Knowledge, Attitudes, and Beliefs About Colorectal Cancer Screening in Puerto Rico

Colorectal cancer screening among the public: knowledge, attitudes, and the perceived barriers

Colorectal cancer (CRC)1 screening tests help in early detection of CRC and improve disease prognosis. This study aimed to assess knowledge, attitude, and barriers to CRC screening and the associated factors among the general population in Jordan. A validated self-administered online survey was distributed on 1542 individuals in Jordan. The participants (n = 1542) reported several barriers and demonstrated insufficient knowledge but positive attitude towards CRC screening. Older age (OR = 1.021, 95% CI = 1.010-1.032, P < 0.001), working in medical field (OR = 3.198, 95% CI = 2.499-4.092, P < 0.001), family history of cancer (OR = 1.248, 95% CI = 1.002-1.555, P < 0.05), and knowing someone with CRC (OR = 1.601, 95% CI = 1.186-2.161, P < 0.01) were significantly associated with higher knowledge. Personal history of CRC (OR = 3.157, 95% CI = 1.188-8.387, P < 0.05), and high knowledge of CRC (OR = 2.795, 95% CI = 2.242-3.484, P < 0.001) were significantly associated with the positive attitude. Future healthcare programs should devise effective techniques to improve public understanding and perception of CRC screening and overcome the identified barriers.

Knowledge, Attitudes, and Practices Related to Colorectal Cancer's Prevention and Early Detection Among Older Adults in Kuwait: A Cross-Sectional Study

BACKGROUND

Worldwide, colorectal cancer is one of the significant public health concerns that imposes a substantial risk of morbidity and mortality. Early detection and management of colorectal cancer are necessary to improve the patient's prognosis and outcomes. Hence, several guidelines recommend screening patients at risk of colorectal cancer periodically. Patients' knowledge and attitudes toward screening measures influence their compliance with the guidelines. This study aimed to determine knowledge, attitudes, and practices related to prevention and early detection among older adults in Kuwait.

METHODS

A cross-sectional study was conducted among Kuwaiti adults aged between 45 and 75 years attending the outpatient department in Kuwait's seven major hospitals. A convenience sampling technique was used to recruit the participants. A self-administered questionnaire consisted of four parts: sociodemographic and baseline characteristics, knowledge of colorectal cancer screening, attitudes toward colorectal cancer screening, and practices toward colorectal cancer screening.

RESULTS

A total of 570 Kuwaiti patients were included, and half of them were males (n = 285). Most patients were aged between 45 and 50 years (53.8%), had a secondary school certificate (n = 357, 62.6%), and were unmarried (n = 419, 73.5%). Low levels of knowledge (<50%) and practices (<30%) toward colorectal cancer screening were seen among the participants. Statistically significant correlations were found between patients' knowledge about colorectal cancer screening and their attitudes (r = 0.317, P < 0.001) and practices (r = 0.330, P < 0.001). In addition, a moderately significant association was found between patients' attitudes and practices toward colorectal cancer screening.

CONCLUSION

The study found that despite positive attitudes, Kuwaiti patients have low levels of knowledge and practice regarding colorectal cancer screening. This suggests a need for targeted, culturally sensitive educational programs and national campaigns to improve screening rates and address knowledge gaps.

Effect of a Theory-Based Narrative Video on Colorectal Cancer Screening Intention, Knowledge, and Psychosocial Variables Among a Predominantly Hispanic Population

Colorectal cancer (CRC) remains the third leading cause of cancer death in the USA. Latinx adults are overrepresented in late-stage CRC diagnosis as CRC screening utilization remains low among Latinx-identifying individuals. This study aims to evaluate the effect of a theory-based narrative video following a culturally appropriate storyline on CRC screening intention, knowledge, and psychosocial variables along the U.S.-Mexico border. We designed and analyzed a non-randomized pre-posttest evaluation of a narrative, culturally tailored video embedded within a community program. The study is set in the U.S.-Mexico border community. Outreach provided a link or QR code to access the survey. In all, 458 participants started the survey, and 304 completed the survey. Participants were recruited through flyers distributed throughout various community events by the program's community health workers and via social media. The intervention evaluated changes in participant's knowledge, perceived barriers, perceived susceptibility, self-efficacy, and perceived benefits and intention to screen. Participants were a mean age of 39 and identified mainly as female (72.7%) and Hispanic/Latinx (88.49%). After viewing the narrative video, participants had significantly improved perceived susceptibility, self-efficacy, and benefits, while perceived barriers and sense of fatalism significantly decreased. Paradoxically, this was associated with a significant decrease in knowledge scores. Results from this intervention suggest that a theory-based narrative video following a culturally appropriate storyline effectively improves psychosocial variables and intention to carry out CRC screening in a predominantly Hispanic border population.

Social determinants and participation in fecal occult blood test based colorectal cancer screening: A qualitative systematic review and meta-synthesis

ISSUE ADDRESSED

Colorectal cancer (CRC) screening through fecal occult blood testing (FOBT) has saved thousands of lives globally with multiple countries adopting comprehensive population wide screening programs. Participation rates in FOBT based CRC screening for the socially and economically disadvantaged remains low. The aim of this systematic review is to explore empirical evidence that will guide targeted interventions to improve participation rates within priority populations.

METHODS

PubMed, Embase, Scopus, Cinahl and PsycInfo were systematically searched from inception to 22 June 2022. Eligible studies contained qualitative evidence identifying barriers to FOBT based CRC screening for populations impacted by the social determinants of health. An inductive thematic synthesis approach was applied using grounded theory methodology, to explore descriptive themes and interpret these into higher order analytical constructs and theories.

RESULTS

A total of 8,501 publications were identified and screened. A total of 48 studies from 10 countries were eligible for inclusion, representing 2,232 subjects. Coding within included studies resulted in 30 key descriptive themes with a thematic frequency greater than 10%. Coded themes applied to four overarching, interconnected barriers driving inequality for priority populations: social, behavioural, economic and technical/interfaces. SO WHAT?: This study has highlighted the need for stronger patient/provider relationships to mitigate barriers to FOBT screening participation for diverse groups. Findings can assist health professionals and policy makers address the systemic exclusion of priority populations in cancer screening by moving beyond the responsibility of the individual to a focus on addressing the information asymmetry driving low value perceptions.

Assessing the Feasibility of a Faith-Based Colorectal Cancer Education and Screening Intervention for Latino Men in Pennsylvania

Introduction: Limited health knowledge, literacy, engagement in preventive health services, participation in health promotion behaviors, and cultural factors place Latino men at high risk for colorectal cancer (CRC). This pilot study aimed to determine the feasibility and acceptability of a faith-based cancer education intervention focusing on Latino men between 45 and 74 years old. Methods: This pilot study used a single group pre- and post-intervention research design to compare changes in knowledge, perceived benefit of screening, perceived susceptibility and severity of CRC, and the completion of CRC screening after the intervention. Results: In this study, Latino men were willing to participate in a CRC educational intervention supported by a faith-based institution. The participants had limited knowledge about CRC, yet most recognized that screening is beneficial and that getting CRC is serious. Sixty percent of the participants completed the fecal immunochemical screening test, which showed that the intervention impacted the screening uptake among this group. Conclusion: The findings of this study support the further development of faith-based interventions focusing on Latino men.

Breast and Colorectal Cancer Screening Utilization after Hurricane María and the COVID-19 Pandemic in Puerto Rico

Puerto Rico (PR) has faced environmental and public health challenges that could have significantly affected cancer screening access. Using administrative claims data from PR's Medicaid population, this study assessed trends in colorectal and breast cancer screening from 2016 to 2021, the impact of disasters in screening, and the absolute deficit in screening due to the pandemic. The monthly rates of claims were analyzed using Poisson regression. Significant reductions in breast and colorectal cancer screening utilization were observed. The colorectal cancer screening rate in 2017 was 77% lower a month after Hurricanes Irma and María [RRadj: 0.23; 95% CI: 0.20, 0.25] compared to the same time period in 2016. Breast cancer screening dropped 50% in November 2017 compared to November 2016 [RRadj: 0.50; 95% CI: 0.47, 0.54]. Prospectively, a recovery in utilization has been observed only for breast cancer screening. The results revealed that cancer screening utilization substantially declined after environmental disasters and the pandemic. These findings have potentially severe long-term implications for cancer health disparities and mortality in PR.

Trends and Factors Associated with Fecal Occult Blood Test Utilization among Hispanic Adults in Puerto Rico and the United States: BRFSS 2012-2020

Identifying factors associated with colorectal cancer screening utilization is important to guide colorectal cancer prevention and control programs. We evaluated trends and factors associated with previous-year fecal occult blood test (FOBT) use among Hispanic adults living in Puerto Rico and the U.S. mainland. Using data from the Behavioral Risk Factor Surveillance System (2012-2020), trends in FOBT use were analyzed using joinpoint regression to estimate annual percentage change (APC). Logistic regression stratified by location identified factors associated with FOBT use. FOBT was more common among Hispanic adults ages 50 to 75 years living in Puerto Rico than in the U.S. mainland [Puerto Rico: 20.5%[2012] to 45.6%[2020], APC = 11.4%; U.S. mainland: 9.9%[2012] to 16.7%[2020], APC = 5.9%]. Factors inversely associated with FOBT use were similar in Puerto Rico and the U.S. mainland, including lack of health insurance, not having a personal doctor, having a checkup >12 months ago, and not being able to see a doctor due to cost, as were factors associated with higher FOBT use, including older age, retirement, or having two or more chronic diseases. Among Hispanics living in the U.S. mainland, lack of exercise and less education were inversely associated with FOBT. Factors related to poor access to healthcare were associated with lower use of FOBT among Hispanics. Efforts to improve colorectal cancer screening in Hispanics are necessary to address health disparities across the colorectal cancer care continuum.

PREVENTION RELEVANCE

Colorectal cancer screening reduces cancer incidence and mortality. All screening modalities, including less invasive FOBT tests, are underutilized, especially in non-White and low-income populations. Evaluation of trends and factors associated with the increase in the use of colorectal cancer screening can inform programs to address the lack of screening among racial minorities.