The health belief model and colorectal cancer screening in the general population: A systematic review

"I know now that it's something that you can do something about": Deductive thematic analysis of experiences at an arts-based dementia risk reduction exhibit

Dementia is one of the leading global health crises. Despite the devastating impacts of the illness, general population knowledge pertaining to risk reduction is still limited. Previous research on the impact of dementia risk reduction campaigns has largely focused on awareness rather than behaviour change. Our research introduced an arts-based exhibit to address dementia modifiability, aiming to enhance effectiveness by providing an immersive experience for altering adults' perceptions of risk reduction and lifestyle behaviours. Interviews were conducted with adults (n = 38 [13 male, 25 female]) who attended an interactive dementia awareness and risk reduction exhibit. Data was analysed using deductive thematic analysis within the Health Belief Model framework to determine key mechanisms of behaviour change. Four key themes encompassing exhibit significance and factors underlying behaviour change were identified. Participants recounted positive experiences, particularly being engaged by the artistic aspects of the exhibit, and recorded heightened engagement in behaviours supporting dementia risk reduction post-exhibit. Areas for improvement included the need for a take-home summary and variation in formats. Participants described prior encounters with dementia and their age as factors which influenced their engagement with dementia risk reduction behaviour, with younger participants reporting lesser engagement with risk reduction information. Our research found that arts-based educational initiatives have the potential to advance public understanding and promote behavioural changes for dementia risk reduction. Our study recommends enhancing the impact of future interventions by employing innovative formats and tailoring them to varied audiences, with a specific emphasis on engaging younger individuals.

The effect of educational intervention based on health belief model on colorectal cancer screening behaviors

BACKGROUND

Colorectal cancer is the second most prevalent cause of death from malignancies globally. The present study was conducted targeting the influence of an educational intervention based on the health belief model (HBM) on colorectal cancer screening behaviors in people 50 years old and older.

METHODS

All 134 samples were included in this quasi-experimental study from Fasa City Health Service Center, equal halves were random into experimental group and control group. The data collection tool was a questionnaire that contained questions on demographic variables, knowledge, and HBM constructs (perceived sensitivity, perceived intensity, perceived benefits, perceived barriers, self-efficacy, and screening behaviors). Both groups answered the questionnaire before and two months following the intervention. There were six 90-minute instruction sessions for the intervention group. SPSS 22 and descriptive and analytical tests (independent t-test, paired t-test, and Chi-square test) were used for data analysis (P < 0.05).

RESULTS

59 women and 75 men took part in this study. A majority of participants were married and had at least high school diploma. The findings indicated that the mean scores for knowledge, each of the HBM's constructs, and cancer screening behaviors did not differ significantly from one another before the intervention between the test group and the control group. However, post the intervention, the intervention group exhibited a significant rise in all mentioned dimensions.

CONCLUSION

In light of the outcomes, the application of the HBM on colorectal cancer screening behaviors in people 50 years and older was successful. This approach might serve as a helpful foundation for planning, carrying out, and overseeing colorectal cancer screening programs.

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.

An Integrated Health Belief Model: Predicting Uptake of the First COVID-19 Booster Vaccine

Public health campaigns have turned to the Health Belief Model (HBM) as a guiding framework for the past six decades. Carpenter's 2010 HBM meta-analysis revealed important shortcomings as well as a path forward that has largely been ignored by recent COVID-19 research using this framework. Consistent with Carpenter's recommendations, this study on the uptake of the first COVID-19 booster vaccine focused on the overlooked interactional processes of the original HBM founders. Our study used SEM and Hayes's PROCESS 4.1 to explore the possibilities of the interdependent nature of the core three beliefs to form a model that is integrated. The study indicated that the core variables of the original HBM were significant predictors of the intent to take the first COVID-19 booster vaccine when considered in an interactional process framework. Our study results have implications for those designing public health advocacy campaigns regarding COVID-19 as it enters an endemic stage with future vaccines and medications.

The predictors of voluntary participation in pulmonary tuberculosis screening program: a study in a suburban community of southern Thailand

Background

The health belief model (HBM), baseline health condition, and sociocultural factors impact the decision to participate in a tuberculosis screening program.

Methods

This cross-sectional and descriptive study was carried out among the "Kao Taew" community dwellers aged 18 years and above, who voluntarily underwent the provided pulmonary tuberculosis (PTB) screening by chest radiographs (CXRs). The level of individual HBM domain perception, attitudes toward PTB prevention, and regularity of PTB prevention practices by the participants were evaluated. The significantly associated or correlated factors such as demographic characteristics, individual HBM domain perception, and attitudes toward PTB prevention with the regularity of PTB prevention practices from the univariate analysis were further analyzed by multiple linear regression (p < 0.05) to determine the independent significant predictors of PTB prevention practices.

Results

Among 311 participants comprising 65% women, 57.9% aged ≥ 65 years and 67.2% had an underlying disease. The study participants had a high level of perception of HBM domains but a low level of perception of the barrier. In addition, a high level of attitudes toward PTB prevention and a high regularity of PTB prevention practices were found. A multiple linear regression analysis revealed that the perceived benefits of PTB screening [Beta = 0.20 (0.04, 0.36) p = 0.016] and acquiring underlying diseases [Beta = 1.06 (0.38, 1.73), p = 0.002] were significant predictors for PTB prevention practices, while belief in Islam was a reverse predictor [Beta = -0.84 (-1.47, -0.21), p = 0.010].

Conclusions

The level of perception of the individual domain of HBM, health status, and religious belief significantly predicted voluntary participation in PTB screening programs. Careful consideration by integration of the relevant health psychology, physical, and sociocultural factors is crucial for planning a health screening program.

Assessment of the Psychosocial Impact of Pancreatic Cancer Surveillance in High-Risk Individuals

OBJECTIVES

Pancreatic cancer (PC) surveillance of high-risk individuals (HRIs) downstages PC and improves survival. However, it remains less clear whether PC surveillance has a positive psychosocial impact on HRIs. Herein, we aimed to define the attitudes and beliefs of HRIs undergoing PC surveillance, and the immediate and sustained psychosocial impact of PC surveillance in HRIs.

METHODS

100 HRIs undergoing PC surveillance by endoscopic ultrasound (EUS) completed three surveys addressing different components of the psychosocial impact of PC surveillance. Logistic regression analyses were performed to identify predictive factors relating to these components.

RESULTS

Most HRIs reported increased perceived benefits of PC surveillance, self-efficacy, and perceived severity of PC. HRIs reported few negative emotions prior to surveillance and frequent positive emotions after surveillance. Compared to prior to surveillance, there was a 53.5% decrease in the level of distress reported by HRIs after surveillance, which was sustained for 4-6 weeks post-surveillance. Family history of PC and lower self-reported mental health were identified as predictors for increased perceived susceptibility to PC (p < 0.01) and greater change in distress pre- to post-surveillance (p < 0.01), respectively.

CONCLUSIONS

Our findings suggest that PC surveillance can lead to sustained psychosocial benefits in HRIs.

Uptake and Utilization of the COVID-19 Alert App within a University Community in New York

The rapid onset of the COVID-19 pandemic elicited a swift response to control the virus ubiquitous within the United States. Expanded telehealth and health informatics became critical components of the pandemic response. The aim of this study was to assess the utilization of the COVID-19 New York (NY) Alert App and identify the perceived benefits and limitations of the App. A cross-sectional design was employed to collect data by using questionnaires with closed-ended and open-ended questions. The survey was developed and administered during March through April 2021. The study found that the highest rated benefit from using the COVID-19 NY Alert App was receiving alerts about being in close proximity to individuals diagnosed with COVID-19. Results showed that ineffective (insufficient and inappropriate) usage was the highest rated potential challenge for using the App. Study subjects were likely to download this Alert App when they perceived more benefits and less barriers to using the App. Findings from this study can help improve utilization of the App and inform development of similar tele-education tools. The study illuminated considerations for health information applications in scaling-up traditional COVID-19 tracing efforts and may facilitate the design of similar emergency preparedness health technology.

Successful quality improvement project to increase hydroxyurea prescriptions for children with sickle cell anaemia

Hydroxyurea (HU) is an effective but underused disease-modifying therapy for patients with sickle cell anaemia (SCA). EMBRACE SCD, a sickle cell disease treatment demonstration project, aimed to improve access to HU by increasing prescription (Rx) rates by at least 10% from baseline in children with SCA.The Model for Improvement was used as the quality improvement framework. HU Rx was assessed from clinical databases in three paediatric haematology centres. Children aged 9 months-18 years with SCA not on chronic transfusions were eligible for HU treatment. The health belief model was the conceptual framework to discuss with patients and promote HU acceptance. A visual aid showing erythrocytes under the effect of HU and the American Society of Hematology HU brochure were used as educational tools. At least 6 months after offering HU, a Barrier Assessment Questionnaire was given to assess reasons for HU acceptance and refusals. If HU was declined, the providers discussed with family again. We conducted chart audits to find missed opportunities to prescribe HU as one plan-do-study-act cycle.At initial measurement, 50.2% of 524 eligible patients had HU prescribed. During the testing and initial implementation phase, the mean performance after 10 data points was 53%. After 2 years, the mean performance was 59%, achieving an 11% increase in mean performance and a 29% increase from initial to the last measurement (64.8% HU Rx). During a 15-month period, 32.1% (N=168) of the eligible patients who were offered HU completed the barrier questionnaire with 19% (N=32) refusing HU, mostly based on not perceiving enough severity of their children's SCA or fearing side effects.Reviewing patient charts for missed opportunity of offering HU with feedback and evaluating the reasons of declining HU via a questionnaire were key components in increasing HU Rx in our population.

Testing the validity of a new scale designed to assess beliefs and perceptions about colorectal cancer and colorectal cancer screening in Malaysia: a principal component analysis

OBJECTIVE

To conduct a cultural adaptation and validation of the Champion Health Belief Model Scale (CHBMS) for colorectal cancer (CRC) screening (CHBMS-CRC-M) in order to assess and investigate perceptions and beliefs about CRC screening in Malaysia.

DESIGNS AND PARTICIPANTS

The results from an evidence synthesis and the outcomes from an expert panel discussion were used to shape CHBMS scale content into an assessment of beliefs about CRC screening (CHBMS-CRC). This questionnaire assessment was translated into the official language of Malaysia. An initial study tested the face validity of the new scale or questionnaire with 30 men and women from various ethnic groups. Factorial or structural validity was investigated in a community sample of 954 multiethnic Malaysians.

SETTING

Selangor state, Malaysia.

RESULTS

The new scale was culturally acceptable to the three main ethnic groups in Malaysia and achieved good face validity. Cronbach's alpha coefficients ranged from 0.66 to 0.93, indicating moderate to good internal consistency. Items relating to perceived susceptibility to CRC 'loaded' on Factor 1 (with loadings scoring above 0.90); perceived benefits of CRC screening items loaded on factor 2 and were correlated strongly (loadings ranged between 0.63 and 0.83) and perceived barriers (PBA) to CRC screening (PBA) items loaded on factor 3 (range 0.30-0.72).

CONCLUSION

The newly developed CHBMS-CRC-M fills an important gap by providing a robust scale with which to investigate and assess CRC screening beliefs and contribute to efforts to enhance CRC screening uptake and early detection of CRC in Malaysia and in other Malay-speaking communities in the region.

Video Interventions for Reducing Health Inequity in Cancer Screening Programmes: a Systematic Review

BACKGROUND

Health equity can lead to disparities in cancer screening, treatment, and mortality. This systematic review aims to identify and describe interventions that used video or DVD formats to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates compared to usual care conditions.

METHODS

We searched PubMed, Web of Science, Embase, and Cochrane databases for randomized control trials (RCTs) published until 18/01/2023 that compared intervention versus usual care control groups, with the percentage of cancer screening uptake during follow-up as an outcome. The risk of Bias was assessed with the Cochrane Collaboration tool.

RESULTS

After screening 4201 abstracts, 192 full texts were assessed for eligibility and 18 were included that focused on colorectal (n = 9), cervical (n = 5), breast (n = 5), and prostate (n = 1) cancer screening. All were based in the USA except one and most focused on ethnicity/race, while some included low-income populations. Most of the video interventions used to increase cervical cancer screening reported positive results. Studies aimed at increasing mammography uptake were mostly effective only in specific groups of participants, such as low-income or less-educated African American women. Results for colorectal cancer screening were conflicting. Videos that were culturally tailored or used emotive format were generally more effective than information-only videos.

CONCLUSIONS

Video interventions to increase cancer screening among populations with low screening uptake show some positive effects, though results are mixed. Interventions that use individual and cultural tailoring of the educational material should be further developed and investigated outside of the USA.

Determinants of gastric cancer screening attendance in Southeastern China: a cross-sectional study

OBJECTIVES

This study aimed to identify the determinants of gastric cancer screening attendance among individuals aged 40 years in a region with high gastric cancer in China.

DESIGN

An anonymous, cross-sectional survey was conducted between October 2021 and March 2022.

SETTING

A self-administered online survey was conducted in Fujian Province in Southeastern China.

PARTICIPANTS

People aged 40 years living in five selected cities in Fujian Province with no history of cancer.

MAIN OUTCOME MEASURES

Gastric cancer screening attendance was measured with the question 'Have you ever been screened for gastric cancer in the past'.

RESULTS

In total, 2547 complete responses were obtained. The mean age of respondents was 47.72±7.20 years, and 59.8% were men. A total of 42.6% of participants reported that they had undergone gastric cancer screening. The result of multivariable logistic regression analysis showed that participants with a first-degree relative affected with gastric cancer (OR=2.02, 95% CI: 1.58 to 2.59) and high perceived susceptibility of gastric cancer (OR=2.03, 95% CI: 1.58 to 2.59) were the strongest facilitators for screening attendance. Other factors positively associated with screening attendance were age 51-60 years (OR=1.69, 95% CI: 1.31 to 2.18), living in urban regions (OR=1.27, 95% CI: 1.05 to 1.55), friends/neighbours/colleagues with gastric cancer (OR=1.30, 95% CI: 1.07 to 1.58), history of chronic gastric disease (OR=1.90, 95% CI: 1.57 to 2.30), perceived high cost (OR=1.28, 95% CI: 1.01 to 1.61) and physician recommendation (OR=1.71, 95% CI: 1.36 to 2.16). On the other hand, factors negatively associated with screening attendance included perceived barriers, namely screening is only necessary when symptoms present (OR=0.71, 95% CI: 0.58 to 0.87) and perceived appointment for gastroscopy screening is difficult and time-consuming (OR=0.75, 95% CI: 0.60 to 0.94). No significant association was found between knowledge level and participation in screening.

CONCLUSION

This study highlights important individual-level factors and barriers to gastric cancer screening. Strategies targeting under-screened populations and eliminating patient-perceived barriers to gastric cancer screening are essential.

Relationship between health information literacy and health promoting lifestyle among first-degree relatives of patients with colorectal cancer in China: the mediating effect of health belief

Background

History of first-degree relatives with colorectal cancer is one of the most important and common risk factors for colorectal cancer in China. Most chronic diseases, such as malignancies, are preventable by adopting health-promoting behaviors and other approaches. However, the relationships among factors affecting the health-promoting lifestyles of first-degree relatives with colorectal cancer have not been sufficiently studied. This study aimed to test the mediation effects of Health belief in the relationship between health-promoting lifestyle and health information literacy among first-degree relatives with colorectal cancer.

Methods

A cross-sectional descriptive design was conducted using convenience sampling of 856 first-degree relatives of CRC patients attending three tertiary care hospitals in Nanchong and Deyang of China from December 2020 to December 2022. Questionnaires were used to collect data on the participants' demographic information, the colorectal cancer health beliefs, the health promotion lifestyle, and the health information literacy. Data were analyzed with descriptive statistics, one-way ANOVA, Pearson's correlation coefficients, and mediation analysis using SPSS 25.0 program and its macro-program PROCESS.

Results

The findings indicated health information literacy was less, health belief was at the medium level, and performance of health promotion behavior was average for first-degree relatives of colorectal cancer. Whereas first-degree relatives of colorectal cancer health-promotion lifestyle had a positive correlation with health beliefs (r = 0.376, p < 0.01) and health information literacy (r = 0.533, p < 0.01), health beliefs had a positive correlation with health information literacy (r = 0.337, p < 0.01). Health beliefs mediated the positive effect of health information literacy on health-promoting lifestyles (β =0.420, 95% CI, 0.288-0.581), and indirect effects accounted for 14.0% of the total effect.

Conclusion

Health information literacy and health beliefs are key factors associated with a health-promoting lifestyle among first-degree relatives with colorectal cancer. These factors have direct and indirect effects on each other and on health-promoting lifestyles. To enhance health-promoting lifestyles among first-degree relatives with colorectal cancer, interventions that strengthen health beliefs and provide health information literacy should be developed.

Qualitative Research and Applications in Colorectal Surgery

Traditionally employed in medical anthropologic and sociologic literature, qualitative methods are emerging as an essential component of clinical research as surgeons and researchers strive to optimize care informed by patient perspectives. Qualitative methods in health care-related research may be used to understand subjective experiences, beliefs, and concepts that are not captured using quantitative analyses and to gain in-depth knowledge of a specific context or culture. A qualitative approach may also be employed to explore under-researched problems and generate new ideas. Here, we provide an overview of aspects to consider when designing and conducting a qualitative research study.

Interactive or tailored digital interventions to increase uptake in cervical, breast, and colorectal cancer screening to reduce health inequity: a systematic review

BACKGROUND AND OBJECTIVES

Significant health inequities exist in screening uptake for certain types of cancer. The review question was to identify and describe interactive, tailored digital, computer, and web-based interventions to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates versus usual care.

METHODS

We searched four medical literature databases for randomized control trials (RCTs) published until 12 January 2023 that evaluated interventions aimed at increasing the percentage of breast, prostate, cervical, or colorectal cancer screening uptake. Meta-analysis was not conducted due to heterogeneity among studies.

RESULTS

After screening 4200 titles and abstracts, 17 studies were included. Studies focused on colorectal ( n  = 10), breast ( n  = 4), cervical ( n  = 2), and prostate ( n  = 1) cancer screening. All were based in the USA except two. Most studies focused on ethnicity/race, while some included low-income populations. Intervention types were heterogeneous and used computer programs, apps, or web-based methods to provide tailored or interactive information to participants about screening risks and options. Some studies found positive effects for increasing cancer screening uptake in the intervention groups compared to usual care, but results were heterogeneous.

CONCLUSION

Interventions that use individual and cultural tailoring of cancer screening educational material should be further developed and investigated outside of the USA. Designing effective digital intervention strategies, with components that can be adapted to remote delivery may be an important strategy for reducing health inequities in cancer screening during the coronavirus disease 2019 pandemic.

The relationship between family history of cancer and cancer attitudes & beliefs within the Community Initiative Towards Improving Equity and Health Status (CITIES) cohort

OBJECTIVE

To determine the relationship between family history of cancer with cancer attitudes and beliefs (CABs) and cancer screening knowledge.

METHODS

This study used data collected for the Community Initiative Towards Improving Equity and Health Status (CITIES) project which surveyed Ohioans ages 21-74. In the current analysis, we included data on age, gender, race, marital status, education, income, financial security, health insurance, CABs, knowledge about the correct age to begin cancer screenings, and presence of a first-degree relative with cancer. Multivariable logistic regression was used to examine the association of family history of cancer with CABs and knowledge about the correct age to begin cancer screening.

RESULTS

Participants were predominantly over the age of 41, female, and white. Out of 603 participants, 295 (48.92%) reported not having a first-degree relative with cancer and 308 (51.08%) reported having a first-degree relative with cancer. Overall, 109 (18.08%) participants reported negative CABs, 378 (62.69%) reported moderate CABs, and 116 (19.24%) reported positive CABs. Participants who reported a first-degree relative with cancer were more likely to report positive CABs, but the association was not significant (p = .11). We observed that older, more educated, and married participants were more likely to have positive CABs (all p < 0.05). Family history of cancer was not associated with differences in knowledge about the correct age for beginning colorectal cancer screening (p = .85) and mammography (p = .88).

CONCLUSIONS

Having a first-degree relative with cancer was not found to be associated with CABs or knowledge about cancer screening. However, age and socioeconomic status were associated with more positive CABs and increased knowledge about cancer screening. Future research should focus on standardizing a CABs scale and expanding the generalizability of our findings.

Disparities in telehealth access, not willingness to use services, likely explain rural telehealth disparities

PURPOSE

Although telehealth access and utilization have increased during the pandemic, rural and low-income disparities persist. We sought to assess whether access or willingness to use telehealth differed between rural and non-rural and low-income and non-low-income adults and measure the prevalence of perceived barriers.

METHODS

We conducted a cross-sectional study using COVID-19's Unequal Racial Burden (CURB) online survey (December 17, 2020-February 17, 2021), which included 2 nationally representative cohorts of rural and low-income Black/African American, Latino, and White adults. Non-rural and non-low-income participants from the main, nationally representative sample were matched for rural versus non-rural and low-income versus non-low-income comparisons. We measured perceived telehealth access, willingness to use telehealth, and perceived telehealth barriers.

FINDINGS

Rural (38.6% vs 44.9%) and low-income adults (42.0% vs 47.4%) were less likely to report telehealth access, compared to non-rural and non-low-income counterparts. After adjustment, rural adults were still less likely to report telehealth access (adjusted prevalence ratio [aPR] = 0.89, 95% CI = 0.79-0.99); no differences were seen between low-income and non-low-income adults (aPR = 1.02, 95% CI = 0.88-1.17). The majority of adults reported willingness to use telehealth (rural = 78.4%; low-income = 79.0%), with no differences between rural and non-rural (aPR = 0.99, 95% CI = 0.92-1.08) or low-income versus non-low-income (aPR = 1.01, 95% CI = 0.91-1.13). No racial/ethnic differences were observed in willingness to use telehealth. The prevalence of perceived telehealth barriers was low, with the majority reporting no barriers (rural = 57.4%; low-income = 56.9%).

CONCLUSIONS

Lack of access (and awareness of access) is likely a primary driver of disparities in rural telehealth use. Race/ethnicity was not associated with telehealth willingness, suggesting that equal utilization is possible once granted access.

Determination of factors influencing young adults' intention to have COVID-19 vaccine in the Philippines: An integration of Health Belief Model and the Theory of Planned Behavior

Objectives

The COVID-19 pandemic continues to increase around the world and businesses and markets across the world significantly decreased. The purpose of this study was to determine the factors that affect the intention to be vaccinated for the COVID-19 vaccine among young Filipino adults by integrating the Health Belief Model and Extended Theory of Planned Behavior.

Study design

A cross-sectional study design was utilized.

Methods

Factors such as understanding of the COVID-19 vaccine, self-efficacy, cues to action, perceived barriers, perceived benefits, perceived side effects, perceived behavioral control, attitude, subjective norm, and intention to be vaccinated were analyzed by utilizing Structural Equation Modeling (SEM).

Results

With 865 young Filipino adults who answered a self-administered survey, it was seen that Understanding of the COVID-19 vaccine has the highest direct significant effect on cues to action, followed by perceived barriers, and perceived benefits. Interestingly, the primary factor was Understanding COVID-19 vaccines which had an indirect significant effect on the intention to get vaccinated. This is because knowing what the vaccine is for, its effects, and the application would lead to the acceptance of the COVID-19 vaccine. Moreover, the impact of being known to have the COVID-19 vaccine would lead to the intention to get vaccinated.

Conclusions

The findings of this study can be utilized especially by the government in developing strategies for encouraging people to take the COVID-19 vaccine. Finally, the model construct of the study can be applied to explore more factors that can affect the intention to be vaccinated with the COVID-19 vaccine and other vaccines people worldwide.

A theory-informed systematic review to understand physical activity among women in Gulf Cooperation Council countries

BACKGROUND

This systematic review was conducted to identify health beliefs and modifying factors influencing physical (in) activity among adult women in Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates).

METHODS

A comprehensive search of the Medline (Ovid), EMBASE, Cochrane Central, Web of Science, and Google Scholar databases was conducted to identify relevant articles published between 2009 and 2019. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Data collection and analysis based on the health belief model were performed to systematically examine the relationships of health beliefs and modifying factors to physical activity.

RESULTS

The sample comprised 15 studies (Saudi Arabia, n = 6; Oman, n = 5; Qatar, n = 2; Kuwait, n = 2). Reported physical activity prevalences were low (nearly 0% to 50%) and depended on the location, subpopulation, and measurement instrument. Evidence for relationships of modifying factors and health beliefs to physical activity was scarce and sometimes inconclusive. Among modifying factors, middle age and employment were associated positively with physical activity; marital status, educational level, income, and body mass index were not associated. Regarding health beliefs, the only conclusive evidence reported was that a lack of time was not associated significantly with physical activity in a population of men and women. Women reported a lack of social support and lack of skills significantly more frequently than men; these factors may explain the gender difference in physical activity prevalence. Differences in the reporting of fear of injury and lack of willpower were not significant.

CONCLUSIONS

Robust qualitative and quantitative research on the contributions of health beliefs and modifying factors to the low prevalence of physical activity among women in GCC countries is urgently needed. Current evidence indicates that unemployed women, women aged < 25 years, and elderly women are less likely to be physically active. Women in this population are more likely than men to believe that a lack social support and skills affects their physical activity. Many known factors and health beliefs appear to be unrelated to physical activity among adult women in GCC countries.

Defensive information processing and nonadherence to health-protective behaviors

PLAIN LANGUAGE SUMMARY

In this issue of Cancer, Clarke et al. measure defensive information processing (DIP) to avoid fecal immunochemical testing for colorectal cancer. DIP is a way of reducing the negative psychological effects of threats such as cancer and may influence health-protective behaviors such as the completion of recommended cancer screening. This editorial complements Clarke et al.'s study with a discussion of interventions for decreasing DIP around cancer screening and other health-protective recommendations.

The role of defensive information processing in population-based colorectal cancer screening uptake

BACKGROUND

Internationally, colorectal cancer screening participation remains low despite the availability of home-based testing and numerous interventions to increase uptake. To be effective, interventions should be based on an understanding of what influences individuals' decisions about screening participation. This study investigates the association of defensive information processing (DIP) with fecal immunochemical test (FIT)-based colorectal cancer screening uptake.

METHODS

Regression modeling of data from a cross-sectional survey within a population-based FIT screening program was conducted. The survey included the seven subdomains of the McQueen DIP measure. The primary outcome variable was the uptake status (screening user or nonuser). Multivariable logistic regression was used to estimate the odds ratio (OR) for screening nonuse by DIP (sub)domain score, with adjustments made for sociodemographic and behavioral factors associated with uptake.

RESULTS

Higher scores (equating to greater defensiveness) on all DIP domains were significantly associated with lower uptake in the model adjusted for sociodemographic factors. In the model with additional adjustments for behavioral factors, the suppression subdomains of "deny immediacy to be tested" (OR, 0.53; 95% confidence interval [CI], 0.43-0.65; p < .001) and "self-exemption" (OR, 0.80; 95% CI, 0.68-0.96; p < .001) independently predicted nonuse of FIT-based screening.

CONCLUSIONS

This is the first study outside the United States that has identified DIP as a barrier to colorectal cancer screening uptake, and it is the first focused specifically on FIT-based screening. The findings suggest that two suppression barriers, namely denying the immediacy to be tested and self-exempting oneself from screening, may be promising targets for future interventions to improve uptake.

Qualitative Analysis of Colorectal Cancer Screening in Rural Nebraska

Compared to urban residents, rural populations are less likely to engage in colorectal cancer (CRC) screening. As part of a statewide cancer needs assessment, we aimed to elicit rural perspectives about CRC screening and resources. We conducted three focus groups with rural Nebraska cancer survivors and caregivers (N = 20) in Spring 2021 using a collective case study design. Participant awareness of and knowledge about CRC screening methods varied across focus groups; overall, 95% of participants had heard of colonoscopy. Participants were less familiar with fecal tests and had confusion about them. Colonoscopy was associated with negative perceptions regarding the time, cost, and discomfort of the preparation and procedure, but some providers did not discuss alternative methods unless the patient resisted colonoscopy. Healthcare providers played a key role educating rural communities about CRC screening recommendations (age, risk) and testing options and being persistent in those recommendations. CRC awareness campaigns should include a variety of communication channels (TV, radio, billboards, health fairs, churches, healthcare settings). Promotion of CRC screening should include education about screening age guidelines, alternative test types, and informed decision-making between provider and patient regarding preferred screening methods based on the pros and cons of each test type. Individuals with a family history of colon issues (Crohn's disease, CRC) are considered high risk and need to be aware that screening should be discussed at earlier ages.

Predictive factors based on the health belief model on cancer screening behaviour in first degree relatives of patients with Lynch syndrome-associated colorectal cancer

Objectives

This study aimed to investigate colorectal cancer-related knowledge, health beliefs, and screening behaviour in first-degree relatives (FDRs) of patients with Lynch syndrome-associated colorectal cancer (CRC) and explore the predictive factors of screening behaviour based on a health belief model.

Methods

This cross-sectional study was conducted in the colorectal department of a Class A tertiary hospital in Guangzhou from December 2017 to December 2019. A total of 265 FDRs of 96 patients with Lynch syndrome-related CRC were selected. The study was conducted in the colorectal department of a tertiary cancer centre in Guangzhou. The demographic questionnaire, the simplified CRC knowledge questionnaire, and the Champion's Health Belief Model Scale were used for evaluation. Data were analyzed using statistical description, between-group comparisons, and binary logistic regression.

Results

A total of 160 (60.4%), 61 (23.0%), and 44 (16.6%) of the participants had high, medium, and low levels of knowledge about CRC, respectively; the average overall score of health belief was 121.36 ± 13.02. Sixty-one participants (23.0%) underwent Lynch syndrome-associated cancer screening. The predictive factors of screening behaviour included sex (male), age (older), married status (married), multiple primary cancers of the index patients, and high levels of knowledge and health beliefs (P < 0.05).

Conclusions

The knowledge and health beliefs of cancer and cancer screening in FDRs of patients with Lynch syndrome-associated CRC should be improved. Both knowledge and beliefs are critical in promoting their cancer screening behaviour. Interventions should focus on health education and enhance health beliefs of the FDRs for better screening behaviour.

Newborn Feeding Knowledge and Attitudes among Medical Students

This study sought to assess newborn feeding knowledge and attitudes among medical students. A sample of 649 Portuguese medical students completed an online survey containing a sociodemographic questionnaire, the Newborn Feeding Ability Questionnaire (NFA), and the Iowa Infant Feeding Attitudes Scale (IIFAS). The overall sample showed moderate scores for all variables. Gender analysis identified significant differences only for the dimension related to the benefits of skin-to-skin contact between mother and newborn where women scored higher. Analysis by year of training found that students with more years of training scored higher on all variables of newborn feeding knowledge that were positively correlated and were positive predictors of newborn feeding attitudes. Students with fewer years of training scored higher on work practices interfering with newborn feeding ability, which were negatively correlated and were negative predictors of newborn feeding attitudes. These results demonstrate that medical students with more years of training are the most prepared, however, the moderate results of the sample raise concerns. Our results point to the importance of providing medical students with adequate knowledge in order to influence their attitudes toward newborn feeding and contribute to better working practices for future health professionals.

Awareness and knowledge of Colorectal Cancer Screening among Latinos in Omaha, Nebraska

BACKGROUND

Colorectal cancer (CRC) screening rates remain low in Latino communities. We sought to determine the screening awareness and attitudes in Omaha, Nebraska.

METHODS

We interviewed 150 Latinos at an urban Federally Qualified Health Center, June-October 2017. Chi-square or Fisher-exact tests and multiple logistic regression models were used for data analysis.

RESULTS

Participants reported low educational attainment, low income, and limited access to insurance or a primary provider. Less than one-third of participants aged 50 + had ever heard of FOBT (32.6%) or colonoscopy (30.4%). For individuals 50+, access to a primary care provider (p = .03) and knowing the screening initiation age (p = .03) were associated with ever having a colonoscopy. Higher knowledge score was a strong predictor of any CRC screening.

DISCUSSION

Knowledge predicted screening, suggesting interventions should aim to educate this population regarding CRC screening guidelines and options and work with stakeholders to make CRC screening more accessible.

Validity and Reliability of the COVID-19 Knowledge, Attitude and Behavior Scale

BACKGROUND

The aim of this research is to develop a scale that will evaluate the knowledge, attitudes and behaviors of employees about COVID-19 and to test its validity and reliability.

METHODOLOGY

The methodological type of research was used between August-November 2020, under observation in organized industrial zones. Information was collected from a total of 543 employees. Confirmatory factor analysis and correlation analysis were performed for the value, item-total correlations and construct validity. SPSS 25.0 (IBM Inc., Armonk, NY, USA), Jasp 0.14 (University of Amsterdam) and Lisrel 9.1(Scientific Software International, Inc., Chapel Hill, NC, USA) programs were used in the analysis.

RESULTS

83.1% of the participants in the study are male, the average age is 37.4 ± 8.0, 76.1% are married, and 49.4% are high school graduates. The Cronbach alpha value of the COVID-19 information part is 0.86 in total, the contamination information dimension is 0.71 and the protection information dimension is 0.84. The COVID-19 attitude section consists of four sub-dimensions and 13 items classified within the framework of the health belief model. In summary, the goodness of fit values for the knowledge, attitude and behavior sections, respectively, are: RMSEA values 0.05, 0.03 and 0.04; CFI values 0.98, 0.98 and 0.99; GFI values 0.97, 0.97 and 0.99.

CONCLUSIONS

It has been determined that the internal consistency of the COVID-19 knowledge, attitude and behavior scale conducted on employees is high and compatible, and its validity findings are sufficient. The scale is recommended as an applicable tool to measure COVID-19 knowledge, attitudes and behaviors.

Patient Perspectives on a Targeted Text Messaging Campaign to Encourage Screening for Diabetes: Qualitative Study

BACKGROUND

A sizeable proportion of prediabetes and diabetes cases among adults in the United States remain undiagnosed. Patient-facing clinical decision support (CDS) tools that leverage electronic health records (EHRs) have the potential to increase diabetes screening. Given the widespread mobile phone ownership across diverse groups, text messages present a viable mode for delivering alerts directly to patients. The use of unsolicited text messages to offer hemoglobin A_1c (HbA_1c) screening has not yet been studied. It is imperative to gauge perceptions of "cold texts" to ensure that information and language are optimized to promote engagement with text messages that affect follow-through with health behaviors.

OBJECTIVE

This study aims to gauge the perceptions of and receptiveness to text messages to inform content that would facilitate engagement with text messages intended to initiate a mobile health (mHealth) intervention for targeted screening. Messages were designed to invite those not already diagnosed with diabetes to make a decision to take part in HbA_1c screening and walk them through the steps required to perform the behavior based solely on an automated text exchange.

METHODS

In total, 6 focus groups were conducted at Wake Forest Baptist Health (WFBH) between September 2019 and February 2020. The participants were adult patients without diabetes who had completed an in-person visit at the Family and Community Medicine Clinic within the previous year. We displayed a series of text messages and asked the participants to react to the message content and suggest improvements. Content was deductively coded with respect to the Health Belief Model (HBM) and inductively coded to identify other emergent themes that could potentially impact engagement with text messages.

RESULTS

Participants (N=36) were generally receptive to the idea of receiving a text-based alert for HbA_1c screening. Plain language, personalization, and content, which highlighted perceived benefits over perceived susceptibility and perceived severity, were important to participants' understanding of and receptiveness to messages. The patient-physician relationship emerged as a recurring theme in which patients either had a desire or held an assumption that their provider would be working behind the scenes throughout each step of the process. Participants needed further clarification to understand the steps involved in following through with HbA_1c screening and receiving results.

CONCLUSIONS

Our findings suggest that patients may be receptive to text messages that alert them to a risk of having an elevated HbA_1c in direct-to-patient alerts that use cold texting. Using plain and positive language, integrating elements of personalization, and defining new processes clearly were identified by participants as modifiable content elements that could act as facilitators that would help overcome barriers to engagement with these messages. A patient's relationship with their provider and the financial costs associated with texts and screening may affect receptiveness and engagement in this process.

“It's cancer screening after all”. Barriers to cervical and colorectal cancer screening and attitudes to promotion of self-sampling kits upon attendance for breast cancer screening

Objectives

To explore barriers to cervical and colorectal cancer screening and attitudes to promotion of self-sampling kits upon attendance for breast cancer screening.

Methods

Interview study with women who had not responded to one or more invitations to cervical or colorectal cancer screening. A semi-structured interview guide was used and interviews were audio recorded and transcribed verbatim. Concepts from Temporal Motivation Theory were used to structure and analyse the data.

Results

Twenty-two women were interviewed. Screening was highly valued but the women perceived screening for cervical cancer and colorectal cancer as more troublesome to participate in, compared with participation in breast cancer screening. The lack of a pre-booked appointment or a suggested deadline attenuated the perceived value of cervical and colorectal cancer screening and this further increased procrastination. Promotion of self-sampling kits for cervical and colorectal cancer screening upon attendance for breast cancer screening was considered a feasible way to increase salience of both types of screening.

Conclusion

A high number of micro steps and absence of a deadline in cervical and colorectal cancer screening diverted attention away from screening participation in cervical and colorectal cancer screening. The main facilitator could be reduction of micro actions, proposing a suggested deadline, and promotion of self-sampling kits when attending breast cancer screening to increase salience and a renewed attention to all three screening programmes.

Online Health Information Seeking Among Patients With Chronic Conditions: Integrating the Health Belief Model and Social Support Theory

BACKGROUND

Chronic diseases are the leading causes of death and disability. With the growing patient population and climbing health care expenditures, researchers and policy makers are seeking new approaches to improve the accessibility of health information on chronic diseases while lowering costs. Online health information sources can play a substantial role in effective patient education and health communication. However, some contradictory evidence suggests that patients with chronic conditions may not necessarily seek online health information.

OBJECTIVE

This study aims to integrate 2 theories (ie, the health belief model and social support theory) and a critical health literacy perspective to understand online health information seeking (OHIS) among patients with chronic conditions.

METHODS

We used the survey method to collect data from online chronic disease communities and groups on social media platforms. Eligible participants were consumers with at least 1 chronic condition and those who have experience with OHIS. A total of 390 valid questionnaires were collected. The partial least squares approach to structural equation modeling was employed to analyze the data.

RESULTS

The results suggested that perceived risk (t=3.989, P<.001) and perceived benefits (t=3.632, P<.001) significantly affected patients' OHIS. Perceived susceptibility (t=7.743, P<.001) and perceived severity (t=8.852, P<.001) were found to influence the perceived risk of chronic diseases significantly. Informational support (t=5.761, P<.001) and emotional support (t=5.748, P<.001) also impacted the perceived benefits of online sources for patients. In addition, moderation analysis showed that critical health literacy significantly moderated the link between perceived risk and OHIS (t=3.097, P=.002) but not the relationship between perceived benefits and OHIS (t=0.288, P=.774).

CONCLUSIONS

This study shows that the health belief model, when combined with social support theory, can predict patients' OHIS. The perceived susceptibility and severity can effectively explain perceived risk, further predicting patients' OHIS. Informational support and emotional support can contribute to perceived benefits, thereby positively affecting patients' OHIS. This study also demonstrated the important negative moderating effects of critical health literacy on the association between perceived risk and OHIS.

The Impact of Oral Health Behaviors, Health Belief Model, and Absolute Risk Aversion on the Willingness of Japanese University Students to Undergo Regular Dental Check-Ups: A Cross-Sectional Study

Oral health behaviors, risk aversion, and the health belief model are associated with health behaviors. However, there have been few studies that investigated the association between these factors and the willingness to undergo regular dental check-ups. The purpose of this cross-sectional study was to investigate the associations between the willingness of Japanese university students to undergo regular dental check-ups and oral health behaviors, the health belief model, and absolute risk aversion. An analysis was conducted with the cooperation of questionnaire respondents (n = 748) who underwent dental check-ups at Okayama University. The students answered questionnaires on oral health behaviors, the health belief model, absolute risk aversion, and willingness to undergo regular dental check-ups. The logistic regression analysis showed significant positive associations (p < 0.05) between oral health behaviors (use of the inter-dental brush and the dental floss) and the health belief model with the willingness to undergo regular dental check-ups. However, there was no significant association with absolute risk aversion (p > 0.05). These results suggest that willingness to undergo regular dental check-ups was associated with oral health behaviors and the health belief model, but not with absolute risk aversion.

Patient attitudes towards changes in colorectal cancer surveillance: An application of the Health Belief Model

OBJECTIVE

This is to determine whether health beliefs regarding colorectal cancer (CRC) screening could predict discomfort with a change to CRC surveillance proposing regular faecal immunochemical tests (FIT) instead of colonoscopy.

METHODS

Eight hundred individuals enrolled in a South Australian colonoscopy surveillance programme were invited to complete a survey on surveillance preferences. Responses were analysed using binary logistic regression predicting discomfort with a hypothetical FIT-based surveillance change. Predictor variables included constructs based on the Health Belief Model: perceived threat of CRC, perceived confidence to complete FIT and colonoscopy (self-efficacy), perceived benefits from current surveillance and perceived barriers to FIT and colonoscopy.

RESULTS

A total of 408 participants (51%) returned the survey (complete data n = 303; mean age 62 years, 52% male). Most participants (72%) were uncomfortable with FIT-based surveillance reducing colonoscopy frequency. This attitude was predicted by a higher perceived threat of CRC (OR = 1.03 [95% CI 1.01-1.04]), higher colonoscopy self-efficacy (OR = 1.34 [95% CI 1.13-1.59]) and lower perceived barriers to colonoscopy (OR = 0.92 [95% CI 0.86-0.99]).

CONCLUSIONS

Health beliefs regarding colonoscopy and perceived threat of CRC may be important to consider when changing CRC surveillance protocols. If guideline changes were introduced, these factors should be addressed to provide patients reassurance concerning the efficacy of the alternative protocol.

Colorectal cancer mortality in women: trend analysis in Brazil and its regions and states

OBJECTIVES

to analyze colorectal cancer mortality trends in women in Brazil and its regions and states.

METHODS

ecological, time-series study with trend analysis of deaths caused by colorectal cancer in women in Brazil and its regions and states between 2008 and 2019. Polynomial regression was used to treat the data.

RESULTS

48,225 deaths of women caused by colorectal cancer were examined. There was an increasing mortality trend in Brazilian women, with regional differences that resulted from socioeconomic, political, and cultural inequalities. The South Region stood out with the highest rate (7.32) in 2008, which increased to 8.65 in 2019, followed by the Southeast Region, whose rates were 6.72 and 9.05 in 2008 and 2019, respectively.

CONCLUSIONS

colorectal cancer mortality increased, which indicates the need to expand public policies oriented toward screening and early diagnosis of colorectal cancer in women.

Associations between Awareness of the Risk of Exposure to Pollutants Occurring at Fire Scenes and Health Beliefs among Metropolitan Firefighters in the Republic of Korea

Firefighters are repeatedly exposed to various pollutants that occur at fire scenes. There are three levels of exposure: primary exposure to pollutants, secondary exposure to pollutants on personal protective equipment (PPE), and tertiary exposure to contaminated fire stations and fire engines due to pollutants on PPE. Therefore, it is important for firefighters to be aware of the risk of exposure to pollutants and to practice health behaviors such as appropriate PPE management. No clear association has been established in the existing literature between firefighters’ risk perception level and their health beliefs about the health impact of awareness of exposure to hazardous substances at fire scenes. This study aims to evaluate the relationship between awareness of the exposure risk to primary, secondary, and tertiary pollutants and health beliefs. It was designed as a cross-sectional study, in which a web-based survey was conducted from 13 May to 31 May 2021. The analysis was conducted in 1940 firefighters working in the Seoul metropolis who agreed to participate in the research. Participants who perceived susceptibility were likely to be aware of the primary (adjusted odds ratio (AOR) = 2.10, 95% confidence interval (CI) 1.16–3.80), secondary (AOR = 2.77, 95% CI 1.77–4.32), and tertiary (AOR = 2.73, 95% CI 1.85–4.03) exposure risks. Participants who perceived barriers were unlikely to be aware of the risk of exposure to primary (AOR = 0.67, 95% CI 0.49–0.91), secondary (AOR = 0.77, 95% CI 0.61–0.96), and tertiary (AOR = 0.75, 95% CI 0.62–0.91) pollutants. Educational intervention is recommended to improve perceived susceptibility and awareness of the risk of exposure to pollutants and reduce perceived barriers. Consequently, educational intervention is expected to positively impact firefighters’ management of appropriate PPE. We confirmed an association between occupational exposure risk and firefighters’ health beliefs. In the health belief model (HBM), health beliefs that affect health behavior also affect awareness of the exposure risk level. Therefore, an intervention for health beliefs can also be used to raise job-related exposure risk awareness. Regular training on the health impacts of fire scenes is necessary for both newcomers and incumbents to enable firefighters to better recognize the risks of each occupational exposure level. Additionally, laws and regulations are necessary for the removal of harmful substances that contaminate PPE, such as self-contained breathing apparatus (SCBA), during exposure to a fire scene. Our research can be used as a basis for improving fire policies and education programs in the future.

Factors Promoting Breast, Cervical and Colorectal Cancer Screenings participation: A Systematic Review

Objective

The present study aims at systematically reviewing research conducted on factors promoting breast, cervical and colorectal cancer screenings participation.

Methods

A literature search in MEDLINE/PubMed and PsycInfo from January 2017 to October 2021 was performed. Data extraction, researchers' full agreement and the inclusion criteria produced 102 eligible studies. Data were narratively synthesized and critically interpreted.

Results

Multiple factors favoring or hindering breast, cervical and colorectal cancer screenings were identified and summarized as factors operating at the individual level (background information, individual characteristics, emotions related to screening procedure and to cancer, knowledge and awareness), at the relational level (relationships with healthcare staff, significant others, community members), and at the healthcare system level (systems barriers/policy, lack of staff). A critical appraisal of studies revealed a fragmentation in the literature, with a compartmentalization of studies by type of cancer screening, country and specific populations of destination.

Conclusions

Overall findings indicated that greater integration of research results obtained independently for each cancer diagnosis and within the different countries/populations could foster a more comprehensive understanding of factors potentially enhancing the participation in breast, cervical and colorectal cancer screenings worldwide. This review, which is grounded in the current context of globalization and superdiversification in population, can help to enhance a better integration between research and practices, by supporting the development of more effective and inclusive evidence‐based interventions and health‐promotion campaigns worldwide. Research and practical implications are highlighted and discussed.

A comparison of behavioural models explaining cervical cancer screening uptake

BACKGROUND

Cervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS) uptake is influenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifiable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention.

METHODS

A survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models.

RESULTS

CCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefits contributed most significantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specific barriers.

CONCLUSION

Health behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their effectiveness by addressing women's screening attitude, perceived benefits, and emotions as well as reducing context specific barriers to screening.

Improving intervention design to promote cervical cancer screening among hard-to-reach women: assessing beliefs and predicting individual attendance probabilities in Bogotá, Colombia

Background

Despite being a preventable disease, cervical cancer continues to be a public health concern, affecting mainly lower and middle-income countries. Therefore, in Bogotá a home-visit based program was instituted to increase screening uptake. However, around 40% of the visited women fail to attend their Pap smear test appointments. Using this program as a case study, this paper presents a methodology that combines machine learning methods, using routinely collected administrative data, with Champion’s Health Belief Model to assess women’s beliefs about cervical cancer screening. The aim is to improve the cost-effectiveness of behavioural interventions aiming to increase attendance for screening. The results presented here relate specifically to the case study, but the methodology is generic and can be applied in all low-income settings.

Methods

This is a cross-sectional study using two different datasets from the same population and a sequential modelling approach. To assess beliefs, we used a 37-item questionnaire to measure the constructs of the CHBM towards cervical cancer screening. Data were collected through a face-to-face survey (N = 1699). We examined instrument reliability using Cronbach’s coefficient and performed a principal component analysis to assess construct validity. Then, Kruskal–Wallis and Dunn tests were conducted to analyse differences on the HBM scores, among patients with different poverty levels. Next, we used data retrieved from administrative health records (N = 23,370) to fit a LASSO regression model to predict individual no-show probabilities. Finally, we used the results of the CHBM in the LASSO model to improve its accuracy.

Results

Nine components were identified accounting for 57.7% of the variability of our data. Lower income patients were found to have a lower Health motivation score (p-value < 0.001), a higher Severity score (p-value < 0.001) and a higher Barriers score (p-value < 0.001). Additionally, patients between 25 and 30 years old and with higher poverty levels are less likely to attend their appointments (O.R 0.93 (CI: 0.83–0.98) and 0.74 (CI: 0.66–0.85), respectively). We also found a relationship between the CHBM scores and the patient attendance probability. Average AUROC score for our prediction model is 0.9.

Conclusion

In the case of Bogotá, our results highlight the need to develop education campaigns to address misconceptions about the disease mortality and treatment (aiming at decreasing perceived severity), particularly among younger patients living in extreme poverty. Additionally, it is important to conduct an economic evaluation of screening options to strengthen the cervical cancer screening program (to reduce perceived barriers). More widely, our prediction approach has the potential to improve the cost-effectiveness of behavioural interventions to increase attendance for screening in developing countries where funding is limited.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01800-3.

Disparities in Recommendations for Colorectal Cancer Screening Among Average-Risk Individuals: An Ecobiosocial Approach

Regardless of the high global burden of colorectal cancer (CRC), the uptake of CRC screening varies across countries. This systematic review aimed to provide a picture of the disparities in recommendations for CRC screening in average-risk individuals using an ecobiosocial approach. It was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was conducted through Scopus, Web of Science, PubMed, and EBSCOHost. Full-text guidelines which were published between 2011 and 2021, along with guidelines which provided recommendations on CRC screening in average-risk individuals, were included in the review. However, guidelines focusing only on a single screening modality were excluded. Fourteen guidelines fulfilling the eligibility criteria were retained for the final review and analysis. Quality assessment of each guideline was performed using the AGREE II instrument. Disparities in guidelines identified in this review were classified into ecological (screening modalities and strategies), biological (recommended age, gender and ethnicities), and social (smoking history, socioeconomic status, and behavior) factors. In general, unstandardized practices in CRC screening for average-risk individuals are likely attributable to the inconsistent and non-specific recommendations in the literature. This review calls on stakeholders and policymakers to review the existing colorectal cancer screening practices and pursue standardization.

Screening Intention Prediction of Colorectal Cancer among Urban Chinese Based on the Protection Motivation Theory

Colorectal cancer poses a serious threat worldwide. Although early screening has been proved to be the most effective way to prevent and control colorectal cancer, the current situation of colorectal cancer screening remains not optimistic. The aim of this article is to apply the protection motivation theory (PMT) to examine the influencing factors on screening intention of colorectal cancer (CRC). This cross-sectional survey was launched in five communities in Wuhan, China. All the eligible urban Chinese were recruited and interviewed using paper-and-pencil questionnaires. The intention of colorectal cancer screening (CRCS) was measured using six PMT subconstructs, including perceived risk, perceived severity, fear arousal, response efficacy, response cost, and self-efficacy. Data on sociodemographic variables and knowledge of CRC were also collected. The structural equation modeling (SEM) method was used for data analysis. Among all the 569 respondents, 83.66% expressed willingness to participate in CRCS. Data of the research fit the proposed SEM model well (Chi-square/df = 2.04, GFI = 0.93, AGFI = 0.91, CFI = 0.91, IFI = 0.91, RMSEA = 0.04). Two subconstructs of PMT (response efficacy and self-efficacy) and CRC knowledge were directly and positively associated with screening intention. Age, social status, medical history, physical activity, and CRC knowledge were indirectly related to the screening intention through at least one of the two PMT subconstructs (response efficacy and self-efficacy). The findings of this study suggest the significance of enhancing response efficacy and self-efficacy in motivating urban Chinese adults to participate in CRC screening. Knowledge of CRC is significantly associated with screening intention. This study can provide useful information for the formulation and improvement of colorectal cancer screening strategies and plans.

Determinants of COVID-19 testing among late middle-aged and older adults: applying the health belief model

Objectives

The purpose of this study was to examine correlates of taking a COVID-19 test among late middle-aged and older adults using nationally representative data.

Methods

Data were obtained from the 2020 Health and Retirement Study midway release COVID-19 module. Our sample was representative of community residing adults aged 51 and over in the United States (n = 2,870).

Measurements

We regressed taking a COVID-19 test on demographic characteristics, medical comorbidities, and measures related to the health belief model (i.e., perceived severity, perceived susceptibility, cues to action, and perceived barriers) using logistic regression, stratifying the model by 10-year age categories.

Results

Concern about the pandemic was associated with an increase in the likelihood of taking a test among late middle-aged adults. Knowing someone who was diagnosed with COVID-19 was associated with taking a test in most age categories. Financial barriers and knowing someone who died of COVID-19 were not associated with taking a test.

Conclusions

How late middle-aged and older adults perceive the COVID-19 pandemic may significantly influence their likelihood of taking a COVID-19 test.

Mortalidade por câncer colorretal em mulheres: análise de tendência no Brasil, Estados e Regiões

RESUMO Objetivos: analisar as tendências da mortalidade por câncer colorretal em mulheres no Brasil, Estados e Regiões. Métodos: estudo ecológico, de séries temporais, com análise de tendência dos óbitos por câncer colorretal de mulheres, no período de 2008 a 2019. Para análise de tendência, foi utilizado o modelo de regressão polinomial. Resultados: analisaram-se 48.225 óbitos de mulheres por câncer colorretal. Houve tendência crescente da mortalidade em mulheres brasileiras, com diferenças regionais, em razão das desigualdades nos padrões socioeconômicos, políticos e culturais. Destacando um aumento na Região Sul, com as maiores taxas, de 7,32 em 2008 para 8,65 em 2019, seguida pela Região Sudeste, com taxas de mortalidade por câncer colorretal de 6,72 e 9,05 em 2008 e 2019, respectivamente. Conclusões: observa-se um aumento das taxas de mortalidade por câncer colorretal, demonstrando a necessidade do incremento das políticas públicas direcionadas às estratégias de rastreamento e diagnóstico precoce do câncer colorretal em mulheres.

Rate and associated factors of refusal to perform immunochemical Faecal Occult Blood Test (iFOBT) among semi-urban communities

The uptake of the immunochemical faecal occult blood test (iFOBT) in many countries with an opportunistic colorectal cancer (CRC) screening programme remains suboptimal. This study aimed to determine the rate, associated factors and reasons of refusal to perform the iFOBT test offered under an opportunistic CRC screening programme in semi-urban communities. This cross-sectional study was conducted among the average-risk individuals living in semi-urban areas, who sought care from public primary care centres across Kedah state, Malaysia. The information regarding the sociodemographic and clinical characteristics of individuals who were offered the iFOBT between January and April 2019, along with their willingness to perform the test, was gathered. The factors associated with the refusal were further explored using the logistic regression analysis. The individuals offered the iFOBT (n = 920) were mainly female (52.4%) and had a mean age of 58.7±10.6 years. The refusal rate of the iFOBT was 32.2%. Patients who did not have hypertension (adjusted OR: 3.33; 95% CI: 2.44, 4.54), did not have CRC symptoms (adjusted OR: 3.15; 95% CI:1.26, 7.89), had the test offered by either medical assistants (adjusted OR: 2.44; 95% CI: 1.71, 3.49) or nurses (adjusted OR: 2.41; 95% CI 1.65, 3.51), did not have diabetes (adjusted OR: 1.99; 95% CI: 1.42, 2.77),and were not active smokers (adjusted OR: 1.74; 95% CI: 1.22, 2.47), were more likely to refuse the iFOBT. The common reasons of refusing the test included "feeling not ready for the test" (21.6%) and "feeling healthy" (14.9%). The iFOBT was refused by one-third of the average-risk individuals from semi-urban communities. The associated factors and reasons of refusal found in this study could guide policymakers in developing targeted interventions to boost the uptake of CRC screening in Malaysia.

Perceived Susceptibility to and Seriousness of COVID-19: Associations of Risk Perceptions with Changes in Smoking Behavior

During the COVID-19 pandemic, studies have documented increased and decreased cigarette smoking among adults. Individual differences in the perceived susceptibility and seriousness of the virus, for people who smoke in general and for oneself personally, may relate to changes in smoking. Using the Health Belief Model (HBM) as a theoretical framework, we examined associations with self-reported increasing and decreasing smoking a lot during the COVID-19 stay-at-home period. Adults in 30 large U.S. cities who smoked cigarettes daily completed an online survey between 14 July and 30 November 2020. The analytic sample (N = 2768) was 54.0% male and 68.3% white with 23.7% reporting increasing and 11.3% decreasing smoking (6% reported both). Younger age, a diagnosis of COVID-19, and greater pandemic-related stress were associated with greater odds of both increased and decreased smoking. Increased smoking also was associated with heavier nicotine dependence, greater desire to quit, and greater perceived susceptibility and lower perceived seriousness of COVID-19 for people who smoke, while pandemic-related job-loss, lower nicotine dependence, and greater self-efficacy were associated with decreased smoking. Among respondents who had not contracted COVID-19 (n = 2418), correlates were similar with the addition of greater perceived personal susceptibility to COVID-19 associated with both increased and decreased smoking, while greater perceived personal seriousness of COVID-19 was associated with increased smoking. Findings for risk perceptions were largely in directions that contradict the HBM. Circumstances surrounding behavior change during the pandemic are complex and may be especially complex for nicotine addiction.

Patients' Willingness to Share Limited Endoscopic Resources: A Brief Report on the Results of a Large Regional Survey

Background. In some health care systems, patients face long wait times for screening colonoscopy. We sought to assess whether patients at low risk for colorectal cancer (CRC) would be willing to delay their own colonoscopy so higher-risk peers could undergo colonoscopy sooner. Methods. We surveyed 1054 Veterans regarding their attitudes toward repeat colonoscopy and risk-based prioritization. We used multivariable regression to identify patient factors associated with willingness to delay screening for a higher-risk peer. Results. Despite a physician recommendation to stop screening, 29% of respondents reported being "not at all likely" to stop. However, 94% reported that they would be willing to delay their own colonoscopy for a higher-risk peer. Greater trust in physician and greater health literacy were positively associated with willingness to wait, while greater perceived threat of CRC and Black or Latino race/ethnicity were negatively associated with willingness to wait. Conclusion. Despite high enthusiasm for repeat screening, patients were willing to delay their own colonoscopy for higher-risk peers. Appealing to altruism could be effective when utilizing scarce resources.

Colorectal cancer screening in Uruguay: current assessment and roadmap for the future

Cancer is a leading cause of death worldwide and is expected to remain a public health concern for years to come. Within Latin America, Uruguay has the highest colorectal cancer rates. Heeding past calls to action, in this article we provide a critical assessment of colorectal cancer needs and opportunities in Uruguay with a focus on developing a roadmap for future action. First, we provide an overview of risk factors, screening procedures and guidelines, and screening rates. Next, we provide an overview of psychosocial factors that influence colorectal cancer screening, with the goal of providing guidance for future behavioral health promotion initiatives in Uruguay. In this effort, we present four conceptual models that may be used for interventions: the ecological systems theory, informed decision-making, the health beliefs model, and the health literacy model. Subsequently, we propose using an integrated model based on the ecological systems theory and health literacy model to develop national, local, and community-based interventions to increase screening rates and lower the colorectal cancer burden in Uruguay. We close the paper with a summary and implications section, including recommendations for future research programs focused on the assessment of factors that influence screening.

Addressing Cancer Screening Inequities by Promoting Cancer Prevention Knowledge, Awareness, Self-Efficacy, and Screening Uptake Among Low-Income and Illiterate Immigrant Women in France

Objective: Cancer screening rates are suboptimal for disadvantaged populations in France, yet little evidence exists on their cancer-related knowledge and screening barriers. The main objective of this study was to examine cancer-related knowledge, awareness, self-efficacy, and perceptions of screening barriers among low-income, illiterate immigrant women in France following an 8-weeks cancer educational intervention. Methods: Semi-structured qualitative interviews were conducted with 164 female participants in the Ain department of France between January 2019 and March 2020. Adopting the Health Belief Model as an intervention and analytic framework, salient themes were identified using qualitative thematic analysis. Results: Increased levels of perceived susceptibility to and perceived severity of cancer contributed to higher motivation to get screened. Barriers to screening included low French proficiency, shame surrounding illiteracy, and constant worries due to precarious living conditions. Perceived benefits (e.g., valuing one's health and health-promoting behaviors), cues to action from a trusted source, and greater self-efficacy (e.g., more autonomous in healthcare-seeking) outweighed perceived barriers, including cultural barriers. Conclusions: Implications include developing audience-responsive targeted cancer screening communication strategies and educational materials to increase screening rates and reduce cancer and cancer screening inequities.

Rainbow of KIBOU project: Effectiveness of invitation materials for improving cancer screening rate using social marketing and behavioral economics approaches

Studies to date have shown that individual invitation (call) and re-invitation (recall) are effective in improving cancer screening rate. Also, by dividing subjects into segments and sending unique messages to each segment, the cancer screening rate is further improved. However, this approach is not realistic in the local governments due to limited resources, so we used social marketing and nudge techniques to develop cancer screening recommendation materials that do not need to send separately. This study therefore aimed to verify the effect of these materials in the real world. We compared the cancer screening rates in municipalities within Japan that used the invitation materials we developed (colorectal, breast, lung, cervical and stomach cancer), with those from the previous year. In addition, the usefulness of the materials in the real world was examined multilaterally using RE-AIM framework (Reach, Effectiveness, Adaption, Implementation, Maintenance). From 2015 to 2018, 4.3 million residents (Reach) from 787 municipalities (Adaption) were sent invitation materials for cancer screening. Of 167 municipalities that were compared, 141 (83%) showed an increase in screening rate when our materials were used. Overall, the screening rate improved by 2.6% or 1.44 fold (p < 0.001) (Effectiveness). However, the screening rate varied greatly depending on how screening is provided. Of the four years studied, 75 municipalities used the same materials for two or more years (Implementation). The material developed in this study improved the cancer screening rate in the real world, and it may be possible to further improve the screening rate if the number of opportunities for screening and its capacity is increased at the timing of sending materials. The materials can be found on the website (http://rokproject.jp/kenshin/) and free electronic files are available to municipalities wishing to use them.

The Effectiveness of Educational Interventions on Breast Cancer Screening Uptake, Knowledge, and Beliefs among Women: A Systematic Review

There have been various systematic reviews on the significance of educational interventions as necessary components to encourage breast cancer screening (BCS) and reduce the burden of breast cancer (BC). However, only a few studies have attempted to examine these educational interventions comprehensively. This review paper aimed to systematically evaluate the effectiveness of various educational interventions in improving BCS uptake, knowledge, and beliefs among women in different parts of the world. Following the PRISMA guidelines, a comprehensive literature search on four electronic databases, specifically PubMed, Scopus, Web of Science, and ScienceDirect, was performed in May 2019. A total of 22 interventional studies were reviewed. Theory- and language-based multiple intervention strategies, which were mainly performed in community and healthcare settings, were the commonly shared characteristics of the educational interventions. Most of these studies on the effectiveness of interventions showed favorable outcomes in terms of the BCS uptake, knowledge, and beliefs among women. Educational interventions potentially increase BCS among women. The interpretation of the reported findings should be treated with caution due to the heterogeneity of the studies in terms of the characteristics of the participants, research designs, intervention strategies, and outcome measures.