Do benefits and barriers differ by stage of adoption for colorectal cancer screening?

Familial risk and colorectal cancer screening health beliefs and attitudes in an insured population

OBJECTIVE

To examine the relationship between health beliefs and attitudes toward colorectal cancer screening, strength of family history risk, and being appropriately screened for colorectal cancer.

METHODS

In February 2004, 7000 randomly selected members of a multi-specialty group practice located in Boston, MA were mailed a brief survey that was used to ascertain colorectal cancer family history. A follow-up survey that contained questions representing selected constructs of the Health Belief Model, Theory of Planned Behavior, and healthcare experiences was then mailed to all 355 individuals who reported a family history in the initial survey and 710 randomly selected participants with no colorectal cancer family history.

RESULTS

Participants who were appropriately screened had higher mean scores for perceived cancer risk, subjective norms, and perceived benefits and lower scores for perceived barriers. Multivariate findings indicate that having high perceptions of risk for colorectal cancer was a significant correlate of being screened appropriately among individuals with a strong family history.

CONCLUSIONS

For those at greatest colorectal cancer risk due to family history, ensuring that these individuals understand their personal risk might lead to increased colorectal cancer screening participation. Future intervention research is warranted to examine if raising perceptions of risk can increase screening behaviors in individuals with colorectal cancer risk due to family history.

Perceptions of colon cancer screening by stage of screening test adoption

Colorectal cancer remains the second leading cause of cancer death in the United States. To fully realize the benefits of early detection of colorectal cancer, screening rates must improve. This study assessed differences in beliefs (from the Health Belief Model) by stage of screening behavior adoption (based on the Transtheoretical Model of Change) as a foundation for intervention development. More people were in the precontemplation stage (not thinking about having the screening test) for fecal occult blood test and sigmoidoscopy versus contemplation (thinking about having the test) or action (adherent with screening). Those in precontemplation stage for fecal occult blood test had lower perceived risk than those in contemplation, lower perceived benefits than those in action, and higher barriers than both those in contemplation and those in action. For sigmoidoscopy stage of readiness, again, precontemplators had lower perceived risk and self-efficacy than contemplators and higher barriers than both contemplators and actors. Given the popularity of the transtheoretical model and the success of stage-based interventions to increase other cancer screening, especially mammography, we should begin to translate such effective interventions to colorectal cancer screening. As such, this study is one of very few to quantify beliefs across stages of colorectal cancer and identify significant differences across stages, laying the foundation for the development and testing of stage-based interventions.

Reliability and Validity of the Colorectal Cancer Screening Belief Scale in Turkey

Colorectal cancer is the third leading cause of cancer death in Turkey. The emphasis of the healthcare services in Turkey is on curative rather than preventive and rehabilitative approaches. Although the Ministry of Health provides many healthcare services for prevention and early detection, their availability and accessibility are very low. The purpose of this study was to test the reliability and validity of the Turkish language version of Champion's Health Belief Model Scales in measuring Turkish women's and men's beliefs about colorectal cancer. This study was carried out in Izmir, the third most populous city in Turkey. The Champion's Health Belief Model Scales was translated using a back-translation technique. A convenience sample of 470 individuals was recruited from January 2004 through March 2004. Descriptive statistics were computed for the demographic characteristics. Reliability was assessed by interpreting the item-total subscale score correlation, test-retest reliability, and Cronbach alpha coefficients. For testing the relationship between item performance and scale performance, corrected item-total correlations ranged from 0.41 to 0.79 for all 5 subscales. Cronbach alpha coefficients for the 5 subscales ranged between .54 and .88, and test-retest reliability coefficients ranged from 0.72 to 0.91. The study showed that the Turkish version of the Champion's Health Belief Model Scales has good structural characteristics and is a reliable and valid instrument that can be used for measuring beliefs related to colorectal cancer.

Factors associated with intentions to adhere to colorectal cancer screening follow-up exams

Background

To increase adherence rate to recommendations for follow-up after abnormal colorectal cancer (CRC) screening results, factors that inhibit and facilitate follow-up must be identified. The purpose of this study was to identify the factors associated with intention to adhere to CRC screening follow-up exams.

Methods

During a 4-week period in October 2003, this survey was conducted with 426 subjects participating in a community-based CRC screening program in Nagano, Japan. Study measures included intention to adhere to recommendation for clinical follow-up in the event of an abnormal fecal occult blood test (FOBT) result, perceived susceptibility and severity of CRC, perceived benefits and barriers related to undergoing follow-up examination, social support, knowledge of CRC risk factors, health status, previous CRC screening, personality and social demographic characteristics. Univariate and multivariate logistic regression analyses on intention to adhere to recommendations for follow-up were performed.

Results

Among the 288 individuals analyzed, approximately 74.7% indicated that they would definitely adhere to recommendations for follow-up. After controlling for age, gender, marital status, education, economic status, trait anxiety, bowel symptoms, family history of CRC, and previous screening FOBT, analyses revealed that lower levels of perceived barriers, higher levers of perceived benefits and knowledge of CRC risk factors were significantly associated with high intention respectively.

Conclusion

The results of this study suggest that future interventions should focus on reducing modifiable barriers by clarifying misperceptions about follow-up, promoting the acceptance of complete diagnostic evaluations, addressing psychological distress, and making follow-up testing more convenient and accessible. Moreover, educating the public regarding the risk factors of CRC and increasing understanding of the benefits of follow-up is also important.

Promoting culturally appropriate colorectal cancer screening through a health educator: a randomized controlled trial

BACKGROUND

Colorectal cancer (CRC) is a leading cause of cancer mortality in the US. Surveys reveal low CRC screening levels among Asians in the US, including Chinese Americans.

METHODS

A randomized controlled trial was conducted with Chinese patients to evaluate a clinic-based, culturally and linguistically appropriate intervention promoting fecal occult blood test (FOBT) screening. The multifaceted intervention included a trilingual and bicultural health educator, bilingual materials (a video, a motivational pamphlet, an informational pamphlet, and FOBT instructions), and three FOBT cards. Patients in the control arm received usual care. Our primary outcome measure was FOBT screening within 6 months after randomization. The proportion of FOBT completion in the intervention and control arms was compared by using a chi-square test, and logistic regression analysis was performed to adjust for the effects of sociodemographic variables and prior screening history. Potential effect modifications were also tested by using logistic regression models.

RESULTS

Our intervention had a strong effect on FOBT completion (intervention group, 69.5%; control group, 27.6%), and the adjusted odds of FOBT slightly increased to over 6-fold greater in the intervention arm compared with the control arm. No effect modification by age, gender, language, insurance, or prior FOBT was found.

CONCLUSIONS

The authors' multifaceted, culturally appropriate intervention significantly increased FOBT screening in a group of low-income and less-acculturated minority patients. Given the large effect size, future research should determine the effective core component(s) that can increase CRC screening in both the general and minority populations.

Secondary prevention of cancer

OBJECTIVES

To review criteria for mass cancer screening among asymptomatic populations and barriers to secondary prevention of breast, cervical, and colorectal cancers. To describe challenges to implementing theoretically based interventions to increase appropriate cancer screening, follow-up, and surveillance.

DATA SOURCES

Published journal articles, text books, and epidemiologic reports.

CONCLUSION

Interventions to increase breast, cervical, and colorectal cancer screening participation must be approached from a systems perspective that includes patient, health care provider, and health care system variables.

IMPLICATIONS FOR NURSING PRACTICE

Understanding the array of factors that impede progress in the secondary prevention of cancer is necessary to improve care. Nurses have an important role in decreasing morbidity and mortality from breast, cervical, and colorectal cancers.