Measuring Factors Associated with Colorectal Cancer Screening among Young Adult African American Men: A Psychometric Study

Perceived economic pressure and colorectal cancer-related perceptions among U.S. males (aged 45-75)

PURPOSE

To examine whether a greater perception of economic pressure would be associated with more-negative attitudes, greater perceived barriers, and lower subjective norms regarding colorectal cancer (CRC) and CRC screening among males aged 45-75 years.

METHODS

We recruited 492 self-identified males aged 45-75 years living in the United States. We operationalized perceived economic pressure as a latent factor with three subscales: can't make ends meet, unmet material needs, and financial cutbacks. Our dependent variables were attitudes toward CRC and CRC screening, perceived barriers to completing a CRC screening exam, and subjective norms regarding CRC screening (e.g., how others value CRC screening). We tested a hypothesized model using structural equation modeling with maximum-likelihood estimation, adjusting for covariates, and made post-hoc modifications to improve model fit.

RESULTS

Greater perceived economic pressure was associated with more-negative attitudes toward CRC and CRC screening (β = 0.47, 95% CI: 0.37,0.57) and with greater perceived barriers to CRC screening (β = 0.22, 95% CI: 0.11, 0.34), but was not significantly associated with subjective norms (β = 0.07, 95% CI: - 0.05, 0.19). Perceived economic pressure was an indirect pathway by which lower-income and younger age were associated with more-negative attitudes and greater perceived barriers.

CONCLUSIONS

Our study is one of the first to show that, among males, perceived economic pressure is associated with two social-cognitive mechanisms (i.e., negative attitudes, greater perceived barriers) that are known to influence CRC screening intent and, ultimately, CRC screening completion. Future research on this topic should employ longitudinal study designs.

Factors associated with colorectal cancer screening intent and uptake among adult Non-Hispanic Black men

Non-Hispanic (NH) Black men in the United States have the lowest five-year colorectal cancer (CRC) survival rate across all racial/ethnic and sex subgroups and are less likely than their NH White counterparts to complete CRC screening. We hypothesized that greater masculinity barriers to medical care (MBMC) would be negatively associated with CRC screening uptake. Employing a survey design, we examined the MBMC scale and other psychosocial factors influencing CRC screening intent and uptake in a sample of 319 NH Black men aged 45 to 75 years residing in Minnesota, Ohio, and Utah. A series of ordinary least squares and logistic regression models were run with intention and uptake as the outcome variable while controlling for various demographic characteristics. Independent variables in all models included average score on the MBMC; CRC screening knowledge, beliefs and values; and barriers to and social support for CRC screening. Social support, marital status, and age were positively associated with CRC screening intention. Increased CRC screening knowledge and older age were associated with a greater likelihood of completing a stool-based screening test for CRC. Fewer masculinity-related and CRC screening barriers were associated with a greater likelihood of undergoing a sigmoidoscopy or colonoscopy. Contrary to our primary hypothesis, lesser MBMC-related perceptions were associated with increased CRC screening uptake among NH Black men. Our findings inform future CRC promotion programs and emphasize the need for multilevel interventions tailored toward this marginalized population to reduce disparities in screening and survival.

Psychometric Properties and Analysis of the Masculinity Barriers to Medical Care Scale Among Black, Indigenous, and White Men

Non-Hispanic (NH) Black, American Indian/Alaska Native (Indigenous), and NH-White men have the highest colorectal cancer (CRC) mortality rates among all other racial/ethnic groups. Contributing factors are multifaceted, yet no studies have examined the psychometric properties of a comprehensive survey examining potential masculinity barriers to CRC screening behaviors among these populations. This study assessed the psychometric properties of our Masculinity Barriers to Medical Care (MBMC) Scale among NH-Black, Indigenous, and NH-White men who completed our web-based MBMC, Psychosocial Factors, and CRC Screening Uptake & Intention Survey. We conducted exploratory factor analysis on a sample of 254 men and multivariate analysis of variance (MANOVA) on a separate sample of 637 men nationally representative by age and state of residence. After psychometric assessment, the MBMC scale was reduced from 24 to 18 items and from six to four subscales. NH-Black men’s mean scores were lowest on three of four subscales (Being Strong, Negative and Positive Attitudes) and highest on the Acknowledging Emotions subscale. Compared with both Indigenous and NH-White men, NH-Black men had significantly lower Negative Attitudes subscale scores and significantly higher scores on the Acknowledging Emotions subscale. Compared with both Indigenous and NH-Black men, NH-White men had significantly higher Being Strong and Positive Attitudes subscales scores. This study expands on previous research indicating that, among racialized populations of men, endorsement of traditional masculine ideologies influences engagement in preventive health behaviors. Our scale can be tailored to assess attitudes to screening for other cancers and diseases that disproportionately burden medically underserved populations.

Adaptation and validation of the health belief model scale for colorectal cancer screening

Korea has the second highest incidence of colorectal cancer in the world. Instruments that are culturally and contextually sensitive, as well as valid and reliable, for determining health beliefs regarding colorectal cancer screening are essential for obtaining accurate information. The purpose of this study was to adapt and validate the health belief model scale for Koreans regarding colorectal cancer and fecal occult blood test utilization. Individual and cognitive interviews (also known as cognitive debriefing) with 33 Koreans, expert reviews with seven nursing practitioners and professors, and a pilot test with 18 Koreans were conducted to make the existing health belief model scale culturally and contextually sensitive. Subsequently, a cross-sectional survey with 728 Koreans aged >50 years was conducted. Exploratory and confirmatory factor analyses of the construct validity and internal consistency reliability supported the adapted health belief model scale. The adapted and validated health belief model scale in this study could contribute to the assessment of health beliefs regarding the fecal occult blood test among Koreans with a greater degree of accuracy with respect to Korean culture and context.

Study protocol for developing #CuttingCRC: a barbershop-based trial on masculinity barriers to care and colorectal cancer screening uptake among African-American men using an exploratory sequential mixed-methods design

INTRODUCTION

Colorectal cancer (CRC) is preventable, as screening leads to the identification and removal of precancerous polyps. African-American men consistently have the highest CRC mortality rates, and their CRC-screening uptake remains low for complex reasons. Culture-specific masculinity barriers to care may contribute to the low uptake among African-American men. Examining these barriers to care is vital as CRC screening may challenge cultural role expectations of African-American men, whose tendency is to delay help-seeking medical care. Barbershops provide a pathway for reaching African-American men with masculinity barriers to care who are not regularly receiving healthcare services and CRC screening. This study aims to develop and pilot test a theory-driven, culture-specific, barbershop-based intervention targeting masculinity barriers to care and CRC-screening uptake among African-American men ages 45-75.

METHODS AND ANALYSIS

Guided by the theory of planned behaviour and the behaviour change wheel, we will use a multistage mixed-methods study design, beginning with an exploratory sequential approach to validate items for subsequent use in a pilot mixed-methods intervention. First, we will collect and analyse qualitative data from focus groups, cognitive interviews and expert item review to validate and test a culture-specific Masculinity Barriers to Care Scale (MBCS) among African-American men. Next, we will administer the MBCS to our target population as an online quantitative survey and evaluate the association between scores and CRC-screening uptake. Then, we will consider existing evidence-based approaches, our integrated results (qualitative +quantitative), and community input to design a culture-specific, behavioural intervention aimed at increasing CRC-screening uptake among African-American men and feasible for barbershop delivery. We will test the peer intervention in a pilot study with a two-arm cluster randomised design (six barbershops, randomised by site) to reduce contamination and account for barbershop culture differences. Our primary outcomes for the pilot are recruitment, sample size estimation, preliminary efficacy and acceptability.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the University of Utah Institutional Review Board (00113679), who will also be responsible for receiving communication updates regarding important protocol modifications. To ensure confidentiality, data dispersed to project team members will be blinded of any identifying participant information. Study results will be disseminated through publications in peer-reviewed journals, community dialogue sessions, and presentations at conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov identifier: NCT03733197 (Pre-results);https://clinicaltrials.gov/ct2/show/NCT03733197.