language preference was strongly associated with knowledge but should not be viewed as the sole barrier, supporting interventions that pair linguistically responsive education with culturally responsive, modesty-sensitive counseling and proactive clinician engagement.</p>