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Beydoun HA, Tsai J. Lifetime prevalence and correlates of colorectal cancer screening among low-income U.S. Veterans. Cancer Causes Control 2024; 35:1215-1231. [PMID: 38714606 DOI: 10.1007/s10552-024-01881-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/10/2024] [Indexed: 05/10/2024]
Abstract
PURPOSE The Veterans Health Administration (VHA) is the largest integrated healthcare system in the U.S. While preventive healthcare services are high priority in the VHA, low-income U.S. Veterans experience adverse life circumstances that may negatively impact their access to these services. This study examined lifetime prevalence as well as demographic, socioeconomic, military-specific, and clinical correlates of colorectal cancer (CRC) screening among low-income U.S. Veterans ≥ 50 years of age. METHODS Cross-sectional data on 862 participants were analyzed from the 2021-2022 National Veteran Homeless and Other Poverty Experiences study. RESULTS Overall, 55.3% (95% confidence interval [CI] 51.3-59.3%) reported ever-receiving CRC-screening services. In a multivariable logistic regression model, never-receivers of CRC screening were twice as likely to reside outside of the Northeast, and more likely to be married (odds ratio [OR] = 1.86, 95% CI 1.02, 3.37), have BMI < 25 kg/m2 [vs. 25- < 30 kg/m2] (OR = 1.75, 95% CI 1.19, 2.58), or ≥ 1 chronic condition (OR = 1.46, 95% CI 1.06, 2.02). Never-receivers of CRC screening were less likely to be female (OR = 0.53, 95% CI 0.29, 0.96), aged 65-79y [vs. ≥ 80y] (OR = 0.61, 95% CI 0.40, 0.92), live in 5 + member households (OR = 0.33, 95% CI 0.13, 0.86), disabled (OR = 0.45, 0.22, 0.92), with purchased health insurance (OR = 0.56, 95% CI 0.33, 0.98), or report alcohol-use disorder (OR = 0.10, 95% CI 0.02, 0.49) and/or HIV/AIDS (OR = 0.28, 95% CI 0.12, 0.68). CONCLUSION Nearly 55% of low-income U.S. Veterans reported ever screening for CRC. Variations in CRC-screening behaviors according to veteran characteristics highlight potential disparities as well as opportunities for targeted behavioral interventions.
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Affiliation(s)
- Hind A Beydoun
- National Center on Homelessness Among Veterans (NCHAV), Veterans Health Administration, 810 Vermont Avenue, NW, Washington, DC, 20420, USA.
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Jack Tsai
- National Center on Homelessness Among Veterans (NCHAV), Veterans Health Administration, 810 Vermont Avenue, NW, Washington, DC, 20420, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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Aujoulat P, Le Goff D, Dany A, Robaskiewick M, Nousbaum JB, Derrienic J, Cariou M, Guillou M, Le Reste JY. Improvement of participation rate in colorectal cancer (CRC) screening by training general practitioners in motivational interviewing (AmDepCCR). Trials 2022; 23:144. [PMID: 35164836 PMCID: PMC8842548 DOI: 10.1186/s13063-022-06056-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second leading cause of cancer death in France (17,712 annual deaths). However, this cancer is preventable in the majority of cases by the early detection of adenomas. In France, the organized screening for CRC relies on general practitioners (GPs). The tests delivered by the GPs are carried out in 89% of cases. However, GPs do not systematically offer the test, because of time management and communication. Methods AmDepCCR is a cluster randomized trial. Patients are prospectively included by their GPs. The study is designed in 2 phases for the GPs: first, GPs who have never participated in motivational interviewing (MI) training will be recruited then randomly split in 2 groups. Secondly, a 6-day motivational interviewing training will be carried out for the intervention group. Then, patients will be included in both groups during a period of 1 year. The primary outcome will be the number of CRC screenings achieved in each group and its difference. The secondary outcome will be the reluctance to screening and the patient’s self-estimated life expectancy at 0, 6, 12, and 24 months using the Health Belief Model (HBM). Discussion This study will help to know if GPs motivational interviewing is useful to improve organized CRC screening. In addition, it may help to improve communication between patients and GPs. GPs will be able to improve their practice in other fields of application through motivational interviewing (other screenings, addictions…). Trial registration 2019-A01776-51 NCT04492215. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06056-8.
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Validity and Reliability of the Instruments to Measure Colorectal Cancer Screening Benefits and Barriers-Turkish Version. Cancer Nurs 2020; 45:E364-E373. [PMID: 33399288 DOI: 10.1097/ncc.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Perceptions of benefits and barriers are important determinants in understanding colorectal cancer screening (CRCS) behaviors. There is a need for standardized Turkish tools that measure the benefits and barriers of fecal occult blood test (FOBT) and colonoscopy (COL). OBJECTIVE The aim of this study was to assess the validity and reliability of the Turkish version of the "Instruments to Measure CRCS Benefits and Barriers." METHODS This methodological study was carried out in 2 stages in primary care and in 394 adults between the ages of 50 and 70 years. In the first stage, some items of the scales demonstrated low/unacceptable corrected item-total and factor loadings, and in the second stage, it was decided to add emoji-based facial scales, which include emoji expressions. RESULTS Results with the emoji-based facial scales included internal consistency coefficients of 0.85 for FOBT benefits, 0.79 for FOBT barriers, 0.84 for COL benefits, and 0.86 for COL barriers; the item-total correlations of FOBT varied between 0.39 and 0.73, whereas those of COL varied between 0.38 and 0.76. The factor loadings of all items were higher than 0.40. CONCLUSIONS The emoji-based facial scale for CRC Screening Benefits and Barriers is a valid and reliable tool for measuring the benefits and barriers perceptions of 50- to 70-year-old Turkish adults. IMPLICATIONS FOR PRACTICE The Instruments to Measure CRCS Benefits and Barriers-Turkish version can provide insights for nurses and healthcare professionals to understand individuals' perceived FOBT and COL benefits and barriers and to develop effective interventions to increase CRCS rates.
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Zoellner J, Porter K, Thatcher E, Kennedy E, Werth JL, Grossman B, Roatsey T, Hamilton H, Anderson R, Cohn W. A Multilevel Approach to Understand the Context and Potential Solutions for Low Colorectal Cancer (CRC) Screening Rates in Rural Appalachia Clinics. J Rural Health 2020; 37:585-601. [PMID: 33026682 DOI: 10.1111/jrh.12522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To explore system/staff- and patient-level opportunities to improve colorectal cancer (CRC) screening within an 11-clinic Federally Qualified Health Center (FQHC) in rural Appalachia with CRC screening rates around 22%-30%. METHODS Using a convergent parallel mixed-methods design, staff (n = 26) and patients (n = 60, age 50-75, 67% female, 83% <college, 47% Medicare, 23% Medicaid) were interviewed about CRC-related screening practices. Staff and patient interviews were guided by the Consolidated Framework for Implementation Research and Health Belief Model, respectively, and analyzed using a hybrid inductive-deductive approach. RESULTS Among staff, inner setting factors that could promote CRC screening included high workplace satisfaction, experiences tracking other cancer screenings, and a highly active Performance Improvement Committee. Inner setting hindering factors included electronic medical record inefficiencies and requiring patients to physically return fecal tests to the clinic. Outer setting CRC screening promoting factors included increased Medicaid access, support from outside organizations, and reporting requirements to external regulators, while hindering factors included poor social determinants of health, inadequate colonoscopy access, and lack of patient compliance. Among patients, perceived screening benefits were rated relatively higher than barriers. Top barriers included cost, no symptoms, fear, and transportation. Patients reported high likelihood of getting a stool-based test and colonoscopy if recommended, yet self-efficacy to prevent CRC was considerably lower. CONCLUSIONS Contextualized perceptions of barriers and practical opportunities to improve CRC screening rates were identified among staff and patients. To optimize multilevel CRC screening interventions in rural Appalachia clinics, future quality improvement, research, and policy efforts are needed to address identified challenges.
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Affiliation(s)
- Jamie Zoellner
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Kathleen Porter
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Esther Thatcher
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Erin Kennedy
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - James L Werth
- Stone Mountain Health Services, Damascus, Virginia.,Tri-Area Community Health, Laurel Fork, Virginia
| | - Betsy Grossman
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | | | | | - Roger Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Wendy Cohn
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
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Lau J, Lim TZ, Jianlin Wong G, Tan KK. The health belief model and colorectal cancer screening in the general population: A systematic review. Prev Med Rep 2020; 20:101223. [PMID: 33088680 PMCID: PMC7567954 DOI: 10.1016/j.pmedr.2020.101223] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022] Open
Abstract
Colorectal cancer screening saves lives and is cost-effective. It allows early detection of the pathology, and enables earlier medical intervention. Despite clinical practice guidelines promoting screening for average risk individuals, uptake remains suboptimal in many populations. Few studies have examined how sociobehavioural factors influence screening uptake in the context of behaviour change theories such as the health belief model. This systematic review therefore examines how the health belief model’s constructs are associated with colorectal cancer screening. Four databases were systematically searched from inception to September 2019. Quantitative observational studies that used the health belief model to examine colorectal screening history, intention or behaviour were included. A total of 30 studies met the criteria for review; all were of cross-sectional design. Perceived susceptibility, benefits and cues to action were directly associated with screening history or intention. Perceived barriers inversely associated with screening history or intention. The studies included also found other modifying factors including sociodemographic and cultural norms. Self-report of screening history, intention or behaviour, convenience sampling and lack of temporality among factors were common limitations across studies. The health belief model’s associations with colorectal cancer screening uptake was consistent with preventive health behaviours in general. Future studies should examine how theory-based behavioural interventions can be tailored to account for the influence of socioecological factors.
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Affiliation(s)
- Jerrald Lau
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tian-Zhi Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gretel Jianlin Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Conn ME, Kennedy-Rea S, Subramanian S, Baus A, Hoover S, Cunningham C, Tangka FKL. Cost and Effectiveness of Reminders to Promote Colorectal Cancer Screening Uptake in Rural Federally Qualified Health Centers in West Virginia. Health Promot Pract 2020; 21:891-897. [PMID: 32990048 DOI: 10.1177/1524839920954164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The purpose of this study is to evaluate the effectiveness of the West Virginia Program to Increase Colorectal Cancer Screening in implementing patient reminders to increase fecal immunochemical test (FIT) kit return rates in nine federally qualified health centers (FQHCs). Using process measures and cost data collected, the authors examined the differences in the intensity of the phone calls across FQHCs and compared them with the return rates achieved. They also reported the cost per kit successfully returned as a result of the intervention. Across all FQHCs, 5,041 FIT kits were ordered, and the initial return rate (without a reminder) was 41.1%. A total of 2,201 patients received reminder phone calls; on average, patients received 1.61 reminder calls each. The reminder interventions increased the average FIT kit return rate to 60.7%. The average total cost per FIT kit returned across all FQHCs was $60.18, and the average cost of only the reminders was $11.20 per FIT kit returned. FQHCs achieved an average increase of 19.6 percentage points in FIT kit return rates, and costs across clinics varied. Clinics with high-quality health information systems that enabled tracking of patients with minimal effort were able to implement lower cost reminder interventions.
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Affiliation(s)
| | | | | | - Adam Baus
- West Virginia University, Morgantown, WV, USA
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Lee E, Natipagon-Shah B, Sangsanoi-Terkchareon S, Warda US, Lee SY. Factors Influencing Colorectal Cancer Screening Among Thais in the U.S. J Community Health 2020; 44:230-237. [PMID: 30341745 DOI: 10.1007/s10900-018-0578-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study examined factors related to colorectal cancer (CRC) screening uptake among Thais in the United States. A total of 121 Thais between 50 and 75 years of age, who were married and living in southern California participated in the survey (mean age = 61 years). Out of all the participants, only 21% of the participants had fecal occult blood tests, 21% had sigmoidoscopy, and 45% had colonoscopy that were within the recommended period. Overall, 55% of participants met CRC screening adherence criteria. Participants who had had regular checkups in the previous 2 years without having any symptoms were 16 times more likely to have obtained CRC screening than their counterparts (OR 16.01, CI 3.75-68.75) in the multivariable logistic regression model. Other significant predictors of screening adherence included older age (OR 1.08, 95% CI 1.00-1.17), having lived in the U.S. 15 years or longer (OR 6.65, 95% CI 1.55-28.59), having had at least some college education (OR 3.74, 95% CI 1.23-11.37), and higher levels of perceived self-efficacy (OR 1.88, 95% CI 1.01-3.50) to obtain CRC screening. Targeted interventions for Thais who are less likely receive CRC screening could be effective in improving CRC screening. Interventions to improve the populations' awareness of the importance of preventive measures when they are not sick could be also effective.
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Affiliation(s)
- Eunice Lee
- School of Nursing, University of California, Los Angeles, 700 Tiverton Ave., #-4-258, Los Angeles, CA, 90095, USA
| | - Bulaporn Natipagon-Shah
- School of Nursing, California State University, San Marcos, 333 S. Twin Oaks Valley Rd., San Marcos, CA, 92096, USA
| | | | - Umme Shefa Warda
- School of Nursing, University of California, Los Angeles, 700 Tiverton Ave., #-4-258, Los Angeles, CA, 90095, USA
| | - Shin-Young Lee
- Department of Nursing, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 501-759, Republic of Korea.
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Temucin E, Nahcivan NO. The Effects of the Nurse Navigation Program in Promoting Colorectal Cancer Screening Behaviors: a Randomized Controlled Trial. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:112-124. [PMID: 30470978 DOI: 10.1007/s13187-018-1448-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although screening programs are known and recommended for the early detection of colorectal cancer (CRC), the screening rates for the fecal occult blood test (FOBT) and colonoscopy are very low among adult individuals. Navigation programs, also known as individualized counseling, have recently begun to be used for increasing screening rates. The purpose of this study was to compare the efficacy of the Nurse Navigation Program versus usual care on CRC screening participation and movement in stage of adoption for CRC screening and to examine perceived benefits of and barriers to CRC screening. This study was designed in line with a pre- and posttest two-group methodology. A total of 110 participants (55 nurse-navigated and 55 non-navigated patients) were studied. Data were collected using the following three tools: a sociodemographic information form, the Harvard Colorectal Cancer Risk Assessment Tool, and Instruments to Measure Colorectal Cancer Screening Benefits and Barriers. Following the Nurse Navigation Program, the FOBT (82 and 84%, respectively) and colonoscopy completion rates (15 and 22%, respectively) were significantly higher in the nurse-navigated group than in the non-navigated group at 3 and 6 months follow-up. Following the program, the benefit perceptions of the nurse-navigated group about CRC screening were improved, and their barrier perceptions were reduced. The results showed that the Nurse Navigation Program had significant effects on CRC screening behavior and health-related beliefs concerning CRC screening. Further assessment of the Nurse Navigation Program in different groups should be performed to observe its effects.
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Affiliation(s)
- Elif Temucin
- Nursing Faculty, Oncology Nursing Department, University of Health Sciences, Istanbul, Turkey.
| | - Nursen O Nahcivan
- Florence Nightingale Nursing Faculty, Public Health Nursing Department, Istanbul University, Istanbul, Turkey
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9
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Lee SY. Colorectal Cancer Screening among Korean Americans in Chicago: Does It Matter Whether They had the Screening in Korea or the US? Asian Pac J Cancer Prev 2018; 19:1387-1395. [PMID: 29802705 PMCID: PMC6031846 DOI: 10.22034/apjcp.2018.19.5.1387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Colorectal cancer (CRC) is one of the most common cancers in Korean Americans (KAs) and CRC screening can detect CRC early and may reduce the incidence of CRC by leading to removal of precancerous polyps. Many KAs in the US leave the country, primarily to travel to Korea, for health screening. The aim of this study was to (a) assess CRC screening rates, including fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy and (b) explore factors related to these tests among KAs by location of CRC screening. Methods: Descriptive and correlational research design with cross-sectional surveys was used with 210 KAs. Socio-demographics (age, gender, years in the US, marital status, education, employment, household income, and proficiency in spoken English), access to health care (health insurance and usual source of health care), and location of CRC screening utilization (Korea, the US, or both Korea and US) were measured and analyzed using descriptive statistics and multinominal logistic regression. Results: Out of 133 KA participants who had had lifetime CRC screening (i.e., had ever had FOBT, flexible sigmoidoscopy, or colonoscopy), 19% had visited Korea and undergone CRC screening in their lifetimes. Among socio-demographic factors and access to health care factors, having a usual source of health care in the US (OR=8.45) was significantly associated with having undergone lifetime CRC screening in the US. Having health insurance in the US and having had lifetime CRC screening in the US were marginally significant (OR=2.54). Conclusion: Access to health care in the US is important for KAs to have CRC screening in the US. As medical tourism has been increasing globally, the location of CRC screening utilization must be considered in research on cancer screening to determine correlates of CRC screening.
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Affiliation(s)
- Shin Young Lee
- Department of Nursing, Chosun University 309 Pilmun-daero, Dong-gu, Gwangju, 501-759 Republic of Korea
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Abstract
BACKGROUND Lung cancer screening is a recent recommendation for long-term smokers. Understanding individual health beliefs about screening is a critical component in future efforts to facilitate patient-provider conversations about screening participation. OBJECTIVE The aim of this study was to describe the development and psychometric testing of 4 new scales to measure lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, self-efficacy). METHODS In phase I, 4 scales were developed from extensive literature review, item modification from existing Breast and Colorectal Cancer Screening Health Belief Scales, focus groups with long-term smokers, and evaluation/feedback from a panel of 10 content experts. In phase II, we conducted a survey of 497 long-term smokers to assess the final scales' reliability and validity. RESULTS Phase I: content validity was established with the content expert panel. Phase II: internal consistency reliability of the scales was supported with Cronbach's α's ranging from .88 to .92. Construct validity was established with confirmatory factor analysis and testing for differences between screeners and nonscreeners in theoretically proposed directions. CONCLUSIONS Initial testing supports the scales are valid and reliable. These new scales can help investigators identify long-term smokers more likely to screen for lung cancer and are useful for the development and testing of behavioral interventions regarding lung cancer screening. IMPLICATIONS FOR PRACTICE Development of effective interventions to enhance shared decision making about lung cancer screening between patients and providers must first identify factors influencing the individual's screening participation. Future efforts facilitating patient-provider conversations are better informed by understanding the perspective of the individual making the decision.
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Hughes AG, Watanabe-Galloway S, Schnell P, Soliman AS. Rural-Urban Differences in Colorectal Cancer Screening Barriers in Nebraska. J Community Health 2016; 40:1065-74. [PMID: 25910484 DOI: 10.1007/s10900-015-0032-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Nebraska ranks 36th nationally in colorectal cancer screening. Despite recent increases in CRC screening rates, rural areas in Nebraska have consistently shown lower rates of CRC screening uptake, compared to urban areas. The objective of this study was to investigate reasons for lower CRC screening rates among Nebraska residents, especially among rural residents. We developed a questionnaire based on Health Belief Model (HBM) constructs to identify factors associated with the use of CRC screening. The questionnaire was mailed in 2014 to adults aged 50-75 years in an urban community in the east and a rural community in the west regions of the state. Multiple logistic regression models were created to assess the effects of HBM constructs, rural residence, and demographic factors on CRC screening use. Of the 1200 surveys mailed, 393 were returned (rural n = 200, urban n = 193). Rural respondents were more likely to perceive screening cost as a barrier. Rural residents were also more likely to report that CRC cannot be prevented and it would change their whole life. In multiple regression models, rural residence, perceived embarrassment, and perceived unpleasantness about screening were significantly associated with reduced odds of receiving colonoscopy. Older age (62 years and older), having a personal doctor, and perceived risk of getting CRC were significantly associated with increased odds of receiving colonoscopy. Interventions to increase uptake of colorectal cancer screening in rural residents should be tailored to acknowledge unique perceptions of screening methods and barriers to screening.
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Affiliation(s)
- Alejandro G Hughes
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
| | - Paulette Schnell
- Department of Community Health, Regional West Medical Center, 3700 Avenue B, Scottsbluff, NE, 69361, USA
| | - Amr S Soliman
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
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Zajac IT, Duncan AC, Flight I, Wittert GA, Cole SR, Young GP, Wilson CJ, Turnbull DA. Theory-based modifications of an advanced notification letter improves screening for bowel cancer in men: A randomised controlled trial. Soc Sci Med 2016; 165:1-9. [PMID: 27485727 DOI: 10.1016/j.socscimed.2016.06.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 06/16/2016] [Accepted: 06/20/2016] [Indexed: 11/24/2022]
Abstract
RATIONALE Male participation in screening for bowel cancer is sub-optimal. Theory-based interventions provide a means of improving screening uptake. OBJECTIVE To test the efficacy of modifying consumer invitation material in line with continuum and stage theories of health behaviour on screening participation. METHODS N = 9216 Australian men aged 50-74 years were randomised to one of four trial arms in a 2 × 2 factorial design randomised controlled trial. Participants received either standard invitation material (control group), or combinations of modified advance-notification and invitation letters. A subsample completed baseline and endpoint behavioural surveys. RESULTS Participants who received the modified advance notification letter were 12% more likely to screen than those who received the standard version (RR = 1.12, χ(2)(1) = 10.38, p = 0.001). The modified invitation letter did not impact screening uptake (RR = 0.97, χ(2)(1) = 0.63, p = 0.424). No significant changes in psychological variables due to the intervention were observed. CONCLUSION Modifications to advance notification letters in line with health behaviour theories significantly improves screening uptake in men. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12612001122842 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362688.
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Affiliation(s)
- Ian T Zajac
- CSIRO Health & Biosecurity, South Australia, Australia.
| | - Amy C Duncan
- School of Psychology, University of Adelaide, South Australia, Australia
| | - Ingrid Flight
- CSIRO Health & Biosecurity, South Australia, Australia; Flinders Centre for Innovation in Cancer, Flinders University, South Australia, Australia
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Stephen R Cole
- Flinders Centre for Innovation in Cancer, Flinders University, South Australia, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, South Australia, Australia
| | - Carlene J Wilson
- Flinders Centre for Innovation in Cancer, Flinders University, South Australia, Australia; Cancer Council South Australia, Australia
| | - Deborah A Turnbull
- School of Psychology, University of Adelaide, South Australia, Australia; Freemasons Foundation Centre for Men's Health, School of Medicine, The University of Adelaide, Adelaide, Australia
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Taheri-Kharameh Z, Noorizadeh F, Sangy S, Zamanian H, Shouri-Bidgoli AR, Oveisi H. Factors Associated with Adherence to Colorectal Cancer Screening among Moderate Risk Individuals in Iran. Asian Pac J Cancer Prev 2016; 16:8371-5. [DOI: 10.7314/apjcp.2015.16.18.8371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Predictors of stage of adoption for colorectal cancer screening among African American primary care patients. Cancer Nurs 2015; 37:241-51. [PMID: 24145250 DOI: 10.1097/ncc.0b013e3182a40d8d] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Compared with other racial groups, African Americans have the highest colorectal cancer (CRC) incidence and mortality rates coupled with lower screening rates. OBJECTIVE Our study examined the predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy among African American primary care patients who were nonadherent to published screening guidelines. METHODS Baseline data (N = 815) in a randomized clinical trial were analyzed. Participants were categorized into precontemplation, contemplation, and preparation stages for FOBT and colonoscopy. Predictor variables were demographics, clinical variables, CRC health beliefs and knowledge, and social support. Hierarchical modeling was to identify significant predictors of stage of adoption. RESULTS Older, male, Veterans Affairs participants and those with higher perceived self-efficacy, family/friend encouragement, and a provider recommendation had higher odds of being at a more advanced stage of adoption for FOBT. Patients with a history of cancer and higher perceived barriers had higher odds of being at an earlier stage of adoption for FOBT. Predictors of more advanced stage of adoption for colonoscopy included higher perceived benefits, higher perceived self-efficacy, family/friend encouragement, and a provider recommendation for colonoscopy. Higher income (>30 000 vs <15 000) was predictive of earlier stage of adoption for colonoscopy. CONCLUSIONS Enhancing self-efficacy, encouragement from family and friends, and provider recommendations are important components of interventions to promote CRC screening. IMPLICATIONS FOR PRACTICE Nurses can use knowledge of the characteristics associated with stage of adoption to educate and motivate their African American primary care patients to complete CRC screening tests.
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Carter-Harris L, Ceppa DP, Hanna N, Rawl SM. Lung cancer screening: what do long-term smokers know and believe? Health Expect 2015; 20:59-68. [PMID: 26701339 PMCID: PMC4919238 DOI: 10.1111/hex.12433] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 01/07/2023] Open
Abstract
Objective To explore knowledge and beliefs of long‐term smokers about lung cancer, associated risk factors and lung cancer screening. Design Qualitative study theoretically framed by the expanded Health Belief Model based on four focus group discussions. Content analysis was performed to identify themes of knowledge and beliefs about lung cancer, associated risk factors and lung cancer screening among long‐term smokers' who had and had not been screened for lung cancer. Methods Twenty‐six long‐term smokers were recruited; two groups (n = 9; n = 3) had recently been screened and two groups (n = 7; n = 7) had never been screened. Results While most agreed lung cancer is deadly, confusion or inaccurate information exists regarding the causes and associated risk factors. Knowledge related to lung cancer screening and how it is performed was low; awareness of long‐term smoking's association with lung cancer risk remains suboptimal. Perceived benefits of screening identified include: (i) finding lung cancer early; (ii) giving peace of mind; and (iii) motivation to quit smoking. Perceived barriers to screening identified include: (i) inconvenience; (ii) distrust; and (iii) stigma. Conclusions Perceived barriers to lung cancer screening, such as distrust and stigma, must be addressed as lung cancer screening becomes more widely implemented. Heightened levels of health‐care system distrust may impact successful implementation of screening programmes. Perceived smoking‐related stigma may lead to low levels of patient engagement with medical care and decreased cancer screening participation. It is also important to determine modifiable targets for intervention to enhance the shared decision‐making process between health‐care providers and their high‐risk patients.
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Affiliation(s)
| | | | - Nasser Hanna
- Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Susan M Rawl
- Indiana University School of Nursing, Indianapolis, IN, USA
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Homan SG, Yun S, Stewart BR, Armer JM. Breast Cancer Survivorship Care: Targeting a Colorectal Cancer Education Intervention. J Pers Med 2015; 5:296-310. [PMID: 26258794 PMCID: PMC4600149 DOI: 10.3390/jpm5030296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/27/2015] [Accepted: 07/31/2015] [Indexed: 11/25/2022] Open
Abstract
Breast cancer survivors are at risk of developing a second primary cancer. Colorectal cancer (CRC) is one of the leading second primary cancers, and it is often preventable. We developed a multi-component educational tool to inform and encourage women breast cancer survivors to engage in CRC screening. To assess the strengths and weakness of the tool and to improve the relevancy to the target audience, we convened four focus groups of women breast cancer survivors in Missouri. We also assessed the potential impact of the tool on the knowledge, attitudes, and beliefs regarding CRC and collected information on the barriers to CRC screening through pre- and post-focus groups' questionnaires. A total of 43 women breast cancer survivors participated and provided very valuable suggestions on design and content to update the tool. Through the process and comparing pre- and post-focus group assessments, a significantly higher proportion of breast cancer survivors strongly agreed or agreed that CRC is preventable (78.6% vs. 96.9%, p = 0.02) and became aware that they were at a slightly increased risk for CRC (18.6% vs. 51.7%, p = 0.003). The most cited barrier was the complexity of preparation for colonoscopy.
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Affiliation(s)
- Sherri G Homan
- Public Health Epidemiologist, Missouri Department of Health and Senior Services, Division of Community and Public Health, Office of Epidemiology, 920 Wildwood Drive, Jefferson City, MO 65109, USA.
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
| | - Shumei Yun
- Chronic Disease and Nutrition Epidemiology Team, Missouri Department of Health and Senior Services, Division of Community and Public Health, Office of Epidemiology, 920 Wildwood Drive, Jefferson City, MO 65109, USA.
- School of Medicine, University of Missouri-Columbia, MO 65212, USA.
| | - Bob R Stewart
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
- College of Education, University of Missouri, Columbia, MO 65211, USA.
| | - Jane M Armer
- Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
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Correlates of colorectal cancer screening among South Asian immigrants in the United States. Cancer Nurs 2015; 37:E19-27. [PMID: 23632468 DOI: 10.1097/ncc.0b013e31828db95e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND South Asians are a rapidly increasing population in the United States. Little is known about influences on their cancer screening behaviors, an important prerequisite to designing culturally appropriate education. OBJECTIVE The purpose of this study was to evaluate rates and correlates of colorectal cancer (CRC) screening, knowledge, and beliefs among South Asians. METHODS A subsample of those 50 years or older (n = 275) was drawn from the South Asian Health Descriptor Study, an assessment of multiple health indicators conducted in Chicago, Illinois. RESULTS Indians represented 87% of the sample; 2.2% of participants believed that they were at risk for CRC; 8% reported a past stool blood test (SBT); and 13.6% had had a sigmoidoscopy or colonoscopy. Language acculturation (adjusted odds ratio [AOR], 1.93; confidence interval [CI], 1.1-3.5) and medical mistrust (AOR, 0.243; CI, 0.091-0.650) were significantly related to SBT completion. Language acculturation (AOR, 3.30; CI, 1.8-5.5), income (AOR, 2.70; CI, 1.0-7.1), living in the United States for more than 5 years (AOR, 8.6; CI, 1.9-14.5), perception of CRC risk (AOR, 8.9; CI, 1.1-17.7), and past SBT (AOR, 5.0; CI, 1.8-14.0) were significantly related to endoscopic cancer screening. CONCLUSIONS Facilitators and barriers to different CRC tests vary. Education to increase CRC screening may need to be targeted to culture and specific barriers to each screening test rather than generic messages for all screening tests. IMPLICATIONS FOR PRACTICE Because barriers to CRC screening may differ among people based on the specific screening test being recommended. Primary care practitioners should recognize this fact and identify different barriers to enhance adherence to screening recommendations.
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Fernández ME, Savas LS, Wilson KM, Byrd TL, Atkinson J, Torres-Vigil I, Vernon SW. Colorectal cancer screening among Latinos in three communities on the Texas-Mexico border. HEALTH EDUCATION & BEHAVIOR 2015; 42:16-25. [PMID: 24786793 PMCID: PMC4214900 DOI: 10.1177/1090198114529592] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess colorectal cancer screening (CRCS) prevalence and psychosocial correlates of CRCS among Latinos in South Texas. METHOD Using multivariable analyses, we examined the association of perceived susceptibility, self-efficacy, pros and cons, subjective norms, knowledge and fatalism on CRCS among 544 Latinos (50 years and older). RESULTS In this socioeconomically disadvantaged population, 40% had never heard of any CRCS test, only 34% reported ever completing any type of CRCS, and only 25% were adherent to CRCS guidelines. Insurance status, gender, perceived cons, CRCS self-efficacy, and CRCS norms were significantly associated with CRCS. CONCLUSION CRCS interventions in this population should focus on improving access, increasing self-efficacy and perceived norms, and decreasing negative perceptions of CRCS.
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Affiliation(s)
| | - Lara S Savas
- University of Texas School of Public Health, Houston, TX, USA
| | | | - Theresa L Byrd
- Department of Family and Community Medicine, Texas Tech Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - John Atkinson
- University of Texas School of Public Health, Houston, TX, USA
| | - Isabel Torres-Vigil
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA Dorothy I. Height Center for Health Equity & Evaluation Research, University of Houston Graduate College of Social Work, Houston, TX, USA
| | - Sally W Vernon
- University of Texas School of Public Health, Houston, TX, USA
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Public health and cooperative group partnership: a colorectal cancer intervention. Semin Oncol Nurs 2013; 30:61-73. [PMID: 24559782 DOI: 10.1016/j.soncn.2013.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe the development of a multi-component colorectal cancer educational tool for female breast cancer survivors through a cooperative group and public health partnership. DATA SOURCES PubMed, World Wide Web, guidelines from professional organizations, surveys and focus groups with breast cancer survivors. CONCLUSION Collaboration is at the core of cooperative group and public health research. This partnership led to the development of a colorectal cancer educational tool for breast cancer survivors. Focus groups revealed that female breast cancer survivors were receptive to education on colorectal cancer screening. IMPLICATIONS FOR NURSING PRACTICE Nurses are instrumental in research collaborations between cooperative groups and public health. The colorectal educational intervention for breast cancer survivors serves as an exemplar of partnerships leading to innovative research planning and implementation outcomes.
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Duncan A, Zajac I, Flight I, Stewart BJR, Wilson C, Turnbull D. Comparison of mailed invitation strategies to improve fecal occult blood test participation in men: protocol for a randomized controlled trial. Trials 2013; 14:239. [PMID: 23902589 PMCID: PMC3751457 DOI: 10.1186/1745-6215-14-239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 07/05/2013] [Indexed: 02/03/2023] Open
Abstract
Background Men have a significantly increased risk of being diagnosed with, and dying from, colorectal cancer (CRC) than women. Men also participate in fecal occult blood test (FOBT) screening at a lower rate than women. This study will determine whether strategies that target men’s attitudes toward screening, and matched to stage of readiness to screen, increase men’s FOBT participation compared to a standard approach. Methods/Design Eligible trial participants will be a national sample of 9,200 men aged 50 to 74 years, living in urban Australia and randomly selected from the Australian electoral roll. Trial participants will be mailed an advance notification letter, followed 2 weeks later by an invitation letter and a free fecal immunochemical test (FIT) kit. The intervention is a factorial design, randomized controlled trial (RCT) with four trial arms, including a control. The content of the advance notification and invitation letters will differ by trial arm as follows: 1) standard advance notification and standard invitation (control arm); 2) targeted advance notification and standard invitation; 3) standard advance notification and targeted invitation; and 4) targeted advance notification and targeted invitation. The standard letters will replicate as closely as possible the letters included in the Australian National Bowel Cancer Screening Program (NBCSP). Modified advance notification and invitation letters will incorporate additional messages to target men in the precontemplation (advance notification) and contemplation stages (invitation). The primary outcome is return of the completed FIT within 12 weeks of invitation. Analysts will be blinded to trial assignment and participants will be blinded to the use of varying invitational materials. Subsamples from each trial arm will complete baseline and endpoint surveys to measure the psychological impact of the intervention, and qualitative interviews will be conducted to evaluate attitudes toward the intervention. Discussion The outcomes of this study will have implications for the way FOBT screening is offered to men. Findings will help to identify how invitations for men to screen should be framed and delivered in order to maximize participation. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12612001122842
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Affiliation(s)
- Amy Duncan
- School of Psychology, The University of Adelaide, Adelaide 5005, South Australia, Australia.
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Christy SM, Rawl SM. Shared decision-making about colorectal cancer screening: a conceptual framework to guide research. PATIENT EDUCATION AND COUNSELING 2013; 91:310-7. [PMID: 23419327 PMCID: PMC3756595 DOI: 10.1016/j.pec.2013.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 12/27/2012] [Accepted: 01/11/2013] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To develop a conceptual framework to guide research on shared decision-making about colorectal cancer (CRC) screening among persons at average risk and their providers. METHODS Based upon a comprehensive review of empirical literature and relevant theories, a conceptual framework was developed that incorporated patient characteristics, cultural beliefs, provider/health care system variables, health belief/knowledge/stage of adoption variables, and shared decision-making between patients and providers that may predict behavior. Relationships among concepts in the framework, shared decision-making process and outcomes, and CRC screening behavior were proposed. Directions for future research were presented. RESULTS Many of the concepts in the proposed framework have been examined in prior research. However, these elements have not been combined previously to explain shared decision-making about CRC screening. CONCLUSION Research is needed to test the proposed relationships and hypotheses and to refine the framework. PRACTICE IMPLICATIONS Findings from future research guided by the proposed framework may inform clinical practice to facilitate shared decision-making about CRC screening.
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Affiliation(s)
- Shannon M Christy
- Purdue School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, USA.
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Menon U, Belue R, Wahab S, Rugen K, Kinney AY, Maramaldi P, Wujcik D, Szalacha LA. A randomized trial comparing the effect of two phone-based interventions on colorectal cancer screening adherence. Ann Behav Med 2011; 42:294-303. [PMID: 21826576 PMCID: PMC3232176 DOI: 10.1007/s12160-011-9291-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Early-stage diagnosis of colorectal cancer is associated with high survival rates; screening prevalence, however, remains suboptimal. PURPOSE This study seeks to test the hypothesis that participants receiving telephone-based tailored education or motivational interviewing had higher colorectal cancer screening completion rates compared to usual care. METHODS Primary care patients not adherent with colorectal cancer screening and with no personal or family history of cancer (n = 515) were assigned by block randomization to control (n = 169), tailored education (n = 168), or motivational interview (n = 178). The response rate was 70%; attrition was 24%. RESULTS Highest screening occurred in the tailored education group (23.8%, p < .02); participants had 2.2 times the odds of completing a post-intervention colorectal cancer screening than did the control group (AOR = 2.2, CI = 1.2-4.0). Motivational interviewing was not associated with significant increase in post-intervention screening. CONCLUSIONS Tailored education showed promise as a feasible strategy to increase colorectal cancer screening.
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Affiliation(s)
- Usha Menon
- College of Nursing & Health Innovation, Arizona State University
| | | | | | | | - Anita Y. Kinney
- Department of Internal Medicine and Huntsman Cancer Institute, University of Utah
| | - Peter Maramaldi
- Simmons College School of Social Work, Harvard Medical School
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Kiviniemi MT, Bennett A, Zaiter M, Marshall JR. Individual-level factors in colorectal cancer screening: a review of the literature on the relation of individual-level health behavior constructs and screening behavior. Psychooncology 2011; 20:1023-33. [PMID: 21954045 PMCID: PMC3038178 DOI: 10.1002/pon.1865] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/10/2010] [Accepted: 09/16/2010] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Compliance with colorectal cancer screening recommendations requires considerable conscious effort on the part of the individual patient, making an individual's decisions about engagement in screening an important contributor to compliance or noncompliance. The objective of this paper was to examine the effectiveness of individual-level behavior theories and their associated constructs in accounting for engagement in colorectal cancer screening behavior. METHODS We reviewed the literature examining constructs from formal models of individual-level health behavior as factors associated with compliance with screening for colorectal cancer. All published studies examining one or more constructs from the health belief model, theory of planned behavior, transtheoretical model, or social cognitive theory and their relation to screening behavior or behavioral intentions were included in the analysis. RESULTS By and large, results of studies supported the theory-based predictions for the influence of constructs on cancer screening behavior. However, the evidence base for many of these relations, especially for models other than the health belief model, is quite limited. CONCLUSIONS Suggestions are made for future research on individual-level determinants of colorectal cancer screening.
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Affiliation(s)
- Marc T Kiviniemi
- Department of Health Behavior, University at Buffalo, New York 14124, USA.
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BeLue R, Menon U, Kinney AY, Szalacha LA. Psychosocial risk profiles among black male Veterans Administration patients non-adherent with colorectal cancer screening. Psychooncology 2010; 20:1151-60. [PMID: 20928929 DOI: 10.1002/pon.1838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 07/17/2010] [Accepted: 07/20/2010] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study identifies unique psychosocial characteristics among African American men that put the men at risk for non-adherence to colorectal cancer (CRC) screening (colonoscopy, sigmoidoscopy, and fecal occult blood tests (FOBT)). Subgroups sharing similar psychosocial characteristics may be targeted with specific intervention strategies aimed at increasing participation in screening, which could lead to increased early detection and decreased morbidity and mortality. METHODS The male African American veterans in our sample (n = 260) had a mean age of 57.3 (SD = 7.3) years. Our study employs latent class analysis, a quantitative-based, audience segmentation method to identify homogeneous subgroups of African American men with similar psychosocial characteristics related to CRC screening, potentially in need of different health information and intervention strategies. Latent class regression was used to examine the relationships among latent class structure and demographic characteristics. RESULTS There were four psychosocial risk classes across the three screening tests. A significant subset of men had psychosocial characteristics indicative of willingness to be screened for each test (colonscopy = 21.8%, sigmoidoscopy = 31.5%, and FOBT = 10.8%), although they were currently non-adherent. Men who received a past screening test, had greater than a high school education, or were married were more likely to be represented in a latent class indicative of being prepared for getting colonoscopy or sigmoidoscopy. Sociodemographic variables were unrelated to FOBT latent class structure. CONCLUSIONS Segmenting our sample of male African American veterans based on psychosocial risk characteristics can inform the development of more precisely targeted interventions for African American men who are non-adherent for CRC screening.
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Affiliation(s)
- Rhonda BeLue
- Department of Health Policy and Administration, The Pennsylvania State University, PA, USA.
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Sifri R, Rosenthal M, Hyslop T, Andrel J, Wender R, Vernon SW, Cocroft J, Myers RE. Factors associated with colorectal cancer screening decision stage. Prev Med 2010; 51:329-31. [PMID: 20600255 DOI: 10.1016/j.ypmed.2010.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 06/11/2010] [Accepted: 06/18/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This paper reports on factors associated with colorectal cancer (CRC) screening decision stage (SDS) in screening-eligible primary care patients. METHODS Baseline telephone survey data (i.e., sociodemographic background, CRC screening perceptions, and SDS) were obtained for 1515 patients in a randomized behavioral intervention trial. Respondents reported SDS, a measure of proximity to actual screening, after listening to descriptions of screening stool blood testing and flexible sigmoidoscopy as had never heard of (NHO), were not considering or were undecided (NCU), or decided to do (DTD) each test. Polychotomous regression analyses were performed to differentiate participants by SDS. RESULTS At baseline, SDS was distributed as follows: NHO (8%), NCU (41%), and DTD (51%). We found that individuals who had DTD compared to those who were NCU about screening were older (OR=0.64), had prior cancer screening (OR=1.43), believed screening is important (OR=3.44), and had high social support (OR=2.49). Persons who were NCU compared to NHO participants were female (OR=2.18), were white (OR=2.35), had prior cancer screening (OR=2.81), and believed screening is important (OR=2.44). CONCLUSIONS Prior screening and belief in screening importance were found to be consistently associated with SDS across comparisons, while older age, gender, race, and social support were not.
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Affiliation(s)
- Randa Sifri
- Thomas Jefferson University, Department of Family and Community Medicine, Philadelphia, PA 19107, USA
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O'Donnell S, Goldstein B, DiMatteo MR, Fox SA, John CR, Obrzut JE. Adherence to Mammography and Colorectal Cancer Screening in Women 50–80 Years of Age. Womens Health Issues 2010; 20:343-9. [DOI: 10.1016/j.whi.2010.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 04/07/2010] [Accepted: 04/08/2010] [Indexed: 01/11/2023]
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Wu TY, Hsieh HF, West BT. Stages of mammography adoption in Asian American women. HEALTH EDUCATION RESEARCH 2009; 24:748-759. [PMID: 19318524 DOI: 10.1093/her/cyp009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Asian American women have the lowest mammography screening rate and are often diagnosed at later stages of breast cancer compared with other ethnic groups. This study applied the Transtheoretical Model and examined the relationships between stages of mammography adoption and mammography-related beliefs while controlling for socio-demographic factors. The study consisted of a convenience sample of 315 participants from four populous Asian ethnic groups in Michigan (109 Asian Indians, 51 Chinese, 36 Koreans and 119 Filipinos). In this relatively small sample, Koreans appeared to be more likely to be at the pre-contemplation stage and less likely to be at the maintenance stage. Perceived barriers and decisional balance scores differed by stage, with pre-contemplators reporting highest barriers and lowest scores in decisional balance. In terms of specific barrier items, pre-contemplators also displayed significantly greater agreement for most of the barrier items. Participants in the action stage have less favorable decisional balance than those in two earlier stages (i.e. contemplation and relapse). Common barriers for this sample of Asian participants included the items related to access and modesty issues. Overall, the study supports the notion that assessing differences in mammography-related beliefs by stage of screening behavior may facilitate the development of stage-matched interventions for Asian ethnic groups.
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Affiliation(s)
- Tsu-Yin Wu
- School of Nursing, Eastern Michigan University, Ypsilanti, MI 48197, USA.
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Menon U, Szalacha LA, Belue R, Rugen K, Martin KR, Kinney AY. Interactive, culturally sensitive education on colorectal cancer screening. Med Care 2008; 46:S44-50. [PMID: 18725832 PMCID: PMC3042884 DOI: 10.1097/mlr.0b013e31818105a0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Increasing colorectal cancer screening (CRCS) can have a substantial positive impact on morbidity and mortality. OBJECTIVES The purpose of this report is to describe the development and feasibility testing of a computer-based, theory-guided educational program designed to increase CRCS. RESEARCH DESIGN This mixed-methods study used focus groups and subsequent randomized controlled trial design. SUBJECTS Participants (N = 199) were randomized to an intervention or control group; 75% were African American; mean age was 57.36 (SD = 6.8); 71% were male. MEASURES Previously validated measures on knowledge, beliefs, and screening test adherence were used to establish pre- and post-intervention perceptions. Feasibility was measured by response and completion rates, and participants' perceptions of the program. RESULTS Before feasibility testing, the program was presented to 2 focus groups. Changes were made to the program based on discussion, leading to a visually appealing, easy to understand and navigate, self-paced program. In the RCT pilot test that followed, of the participants in the intervention group, 80% said the education helped them decide to get CRCS; 49% agreed it helped them overcome barriers; 91% agreed it was useful, 68% thought it raised new concerns about cancer, but only 30% said it made them worry about CRC; 95% agreed their doctor's office should continue giving such education, and 99% said they would inform family about the program. CONCLUSIONS The response rate of 83% demonstrated feasibility of conducting colorectal cancer education in the primary care setting; overall the program was well received; participants averaged 23 minutes to complete it. Participants sought no help from attending data collectors and navigated the revised touch screen program with ease. Computer-based education is feasible in primary care clinics.
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Affiliation(s)
- Usha Menon
- University of Illinois at Chicago, Chicago, Illinois 60625, USA.
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