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Laven-Law G, Symonds EL, Winter JM, Chen G, Flight IH, Hughes-Barton D, Wilson CJ, Young GP. Comparing a fecal immunochemical test and circulating tumor DNA blood test for colorectal cancer screening adherence. J Gastroenterol Hepatol 2024; 39:1267-1276. [PMID: 38430185 DOI: 10.1111/jgh.16531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/20/2023] [Accepted: 02/08/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND AND AIM Colorectal cancer (CRC) screening programs are most effective at reducing disease incidence and mortality through sustained screening participation. A novel blood test modality is being explored for CRC screening, but it is unclear whether it will provide sustained screening participation. This study aimed to investigate whether a circulating tumor DNA (ctDNA) blood test improved CRC screening re-participation when compared with a fecal immunochemical test (FIT) and to define the predictors of sustained CRC screening in an Australian population. METHODS South Australians who initially participated in CRC screening using a ctDNA blood test (n = 36) or FIT (n = 547) were offered the same CRC screening test approximately 2 years later through an extended phase of a randomized controlled trial. Surveys collected demographic, psychosocial, and clinical information. Predictors of CRC screening re-participation were explored using chi-square, Wilcoxon tests, and logistic regression. RESULTS Participants offered a second ctDNA blood test were equally likely to re-participate in CRC screening as those who completed a FIT in the first round and who were offered the same test (61% vs 66% re-participation respectively, P = 0.6). CRC fatalism, health activation, and self-efficacy were associated with repeated screening participation. Test awareness was predictive of repeated FIT-based CRC screening. CONCLUSIONS Targeted interventions to improve CRC screening awareness and increase patient health activation may improve CRC screening adherence. A ctDNA blood test may be a suitable CRC screening option to maintain CRC screening adherence in people who do not participate in screening with FIT.
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Affiliation(s)
- Geraldine Laven-Law
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Erin L Symonds
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
- Department of Gastroenterology and Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Jean M Winter
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Caulfield East, Victoria, Australia
| | - Ingrid H Flight
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Donna Hughes-Barton
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Carlene J Wilson
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Graeme P Young
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
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2
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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 2024:10.1007/s10552-024-01881-5. [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] [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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3
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Myers RE, Hallman MH, Shimada A, DiCarlo MA, Davis KV, Leach WT, Chambers CV. Primary care patient interests in joining a planned multi-cancer early detection clinical trial. Cancer Med 2024; 13:e7312. [PMID: 38785202 PMCID: PMC11117448 DOI: 10.1002/cam4.7312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Clinical trials are being conducted and are being planned to assess the safety and efficacy of multi-cancer early detection (MCED) tests for use in cancer screening. This study aimed to determine the feasibility of primary care patient outreach in recruiting participants to a planned MCED clinical trial, assess patient interest in trial participation, and measure decisional conflict related to participation. METHODS The research team used the electronic medical record of a large, urban health care system to identify primary care patients 50-80 years of age who were potentially eligible for a planned MCED trial. We mailed information about the planned MCED trial to identified patients and then contacted the patients by telephone to obtain consent and administer a baseline survey. Subsequently, we contacted consented patients to complete an interview to review the mailed information and elicit perceptions about trial participation. Finally, a research coordinator administered an endpoint telephone survey to assess patient interest in and decisional conflict related to joining the trial. RESULTS We randomly identified 1000 eligible patients and were able to make contact with 690 (69%) by telephone. Of the patients contacted, 217 (31%) completed the decision counseling session and 219 (32%) completed the endpoint survey. Among endpoint survey respondents, 177 (81%) expressed interest in joining the MCED trial and 162 (74%) reported low decisional conflict. CONCLUSIONS Most patients were contacted and about a quarter of those contacted expressed interest in and low decisional conflict about joining the planned MCED trial. Research is needed to determine how to optimize patient outreach and engage patients in shared decision-making about MCED trial participation.
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Affiliation(s)
- Ronald E. Myers
- Division of Population Science, Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Mie H. Hallman
- Division of Population Science, Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental TherapeuticsThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Melissa A. DiCarlo
- Division of Population Science, Department of Medical OncologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Kaitlyn V. Davis
- Department of Family and Community MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - William T. Leach
- Department of Family and Community MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Christopher V. Chambers
- Department of Family and Community MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
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Li C, Lu X, Xu J, Gao F, Lee E, Chan CWH. Effectiveness of a nurse-led decision counselling programme on hepatocellular carcinoma screening uptake among patients with hepatitis B: A randomised controlled trial. Int J Nurs Stud 2023; 148:104610. [PMID: 37801936 DOI: 10.1016/j.ijnurstu.2023.104610] [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: 03/29/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND The globally endemic hepatocellular carcinoma induced by hepatitis B highlights the need for an ultrasonography-based screening strategy to reduce the tumour burden. However, patient non-adherence due to unawareness and complex decisions in weighting uncertainties of hepatocellular carcinoma screening has continuously challenged its continuum. OBJECTIVE To examine the effectiveness and process of a nurse-led decision counselling programme for improving hepatocellular carcinoma screening among patients with hepatitis B. DESIGN Single-blind randomised controlled trial. SETTING AND PARTICIPANTS Between 12 March and 19 July 2021, 178 patients with hepatitis B were recruited from six inpatient wards of a university-affiliated hospital in northern China. METHODS Participants were randomly allocated to receive usual care (n = 89) or usual care plus a nurse-led decision counselling programme (n = 89). Underpinned by the preventive health model, the programme consisted of health education, tailored information, and values clarification exercises to elicit informed and value-based preferences for hepatocellular carcinoma screening. Screening barriers were explored and addressed through procedural problem-solving. Hepatocellular carcinoma screening rate at six months post-baseline was the primary outcome. Secondary outcomes (knowledge, perceptions, and decision conflicts regarding hepatocellular carcinoma screening) were measured at baseline (T0), immediately after the intervention (T1), and the six-month follow-up (T2). A Medical Research Council framework-guided process evaluation was conducted by drawing on data from intervention documentation, WeChat discussions, and interviews with stakeholders (n = 13). RESULTS With a mean age of 47.32 (8.78) years, participants mostly occupied rural residences (63.5 %). Compared with the control group, the intervention group had significantly higher hepatocellular carcinoma screening rates (75.6 % vs. 42.1 %, p < 0.001) and displayed greater improvements in the scores of hepatocellular carcinoma screening knowledge (β = 3.643, 95 % confidence interval [CI] = 3.030, 4.255), salience and coherence (β = 0.410, 95 % CI = 0.234, 0.586), response efficacy (β = 0.327, 95 % CI = 0.181, 0.473), and perceived susceptibility (β = 0.214, 95 % CI = 0.040, 0.388) at T1. Improvement in perceived susceptibility was not maintained, whereas a higher decrease of the decision conflict score was found at T2 (β = -4.156, 95 % CI = -7.851, -0.461). The process evaluation revealed potential intervention mechanisms and contextual factors affecting intervention effectiveness, such as living status and natural disasters. CONCLUSION The programme was effective in improving hepatocellular carcinoma screening and showed that nurses could play a decision counselling role in optimising the screening among patients with hepatitis B. TRIAL REGISTRATION ClinicalTrials.govNCT04659005. Registration date: 9 December, 2020. TWEETABLE ABSTRACT Nurse-led decision counselling improves hepatocellular carcinoma screening in patients with hepatitis B.
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Affiliation(s)
- Caixia Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China.
| | - Xiling Lu
- The Public Health Center, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan Province, China
| | - Juan Xu
- The Public Health Center, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan Province, China
| | - Fei Gao
- The Public Health Center, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan Province, China
| | - Eunice Lee
- School of Nursing, University of California, Los Angeles, CA, USA.
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China.
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Alenezi AM, Alshariyah MMH, Alanazi MN, Abdel-Salam DM, Al-Hazmi AH, Thirunavukkarasu A, Alhuwaydi AM, Alsabilah RH, Mohamed RA. Assessment of Psychosocial Correlates and Associated Factors of Colorectal Cancer Screening among Southwestern Saudi Population: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2791. [PMID: 37893864 PMCID: PMC10606086 DOI: 10.3390/healthcare11202791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Psychosocial correlates are one of the crucial determinants for the uptake of colorectal cancer (CRC) screening by the pre-eligible population. The present study aimed to identify the psychosocial correlates of colorectal cancer screening and determine their associated factors among the Saudi population in the Najran region, Saudi Arabia. Using a validated questionnaire, we assessed five constructs of psychosocial correlates of CRC screening among 790 participants aged 45 years and above. The five constructs were salience and coherence, cancer worries, perceived susceptibility, response efficacy, and social influence. Of the studied population, less than 50% agreed with most of the five constructs' statements, and 27.5% preferred to follow their family members' advice. Significantly higher mean scores (±SD) were identified for the male gender (7.38 ± 2.15, p = 0.027) and participants working in government sectors (7.60 ± 2.03, p = 0.027) in the cancer worries construct, while the mean (±SD) scores of perceived susceptibility were significantly higher among married participants (14.38 ± 4.10, p = 0.023) and smokers (14.95 ± 3.92, p = 0.041). Our survey results could help policymakers to implement focused health education programs for the pre-eligible population on the importance of the uptake of CRC screening. Furthermore, it is recommended to carry out exploratory mixed-method surveys in other regions of Saudi Arabia to understand the region's specific psychosocial correlates towards CRC screening.
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Affiliation(s)
| | | | - Maryam Nazal Alanazi
- Department of Psychological Counseling, College of Sciences and Arts, Qurrayat Campus, Jouf University, Qurrayat 77425, Saudi Arabia;
| | - Doaa Mazen Abdel-Salam
- Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Ahmad Homoud Al-Hazmi
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (A.H.A.-H.); (A.T.)
| | - Ashokkumar Thirunavukkarasu
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (A.H.A.-H.); (A.T.)
| | - Ahmed M. Alhuwaydi
- Department of Internal Medicine, Division of Psychiatry, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia;
| | | | - Rehab A. Mohamed
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt;
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6
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Rodriguez SA, Tiro JA, Baldwin AS, Hamilton-Bevil H, Bowen M. Measurement of Perceived Risk of Developing Diabetes Mellitus: A Systematic Literature Review. J Gen Intern Med 2023; 38:1928-1954. [PMID: 37037984 PMCID: PMC10272015 DOI: 10.1007/s11606-023-08164-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/10/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND This systematic review describes approaches to measuring perceived risk of developing type 2 diabetes among individuals without diagnoses and describes the use of theories, models, and frameworks in studies assessing perceived risk. While a systematic review has synthesized perceived risk of complications among individuals with diabetes, no reviews have systematically assessed how perceived risk is measured among those without a diagnosis. METHODS Medline, PubMed, PsycINFO, and CINAHAL databases were searched for studies conducted through October 2022 with measures of perceived risk among adults ≥ 18 years without a diabetes diagnosis. Extracted data included study characteristics, measures, and health behavior theories, models, or frameworks used. RESULTS Eighty-six studies met inclusion criteria. Six examined perceived risk scales' psychometric properties. Eighty measured perceived risk using (1) a single item; (2) a composite score from multiple items or subconstructs; and (3) multiple subconstructs but no composite score. Studies used items measuring "comparative risk," "absolute or lifetime risk," and "perceived risk" without defining how each differed. Sixty-four studies used cross-sectional designs. Twenty-eight studies mentioned use of health behavior theories in study design or selection of measures. DISCUSSION There was heterogeneity in how studies operationalized perceived risk; only one third of studies referenced a theory, model, or framework as guiding design or scale and item selection. Use of perceived lifetime risk, absolute risk, or comparative risk limits comparisons across studies. Consideration of context, target population, and how data are utilized is important when selecting measures; we present a series of questions to ask when selecting measures for use in research and clinical settings. This review is the first to categorize how perceived risk is measured in the diabetes prevention domain; most literature focuses on perceived risk among those with diabetes diagnoses. Limitations include exclusion of non-English and gray literature and single reviewer screening and data extraction.
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Affiliation(s)
- Serena A. Rodriguez
- Department of Health Promotion & Behavioral Sciences, The University of Texas Health Science Center Houston (UTHealth Houston) School of Public Health, Trinity Towers, 2777 N Stemmons Fwy, Ste 8400, TX 75207 Dallas, USA
- UTHealth Houston School of Public Health, Center for Health Promotion & Prevention Research, 7000 Fannin Street, Houston, TX 77030 USA
| | - Jasmin A. Tiro
- Department of Public Health Sciences, University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637 USA
- University of Chicago Medicine Comprehensive Cancer Center, 5841 S. Maryland Avenue, Chicago, IL 60637 USA
| | - Austin S. Baldwin
- Department of Psychology, Southern Methodist University, Expressway Tower, PO Box 750442, Dallas, TX 75275 USA
| | - Hayley Hamilton-Bevil
- University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 75229 USA
| | - Michael Bowen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390 USA
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7
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Bouchard EG, Saad-Harfouche FG, Clark N, Colon J, LaValley SA, Reid M, Attwood K, Bansal-Travers M, Glaser K. Adapting Community Educational Programs During the COVID-19 Pandemic: Comparing the Feasibility and Efficacy of a Lung Cancer Screening Educational Intervention by Mode of Delivery. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:854-862. [PMID: 35840859 PMCID: PMC9286703 DOI: 10.1007/s13187-022-02197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 06/02/2023]
Abstract
Few eligible patients receive lung cancer screening. We developed the Lung AIR (awareness, information, and resources) intervention to increase community education regarding lung cancer screening. The intervention was designed as an in-person group intervention; however, the COVID-19 pandemic necessitated adapting the mode of delivery. In this study we examined intervention feasibility and efficacy overall and by mode of delivery (in-person group vs. one-on-one phone) to understand the impact of adapting community outreach and engagement strategies. Feasibility was examined through participant demographics. Efficacy was measured through pre/post knowledge, attitudes, and beliefs about lung cancer screening, and intention to complete screening. We reached N = 292 participants. Forty percent had a household income below $35,000, 58% had a high school degree or less, 40% were Hispanic, 57% were Black, and 84% reported current or past smoking. One-on-one phone sessions reached participants who were older, had lower incomes, more current smoking, smoked for more years, more cigarettes per day, lower pre-intervention lung cancer screening knowledge, and higher pre-intervention fear and worry. Overall pre/post test scores show significant increases in knowledge, salience, and coherence, and reduced fear and worry. Participants in the one-on-one phone sessions had significantly higher increases in salience and coherence and intention to complete screening compared to participants in the in-person group sessions. The Lung AIR intervention is a feasible and effective community-based educational intervention for lung cancer screening. Findings point to differences in reach and efficacy of the community-based intervention by mode of delivery.
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Affiliation(s)
- Elizabeth G Bouchard
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
| | - Frances G Saad-Harfouche
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Nikia Clark
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Jomary Colon
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Susan A LaValley
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Mary Reid
- Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - Kathryn Glaser
- Department of Cancer Prevention and Control, Office of Community Outreach and Engagement, Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY, 14263, USA
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8
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Morey BN, Valencia C, Lee S. The Influence of Asian Subgroup and Acculturation on Colorectal Cancer Screening Knowledge and Attitudes Among Chinese and Korean Americans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1806-1815. [PMID: 34106449 PMCID: PMC8188737 DOI: 10.1007/s13187-021-02042-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 06/12/2023]
Abstract
Understanding how knowledge and attitudes about colorectal cancer (CRC) screening differs among Asian immigrants is important for informing targeted health interventions aimed at preventing and treating CRC in this diverse population. This study examines how Asian subgroup and acculturation are associated with CRC knowledge and attitudes among Chinese and Korean immigrants in the United States (U.S.). Data come from the baseline survey of a randomized controlled trial to increase CRC screening among Chinese and Korean American immigrants living in the Baltimore-Washington DC Metropolitan Area (n = 400). We use linear regression to examine how Asian subgroup, time in the U.S., English-speaking proficiency, and ethnic identity are associated with CRC knowledge and screening attitudes, accounting for demographic variables, socioeconomic status, and health insurance status. Results show that greater socioeconomic status was associated with higher CRC knowledge, and socioeconomic status explained more of the variance in CRC knowledge than acculturation factors. Additionally, attitudes varied by Asian subgroup, with Chinese reporting lower CRC screening salience, worry, response efficacy, and social influence compared to Koreans. Findings suggest that in-language interventions aimed at increasing CRC knowledge and capitalizing on attitudes about screening can help to bridge disparities in CRC screening by socioeconomic status and country of origin. We discuss implications for future interventions to increase CRC screening uptake among Chinese and Korean immigrants in the U.S.
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Affiliation(s)
- Brittany N Morey
- Department of Health, Society, & Behavior, Program in Public Health, University of California Irvine, 653 E. Peltason Dr., Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA, 92697-3957, USA.
| | - Connie Valencia
- Department of Health, Society, & Behavior, Program in Public Health, University of California Irvine, 653 E. Peltason Dr., Irvine, CA, 92697-3957, USA
| | - Sunmin Lee
- Department of Medicine, School of Medicine, University of California Irvine, 1001 Health Sciences Rd., Irvine, CA, 92617, USA
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9
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Dix M, Wilson CJ, Flight IH, Wassie MM, Young GP, Cock C, Cohen-Woods S, Symonds EL. Patient attitudes towards changes in colorectal cancer surveillance: An application of the Health Belief Model. Eur J Cancer Care (Engl) 2022; 31:e13713. [PMID: 36151912 DOI: 10.1111/ecc.13713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Maddison Dix
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Carlene J Wilson
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia.,Austin Health, Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ingrid H Flight
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Molla M Wassie
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Charles Cock
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia.,Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Sarah Cohen-Woods
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,College of Education, Psychology, and Social Work, Flinders University, Bedford Park, South Australia, Australia.,Orama Institute for Mental Health and Well-Being, Flinders University, Bedford Park, South Australia, Australia
| | - Erin L Symonds
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia.,Bowel Health Service, Flinders Medical Centre, Bedford Park, South Australia, Australia
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10
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Yang L, Zhao R, Li S, Ji C, Qin J, Song Y, Wu X. Psychometric properties of a Chinese version of four-factor colorectal cancer screening belief scale. Asia Pac J Oncol Nurs 2022; 9:100081. [PMID: 36060833 PMCID: PMC9428841 DOI: 10.1016/j.apjon.2022.100081] [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: 02/05/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Screening improves the early diagnosis rate of colorectal cancer (CRC) and effectively reduces its mortality. The four-factor CRC screening belief scale is conducive to understanding the psychometric properties of screening beliefs, but no Chinese version of this scale is available. The purpose of this study was to test the psychometric properties of a Chinese version of the four-factor CRC screening belief scale in patients with cancer and their relatives. METHODS The four-factor CRC screening belief scale was translated into Chinese based on Brislin's model. A panel review ensured the cultural adaptation and content validity of the scale. The scale was then administered to a convenience sample of 425 Chinese people recruited from July 2019 to June 2021. RESULTS Exploratory factor analysis identified the factor structure for the Chinese version of the four-factor CRC screening belief scale, including perceived barriers, perceived benefits, self-efficacy, and optimism. Confirmatory factor analysis showed that the model fits well. The scale-level content validity index was 1.0. The correlation between the Chinese version of the four-factor CRC screening belief scale and the CRC health belief model scale was statistically significant (r = 0.831, P < 0.01). McDonald's omega coefficients for the entire scale were 0.939 and 0.774-0.948 for the four subscales. The translated scale had test-retest reliability of 0.719 and split-half reliability of 0.646. CONCLUSIONS The Chinese version of the four-factor CRC screening belief scale showed adequate reliability and validity. The translation and validation of psychosocial assessment tools for CRC screening across languages, cultures, and countries will contribute to further international research collaborations and the improvement of the prospects for the prevention and care of CRC.
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Affiliation(s)
- Liu Yang
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rui Zhao
- Department of Nursing, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Shan Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Guangdong Medical University, Guangzhou, China
| | - Chaona Ji
- Intervension Department, First Affiliated Hospital of Shantou University Medical College, Guangzhou, China
| | - Jiexiong Qin
- Gynecology II, Peking University Shenzhen Hospital, Guangzhou, China
| | - Yalan Song
- Department of Nursing, Cancer Center of Guangzhou Medical University, Guangzhou, China
- Corresponding author.
| | - Xiaodan Wu
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Corresponding author.
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11
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Clifton ABW, Mehta SJ, Wainwright JV, Ogden SN, Saia CA, Rendle KA. Exploring Why Financial Incentives Fail to Affect At-home Colorectal Cancer Screening: a Mixed Methods Study. J Gen Intern Med 2022; 37:2751-2758. [PMID: 35037172 PMCID: PMC9411475 DOI: 10.1007/s11606-021-07228-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/19/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite success in increasing other health behaviors, financial incentives have shown limited to no effect on colorectal cancer (CRC screening. Little is known about the factors shaping why and for whom incentives improve screening. OBJECTIVE To explore the perspective of participants enrolled in a larger, four-arm pragmatic trial at urban family medicine practices which assessed and failed to detect significant effects of financial incentives on at-home CRC screening completion. DESIGN We performed a mixed methods study with a subset of randomly selected patients, stratified by study arm, following completion of the pragmatic trial. PARTICIPANTS Sixty patients (46.9% enrollment rate) who were eligible and overdue for colorectal cancer screening at the time of trial enrollment and who continued to receive care at family medicine practices affiliated with an urban academic health system completed the interview and questionnaire. MAIN MEASURES Using Andersen's behavioral model, a semi-structured interview guide assessed motivators, barriers, and facilitators to screening completion and the impact of incentives on decision-making. Participants also completed a brief questionnaire evaluating demographics, screening beliefs, and clinical characteristics. KEY RESULTS The majority of patients (n = 49; 82%) reported that incentives would not change their decision to complete or not complete CRC screening, which was confirmed by qualitative data as largely due to high perceived health benefits. Those who stated financial incentives would impact their decision (n = 11) were significantly less likely to agree that CRC screening is beneficial (72.7% vs 95.9%; p < 0.05) or that CRC could be cured if detected early (63.6% vs 98.0%; p < 0.05). CONCLUSIONS Financial incentives are likely not an effective behavioral intervention to increase CRC screening for all but may be powerful for increasing short-term benefit and therefore completion for some. Targeting financial incentive interventions according to patient screening beliefs may prove a cost-effective strategy in primary care outreach programs to increase CRC screening.
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Affiliation(s)
- Alicia B W Clifton
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Shivan J Mehta
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jocelyn V Wainwright
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, 51 N 39th St., PPMC Mutch Building, Floor 7, Philadelphia, PA, 19104, USA
| | - Shannon N Ogden
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Chelsea A Saia
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, 51 N 39th St., PPMC Mutch Building, Floor 7, Philadelphia, PA, 19104, USA
| | - Katharine A Rendle
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA. .,Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, 51 N 39th St., PPMC Mutch Building, Floor 7, Philadelphia, PA, 19104, USA.
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12
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Christy SM, Sutton SK, Abdulla R, Boxtha C, Gonzalez P, Cousin L, Ewing A, Montoya S, Lopez D, Beehler T, Sanchez J, Carvajal R, Meade CD, Gwede CK. A multilevel, low literacy dual language intervention to promote colorectal cancer screening in community clinics in Florida: A randomized controlled trial. Prev Med 2022; 158:107021. [PMID: 35305995 PMCID: PMC9018599 DOI: 10.1016/j.ypmed.2022.107021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/28/2022] [Accepted: 03/13/2022] [Indexed: 01/27/2023]
Abstract
One of the largest disparities in cancer mortality in the United States occurs with colorectal cancer (CRC). The objectives of this multilevel two-arm intervention trial were to compare the efficacy of two interventions to promote CRC screening (CRCS) with fecal immunochemical test (FIT) and examine sociodemographic and psychosocial predictors of FIT screening. Individuals ages 50-75 (n = 326) who were not up-to-date with CRCS, could understand English or Spanish, and were at average CRC risk were recruited from two federally qualified health centers (FQHCs) in Florida. Prior to intervention, CRCS rates in the FQHCs were 27.1% and 32.9%, respectively. Study enrollment occurred April 2018-November 2019. System-level intervention components included leveraging electronic medical record (EMR) systems and delivering patient reminders. Participants were randomized to C-CARES (education+FIT) or C-CARES Plus (C-CARES+personalized coaching [for those not completing FIT within 90 days]). Primary outcome was completed FIT returned <1 year. Primary outcome analyses were performed using logistic regression. 225 participants completed FIT (69.0% [95% CI: 64.0-74.0%]), with no significant difference in FIT uptake by intervention arm (67.3% C-CARES Plus vs. 70.8% C-CARES; p = .49). FIT uptake was significantly higher among patients who received intervention materials in Spanish (77.2%) compared to those who received materials in English (63.2%, p < .01). The personalized coaching in the C-CARES Plus arm did not appear to provide added benefit beyond the C-CARES intervention. Multilevel approaches that include EMR prompts, reminders, FIT access, and provision of low-literacy, language-concordant education can support efforts to improved community clinics' CRCS rates. Future efforts should focus on repeat FIT screening. Trial registration: The trial was registered at ClinicalTrials.gov (NCT03906110).
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Affiliation(s)
- Shannon M Christy
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America.
| | - Steven K Sutton
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Rania Abdulla
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Carol Boxtha
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Paola Gonzalez
- Formerly with H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Lakeshia Cousin
- Formerly with H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; University of Florida, Gainesville, Florida, United States of America
| | - Aldenise Ewing
- Formerly with H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Ohio State University, Columbus, Ohio, United States of America
| | - Samantha Montoya
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Diana Lopez
- Suncoast Community Health Centers, Inc., Brandon, Florida, United States of America
| | - Tina Beehler
- Premier Community HealthCare Group, Inc., Dade City, Florida, United States of America
| | - Julian Sanchez
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Rodrigo Carvajal
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Cathy D Meade
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
| | - Clement K Gwede
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America; Morsani College of Medicine, University of South Florida, Tampa, Florida, United States of America
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13
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Screening Intention Prediction of Colorectal Cancer among Urban Chinese Based on the Protection Motivation Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074203. [PMID: 35409885 PMCID: PMC8998218 DOI: 10.3390/ijerph19074203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 02/04/2023]
Abstract
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.
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14
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Chavarria EA, Christy SM, Feng H, Miao H, Abdulla R, Gutierrez L, Lopez D, Sanchez J, Gwede CK, Meade CD. Online health information seeking and eHealth literacy among Spanish language- dominant Latinos receiving care in a community clinic (Preprint). JMIR Form Res 2022; 6:e37687. [PMID: 35238785 PMCID: PMC9614617 DOI: 10.2196/37687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background eHealth literacy is the ability to seek, obtain, and decipher online health information (OHI) for health and disease management. Rapid developments in eHealth (eg, health care services and online information) place increased demands on patients to have high eHealth literacy levels. Yet, greater emphasis on eHealth may disproportionately affect groups with limited eHealth literacy. Cultural background, language, and eHealth literacy are influential considerations affecting health care and information access, health care use, and successful eHealth resource use, and they may influence OHI seeking for behavioral change toward cancer prevention. Objective This study aimed to characterize the extent of OHI seeking and eHealth literacy among Spanish-dominant (SD) Latino adults aged 50 to 75 years. Further, we aimed to examine potential associations between sociodemographic characteristics, Preventive Health Model (PHM) constructs, OHI-seeking behaviors, and eHealth literacy, separately. Methods Participants (N=76) self-identified as Latino, were enrolled in a colorectal cancer (CRC) screening intervention, were aged 50 to 75 years, were at average risk for CRC, were not up to date with CRC screening, and preferred receiving health information in Spanish. We describe participants’ sociodemographic characteristics, PHM constructs, OHI-seeking behaviors, and eHealth literacy—among those seeking OHI—assessed at enrollment. Descriptive analyses were first performed for all variables. Next, primary univariate logistic analyses explored possible associations with OHI seeking. Finally, using data from those seeking OHI, exploratory univariate analyses sought possible associations with eHealth literacy. Results A majority (51/76, 67%) of the participants were female, 62% (47/76) reported not having graduated high school, and 41% (31/76) reported being unemployed or having an annual income of less than US $10,000. Additionally, 75% (57/76) of the participants reported not having health insurance. In total, 71% (54/76) of the participants reported not having sought OHI for themselves or others. Univariate logistic regression suggested that higher educational attainment was significantly associated with an increased likelihood of having sought OHI (odds ratio 17.4, 95% CI 2.0-150.7; P=.009). Among those seeking OHI (22/76, 29%), 27% (6/22) were at risk of having low eHealth literacy based on an eHealth Literacy Scale score of less than 26. Among OHI seekers (22/76, 29%), an examination of associations found that higher eHealth literacy was associated with greater self-efficacy for screening with the fecal immunochemical test (β=1.20, 95% CI 0.14-2.26; P=.02). Conclusions Most SD Latino participants had not sought OHI for themselves or others (eg, family or friends), thus potentially limiting access to beneficial online resources. Preliminary findings convey that higher eHealth literacy occurs among those with higher self-efficacy for CRC screening. Findings inform areas of focus for future larger-scale investigations, including further exploration of reasons for not seeking OHI among SD Latino adults and an in-depth look at eHealth literacy and cancer screening behaviors. Trial Registration ClinicalTrials.gov NCT03078361; https://clinicaltrials.gov/ct2/show/NCT03078361
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Affiliation(s)
- Enmanuel A Chavarria
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Cancer Prevention and Control Research Program, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Shannon M Christy
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Han Feng
- School of Medicine, Tulane University, New Orleans, LA, United States
| | - Hongyu Miao
- College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Rania Abdulla
- Non-Therapeutic Research Office, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | | | - Diana Lopez
- Suncoast Community Health Centers, Brandon, FL, United States
| | - Julian Sanchez
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Clement K Gwede
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Cathy D Meade
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
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15
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Li C, Lu X, Wong CL, Gao F, Chan CW. Cross-cultural adaptation and validation of a Chinese Preventive Health Model instrument for measuring the psychosocial factors in hepatocellular carcinoma screening among patients with hepatitis B. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:94-105. [DOI: 10.1016/j.anr.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/31/2021] [Accepted: 03/13/2022] [Indexed: 11/02/2022] Open
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16
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Lillie H, Katz RA, Carcioppolo N, Giorgi EA, Jensen JD. Cancer Information Overload Across Time: Evidence from Two Longitudinal Studies. HEALTH COMMUNICATION 2022:1-9. [PMID: 35172651 PMCID: PMC9378766 DOI: 10.1080/10410236.2022.2038866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A majority of U.S. adults report feeling overwhelmed by the amount of available cancer information, termed cancer information overload (CIO). Research has demonstrated CIO is prevalent and negatively related to health behaviors, but no study to date has examined this disposition across time. Two longitudinal studies - a colonoscopy intervention among older U.S. adults (N = 237) and an HPV vaccination intervention among young U.S. women (N = 411) - were utilized to examine CIO stability across time and its relationship to prevention intentions and indifference. CIO increased indifference for non-adherent individuals but had no effect on intentions. CIO was stable in study 1 but not study 2, suggesting CIO stabilizes across the life course. Results also support a five-item measure of CIO.
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Affiliation(s)
| | | | - Nick Carcioppolo
- Department of Communication Studies, University of Miami
- Sylvester Comprehensive Cancer Center at the University of Miami
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17
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Wainwright JV, Mehta SJ, Clifton A, Bocage C, Ogden SN, Cohen S, Rendle KA. Persistent Barriers to Colorectal Cancer Screening Completion Amid Centralized Outreach: A Mixed Methods Study. Am J Health Promot 2021; 36:697-705. [PMID: 34970929 PMCID: PMC9109679 DOI: 10.1177/08901171211064492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To understand patient experiences and persistent barriers to colorectal cancer (CRC) screening amid centralized outreach at urban family medicine practices. APPROACH Following a pragmatic trial assessing mailed fecal immunochemical test (FIT) outreach, we invited a subset of participants to complete a semi-structured qualitative interview and structured questionnaire. SETTING Single urban academic healthcare system. PARTICIPANTS Sixty patients who were eligible and overdue for CRC screening at the time of trial enrollment. METHOD Using Andersen's Behavioral Model, we developed an interview guide to systematically assess factors shaping screening decisions and FIT uptake. Close-ended responses were analyzed using descriptive statistics. Qualitative data were analyzed using the constant comparative method. RESULTS Most participants (82%) self-reported that they had ever completed any modality of CRC screening, and nearly half (43%) completed the mailed FIT during the trial. Most patients (60%) preferred FIT to colonoscopy due to its private, convenient, and non-invasive nature; however, persistent barriers related to screening beliefs including fear of test results and cancer treatment still prevented some patients from completing any form of CRC screening. CONCLUSIONS Mailed FIT can overcome many structural barriers to CRC screening, yet clear communication and follow-up amid centralized outreach are essential. For some patients, tailored outreach or navigation to address screening-related fears or other screening beliefs may be needed to ensure timely completion of CRC screening.
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Affiliation(s)
- Jocelyn V Wainwright
- Department of Family Medicine and Community Health, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
| | - Shivan J Mehta
- Department of Medicine, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.,Penn Center for Cancer Care Innovation, Abramson Cancer Center, 14640University of Pennsylvania, Philadelphia, PA, USA
| | - Alicia Clifton
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, 14640University of Pennsylvania, Philadelphia, PA, USA
| | - Claire Bocage
- Department of Family Medicine and Community Health, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
| | - Shannon N Ogden
- Department of Health Law, Policy and Management, 27118Boston University School of Public Health, Boston, MA, USA
| | - Sarah Cohen
- Department of Family Medicine and Community Health, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
| | - Katharine A Rendle
- Department of Family Medicine and Community Health, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.,Penn Center for Cancer Care Innovation, Abramson Cancer Center, 14640University of Pennsylvania, Philadelphia, PA, USA
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18
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Ezenwankwo EF, Ogbodo VE, Alom GO, Nwadilibe IB, Ofodum CM, Nwankwo CA, Okigbo CC, Omeje CA, Onyebuchi SJ, Oladoyimbo CA, Ezeani A, Akin-Odanye EO, Ogunsanya M. Behavioural oncology research in Africa: Lessons from the last two decades and key considerations moving forward. Eur J Cancer Care (Engl) 2021; 31:e13545. [PMID: 34931724 DOI: 10.1111/ecc.13545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 09/28/2021] [Accepted: 12/02/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVE To analyse the state of behavioural oncology research in Africa and outline key considerations for future research. METHODS Five bibliographic databases were searched to identify original English-language articles published between January 2000 and August 2020. The Behavioural Epidemiology Framework was applied to studies with data/findings from Africa to delineate their current state. Research gaps/opportunities available for behavioural oncology research in Africa were further highlighted. RESULTS Two hundred eighty-seven original research with findings from Africa has been published over the last two decades, with the highest contribution arising from Nigeria, Kenya, Ethiopia and South Africa. Cervical and breast cancers were the most widely investigated. Prominently studied behaviours relate to cancer screening, health literacy, lifestyle, and vaccination. Behavioural oncology literature in Africa is generally in Phases I and III and lacks in measurement studies (<2%) and studies that seek to evaluate behaviour change/health promotion interventions (<6%) or translate them into practice (13.2%). CONCLUSION Embracing new and progressive approaches, including methodological/analytical paradigms and implementation science is imperative to advance the frontiers of behavioural oncology research in Africa. This calls for a responsive research approach that can mobilise multidisciplinary/multilevel coalitions, ensuring a research structure that effectively integrates behavioural research and cancer prevention/control in the region.
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Affiliation(s)
- Elochukwu Fortune Ezenwankwo
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | | | | | - Chidimma Mirian Ofodum
- Division of Public Health and Epidemiology, School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | | | | | | | - Adaora Ezeani
- Prostate Cancer Transatlantic Consortium, UF, Gainesville, Florida, USA
| | | | - Motolani Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Menéndez Rodríguez M, Garau Ramírez J, Traver Salvador A, Hervás Jiménez Y, García Morales N, Seoane Pillado T, Pin Vieito N, Vega Villaamil P, Montes Martínez A, Cubiella J. Rawl's questionnaire spanish validation for colorectal cancer screening with faecal occult blood testing. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:106-113. [PMID: 34023478 DOI: 10.1016/j.gastrohep.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/05/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Colorectal cancer 5-years-survival is 57%, partway due to a low rate of participation in screening programmes. Instruments analyzing causes of low adherence are needed. OBJECTIVE To evaluate the validity and internal consistency of the Spanish version of Rawl's Questionnaire for the screening of colorectal cancer by faecal occult blood testing. TYPE OF STUDY Questionnaire validation methodology. LOCATION Three Primary Care Centres in Valencia. VARIABLES Age, sex, civil status, educational level, social class, smoking, alcohol consumption, body mass index, personal and family history of cancer. RESULTS We analyzed 408 individuals (237 cases and 171 controls). Mean age was 59.45 years (SD 5.17). Internal consistency of all variables reached a Cronbach's alfa of 0.796. The Cronbach's alfa benefit dimension of the screening was 0.871 and for the barrier dimension of the screening it was 0.817. Intraclass correlation coefficients of the test-retest for the benefit dimension of the screening was 0.809 (CI 95% 0.606-0.913) and 0.499 (CI 95% 0.126-0.750) for the barrier dimension. CONCLUSION The Spanish version of Rawl's Questionnaire is valid, reliable and reproducible, so we have this validated instrument with which to identify barriers and benefits in a colorectal screening programme in Spain.
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Affiliation(s)
- Martín Menéndez Rodríguez
- Centro de Saúde Lavadores, Gerencia de Gestión Integrada de Vigo, Servicio Galego de Saúde, Vigo, España.
| | - Jorge Garau Ramírez
- Centro de Salud Auxiliar de Chile, Área Hospital Clínic-Malvarrosa, Valencia, España
| | | | - Yésica Hervás Jiménez
- Centro de Salud Auxiliar de Chile, Área Hospital Clínic-Malvarrosa, Valencia, España
| | - Natalia García Morales
- Servicio de Digestivo, Complexo Hospitalario Universitario de Vigo, Sergas, Vigo, España; Instituto de Investigación Sanitaria Galicia Sur, Vigo, España
| | - Teresa Seoane Pillado
- Unidad de Medicina Preventiva y Salud Pública, Departamento de Ciencias de la Salud, Universidad de A Coruña-INIBIC, A Coruña, España
| | - Noel Pin Vieito
- Instituto de Investigación Sanitaria Galicia Sur, Vigo, España; Unidad de Medicina Preventiva y Salud Pública, Departamento de Ciencias de la Salud, Universidad de A Coruña-INIBIC, A Coruña, España; Servicio de Aparato Digestivo, Hospital Universitario de Ourense, Ourense, España
| | - Pablo Vega Villaamil
- Instituto de Investigación Sanitaria Galicia Sur, Vigo, España; Servicio de Aparato Digestivo, Hospital Universitario de Ourense, Ourense, España
| | - Agustín Montes Martínez
- Área de Medicina Preventiva e Saúde Pública, Universidade de Santiago de Compostela, Santiago de Compostela, España; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Joaquín Cubiella
- Instituto de Investigación Sanitaria Galicia Sur, Vigo, España; Servicio de Aparato Digestivo, Hospital Universitario de Ourense, Ourense, España; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Ourense, España
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20
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Danan ER, White KM, Wilt TJ, Partin MR. Reactions to Recommendations and Evidence About Prostate Cancer Screening Among White and Black Male Veterans. Am J Mens Health 2021; 15:15579883211022110. [PMID: 34096377 PMCID: PMC8188983 DOI: 10.1177/15579883211022110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/31/2021] [Accepted: 05/11/2021] [Indexed: 11/15/2022] Open
Abstract
U.S. clinical guidelines recommend that prior to screening for prostate cancer with Prostate Specific Antigen (PSA), men should have an informed discussion about the potential benefits and harms of screening. Prostate cancer disproportionately affects Black men. To understand how White and Black men reacted to a draft educational pamphlet about the benefits and harms of PSA screening, we conducted race-specific focus groups at a midwestern VA medical center in 2013 and 2015. White and Black men who had been previously screened reviewed the draft pamphlet using a semistructured focus group facilitator guide. Forty-four men, ages 55-81, participated in four White and two Black focus groups. Three universal themes were: low baseline familiarity with prostate cancer, surprise and resistance to the recommendations not to test routinely, and negative emotions in response to ambiguity. Discussions of benefits and harms of screening, as well as intentions for exercising personal agency in prevention and screening, diverged between White and Black focus groups. Discussion in White groups highlighted the potential benefits of screening, minimized the harms, and emphasized personal choice in screening decisions. Participants in Black groups devoted almost no discussion to benefits, considered harms significant, and emphasized personal and collective responsibility for preventing cancer through diet, exercise, and alternative medicine. Discussion in Black groups also included the role of racism and discrimination in healthcare and medical research. These findings contribute to our understanding of how men's varied perspectives and life experiences affect their responses to prostate cancer screening information.
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Affiliation(s)
- Elisheva R. Danan
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Katie M. White
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Timothy J. Wilt
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Melissa R. Partin
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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21
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Clarke N, Kearney PM, Gallagher P, McNamara D, O'Morain CA, Sharp L. Negative emotions and cancer fatalism are independently associated with uptake of Faecal Immunochemical Test-based colorectal cancer screening: Results from a population-based study. Prev Med 2021; 145:106430. [PMID: 33482227 DOI: 10.1016/j.ypmed.2021.106430] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 12/24/2022]
Abstract
Although systematic colorectal cancer screening is efficacious, many programmes suffer from low uptake. Few behavioural or attitudinal factors have been identified as being associated with participation in colorectal cancer screening. We explored knowledge, beliefs about cancer, subjective health literacy, emotional attitudes to screening, and social influences among individuals invited to a population-based screening programme. Regression modelling of a cross-sectional survey of 2299 individuals (users and non-users) of a population-based Faecal Immunochemical Test (FIT) screening programme in Dublin was conducted. Questions were derived from previous theoretically-informed qualitative work and assessed using previously used and validated measures. The primary outcome variable was uptake status (User/Participation or Non-User/Non-participation); multivariable logistic regression was used to estimate the odds ratios (OR) for screening participation. Stronger fatalistic beliefs independently predicted lower uptake (OR = 0.94; 95% CI 0.90-0.98; P = 0.003). Those aged <65 who disagreed that "cancer can often be cured" also had lower uptake (OR = 0.43; 95% CI 0.22-0.82: P = 0.017). Agreement that the test was disgusting and tempting fate predicted lower uptake (OR = 0.16: 95% CI 0.10-0.27: p < 0.001), while the influence of a partner on decision to be screened was associated with higher uptake (OR = 1.32; 95% CI 1.15-1.50: P < 0.001). Negative cancer-related and screening-related beliefs and emotions are associated with non-participation in FIT (-based screening). Research is warranted to explore if these negative beliefs and emotions are modifiable and, if so, whether this would improve screening uptake. The association between the influence of a partner and screening participation present a challenge around improving uptake among those not in co-habiting relationships.
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Affiliation(s)
| | | | | | - Deirdre McNamara
- Department of Clinical Medicine, Trinity Centre for Health Sciences, Adelaide and Meath Hospital, Dublin, Ireland.
| | - Colm A O'Morain
- Faculty of Health Science, Trinity College Dublin, Dublin, Ireland.
| | - Linda Sharp
- Newcastle University Centre for Cancer, Population Health Sciences Institute, Newcastle University, England, UK.
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22
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Edwards JD, Philllips CB, O'Connor ML, O'Brien JL, Hudak EM, Nicholson JS. Applying the Health Belief Model to Quantify and Investigate Expectations for Computerized Cognitive Training. JOURNAL OF COGNITIVE ENHANCEMENT 2020; 5:51-61. [PMID: 33817548 DOI: 10.1007/s41465-020-00183-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the demonstrated benefits of computerized cognitive training for older adults, little is known about the determinants of training behavior. We developed and tested scales to quantify expectations about such training, examine whether expectations predicted training adherence, and explore if training expectations changed from pre- to post-training. Participants (N=219) were healthy older adults aged 55-96 years (M=75.36, SD=9.39), enrolled in four studies investigating Dakim, Insight, or Posit Science Brain Fitness computerized cognitive training programs. Instruments were adapted from existing health behavior scales: Self Efficacy for Cognitive Training, Outcome Expectations for Cognitive Training, Perceived Susceptibility to Cognitive Decline, Dementia or Alzheimer's Disease, and Perceived Severity of Cognitive Decline, Dementia or Alzheimer's Disease. Participants completed scales at baseline (N=219) and post-training (n=173). Eight composites were derived from factor analyses. Adherence rates were high (M=81%), but none of the composites predicted training adherence. There was an overall significant effect of time, Wilks' λ=.843, F(8, 114)=2.65, p=.010, partial η 2 =.157, a significant overall effect of training group, Wilks' λ=.770, F(16, 228)=1.99, p=.015, partial η 2 =.123, and an overall significant group x time interaction, Wilks' λ=.728, F(16, 226)=2.44, p=.002, partial η 2 =.147. Significant effects of time were found for expected psychological outcomes and self-efficacy. Post-training, participants more strongly agreed that training was enjoyable and increased their sense of accomplishment. Changes in self-efficacy for cognitive training varied by program, improvingfor Dakim- and declining for the more challenging Brain Fitness- and InSight participants. These newly devised scales may be useful for examining cognitive training behaviors. However, more work is needed to understand factors that influence older adults' enrollment in and adherence to cognitive training.
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Affiliation(s)
- Jerri D Edwards
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, USA
- Department of Communication Sciences and Disorders, University of South Florida, USA
| | | | | | - Jennifer L O'Brien
- Department of Communication Sciences and Disorders, University of South Florida, USA
- Department of Psychology, University of South Florida, USA
| | - Elizabeth M Hudak
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, USA
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23
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Weinstein L, LaNoue M, Hurley K, Payton C, Sifri R, Myers R. Feasibility Pilot Outcomes of a Mammography Decision Support and Navigation Intervention for Women With Serious Mental Illness Living in Supportive Housing Settings. J Prim Care Community Health 2020; 10:2150132719867587. [PMID: 31416398 PMCID: PMC6698985 DOI: 10.1177/2150132719867587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: People with serious mental illness (SMI) experience
significant disparities in morbidity and mortality from preventable and
treatable medical conditions. Women with SMI have low mammography screening
rates. SMI, poverty, and poor access to care can have a significant effect on a
woman’s opportunity to learn about and discuss breast cancer screening with
health care providers. This study examines the feasibility pilot outcomes of
mammography decision support and patient navigation intervention (DSNI) for
women with SMI living in supportive housing settings. The primary research
question was: Does the DSNI increase knowledge, promote favorable attitudes, and
decrease decisional conflict relating to screening mammography?
Methods: We developed the intervention with the community using
participatory methods. Women (n = 21) with SMI who had not undergone screening
mammography in the past year participated in an educational module and decision
counseling session and received patient navigation over a 6-month period. We
conducted surveys and interviews at baseline and follow-ups to assess
mammography decisional conflict. Results: Among study participants,
67% received a mammogram. The mammogram DSNI was feasible and acceptable to
women with SMI living in supportive housing settings. From baseline to 1-month
follow-up, decisional conflict decreased significantly (P =
.01). The patient navigation process resulted in 270 attempted contacts
(M = 12.86, SD = 10.61) by study staff (phone calls and
emails with patient and/or case manager) and 165 navigation conversations
(M = 7.86, SD = 4.84). A barrier to navigation was phone
communication, with in-person navigation being more successful. Participants
reported they found the intervention helpful and made suggestions for further
improvement. Conclusions: The process and outcomes evaluation
support the feasibility and acceptability of the mammography DSNI. This project
provides initial evidence that an intervention developed with participatory
methods can improve cancer screening outcomes in supportive housing programs for
people with SMI.
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Affiliation(s)
| | | | | | | | - Randa Sifri
- 2 Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Ronald Myers
- 1 Thomas Jefferson University, Philadelphia, PA, USA
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24
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Daskalakis C, DiCarlo M, Hegarty S, Gudur A, Vernon SW, Myers RE. Predictors of overall and test-specific colorectal Cancer screening adherence. Prev Med 2020; 133:106022. [PMID: 32045616 PMCID: PMC7415480 DOI: 10.1016/j.ypmed.2020.106022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 01/18/2023]
Abstract
This study investigated predictors of overall and test-specific colorectal cancer screening (CRCS). Stool blood test (SBT) and/or colonoscopy screening were offered to primary care patients in two randomized controlled trials which assessed the impact of behavioral interventions on screening. Data were obtained through surveys and electronic medical records. Among 1942 participants, 646 (33%) screened. Exposure to interventions was associated with higher overall CRCS by twofold to threefold; older age, African American race, being married, and having a higher screening decision stage were also associated with higher overall CRCS (odds ratios = 1.30, 1.31, 1.34, and 5.59, respectively). Intervention, older age, female gender, and being married were associated with higher SBT adherence, while preference for colonoscopy was associated with lower SBT adherence. Intervention and higher decision stage were associated with higher colonoscopy adherence, while preference for SBT was associated with lower colonoscopy adherence. Among older individuals, African Americans had higher overall CRCS than whites, but this was not true among younger individuals (interaction p = .041). The higher screening adherence of African Americans over whites was due to stronger screening with a non-preferred test, i.e., higher SBT adherence only among individuals who preferred colonoscopy and higher colonoscopy adherence only among individuals who preferred SBT. Intervention exposure, sociodemographic background, and screening decision stage predicted overall CRCS adherence. Gender and test preference also affected test-specific screening adherence. Interactions involving race and test preference suggest that it is important to provide both colonoscopy and SBT screening options to patients, particularly African Americans.
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Affiliation(s)
- Constantine Daskalakis
- Thomas Jefferson University, Department of Pharmacology & Experimental Therapeutics, Division of Biostatistics, United States of America.
| | - Melissa DiCarlo
- Thomas Jefferson University, Department of Medical Oncology, Division of Population Science, United States of America
| | - Sarah Hegarty
- Thomas Jefferson University, Department of Pharmacology & Experimental Therapeutics, Division of Biostatistics, United States of America
| | - Anuragh Gudur
- Drexel University College of Medicine, United States of America
| | - Sally W Vernon
- University of Texas School of Public Health, Center for Health Promotion and Prevention Research, Division of Health Promotion and Behavioral Sciences, United States of America
| | - Ronald E Myers
- Thomas Jefferson University, Department of Medical Oncology, Division of Population Science, United States of America
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25
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Loi CXA, Tyson DM, Chavarria EA, Gutierrez L, Klasko L, Davis S, Lopez D, Johns T, Meade CD, Gwede CK. 'Simple and easy:' providers' and latinos' perceptions of the fecal immunochemical test (FIT) for colorectal cancer screening. ETHNICITY & HEALTH 2020; 25:206-221. [PMID: 29319331 PMCID: PMC6513709 DOI: 10.1080/13557858.2017.1418298] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Objective: Colorectal cancer (CRC) screening efforts have effectively reduced CRC morbidity and mortality, yet screening remains relatively low among Latinos. The study's purpose was to document the awareness/knowledge of Fecal Immunochemical Test (FIT) among Latinos, gain better understanding of patient and health care provider perceptions about FIT, and explore the feasibility of adoption/uptake.Design/Methods: The study was guided by qualitative, ethnography design and methods. Eight focus groups (FG) with patients who self-identified as Hispanic/Latino between 50-75 years of age and key informant interviews with providers (N = 10) were conducted followed by a brief demographic questionnaire.Results: Awareness levels varied based on prior screening experiences among patients and providers. Both patients and providers believed the FIT is simple and easy to use; although, a minority of patients expressed doubts about the efficacy of the FIT when compared to colonoscopy.Conclusions: Despite the increasing acceptance of the FIT among the health care community, a significant lag time still exists among our study's populations. Study findings speak to novelty of the FIT test among underserved populations and the health disparity gap between health innovations/discoveries. Increased awareness and education efforts about the efficacy coupled with information about its accessibility, ease, and user instructions may increase the adoption of FIT.
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Affiliation(s)
- Claudia X. Aguado Loi
- Department of Health Science and Human Performance, College of Natural and Health Sciences, University of Tampa, 401 W. Kennedy Blvd, Box 30F, Tampa, FL 33606, USA
- Corresponding Author: Claudia X. Aguado Loi, Department of Health Science and Human Performance, College of Natural and Health Sciences, University of Tampa, 401 W. Kennedy Blvd, Box 30F, Tampa, FL 33606,
| | - Dinorah Martinez Tyson
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA
| | - Enmanuel A. Chavarria
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Brownsville Regional Campus, One West University Blvd., SPH Building N1.102H, Brownsville, TX 78520, USA
| | - Liliana Gutierrez
- Department of Health Outcomes and Behavior, Division of Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, FOW-EDU, Tampa, FL 33612, USA
| | - Lynne Klasko
- Department of Health Outcomes and Behavior, Division of Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, FOW-EDU, Tampa, FL 33612, USA
| | - Stacy Davis
- Department of Health Outcomes and Behavior, Division of Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, FOW-EDU, Tampa, FL 33612, USA
| | - Diana Lopez
- Suncoast Community Health Centers, Inc., 2814 14th Ave SE, Ruskin, FL, 33570, USA
| | - Tracy Johns
- Turley Family Health Center, BayCare Health System, 807 N Myrtle Ave, Clearwater, FL 33755, USA
| | - Cathy D. Meade
- Department of Health Outcomes and Behavior, Division of Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, FOW-EDU, Tampa, FL 33612, USA
| | - Clement K. Gwede
- Department of Health Outcomes and Behavior, Division of Population Sciences, Moffitt Cancer Center, 12902 Magnolia Drive, FOW-EDU, Tampa, FL 33612, USA
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26
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Davis SN, Wischhusen JW, Sutton SK, Christy SM, Chavarria EA, Sutter ME, Roy S, Meade CD, Gwede CK. Demographic and psychosocial factors associated with limited health literacy in a community-based sample of older Black Americans. PATIENT EDUCATION AND COUNSELING 2020; 103:385-391. [PMID: 31466881 PMCID: PMC7012696 DOI: 10.1016/j.pec.2019.08.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/15/2019] [Accepted: 08/17/2019] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Individuals with limited health literacy often experience suboptimal health outcomes. This study examined the frequency of limited health literacy and demographic and psychosocial factors associated with limited health literacy in a sample of older Black Americans. METHODS Participants (n = 330) enrolled in a community-based intervention to promote colorectal cancer (CRC) screening completed baseline surveys assessing health literacy with the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) test, CRC awareness, cancer fatalism, Preventive Health Model (PHM) constructs, and demographics. RESULTS Approximately 52% of participants had limited health literacy, the REALM-R score was 5.4 (SD = 2.7). Univariable correlates of limited health literacy were gender, employment, income, prior screening, cancer fatalism, CRC awareness, and PHM constructs (religious beliefs, salience/coherence, perceived susceptibility). Multivariable correlates of limited health literacy were male gender (OR = 2.3, CI = 1.4-3.8), unable to work (OR = 2.8, CI = 1.3-6.1), lower household income (OR = 3.0, CI = 1.6, 5.5), and higher PHM religious beliefs (OR = 1.1, CI = 1.0-1.2). CONCLUSION Limited health literacy was associated with multiple complex factors. Interventions should incorporate patient health literacy and low-literacy materials that can be delivered through multiple channels. PRACTICE IMPLICATIONS Future studies are needed to understand the role of health literacy in an individual's health behavior and the provision of effective healthcare.
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Affiliation(s)
- Stacy N Davis
- Health Behavior, Society and Policy, Rutgers the State University of New Jersey, New Brunswick, USA; Formally affiliated with Moffitt Cancer Center, Tampa, USA.
| | - Jonathan W Wischhusen
- Formally affiliated with Moffitt Cancer Center, Tampa, USA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Steven K Sutton
- Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, USA; Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Shannon M Christy
- Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, USA; Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Enmanuel A Chavarria
- Formally affiliated with Moffitt Cancer Center, Tampa, USA; School of Public Health, University of Texas Health Science Center at Houston, Brownsville USA
| | - Megan E Sutter
- Formally affiliated with Moffitt Cancer Center, Tampa, USA; Department of Population Health, New York University, New York City, USA
| | - Siddhartha Roy
- Formally affiliated with Moffitt Cancer Center, Tampa, USA; Family and Community Medicine, Penn State College of Medicine, Hershey, USA
| | - Cathy D Meade
- Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, USA; Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Clement K Gwede
- Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, USA; Morsani College of Medicine, University of South Florida, Tampa, USA
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27
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Rochefort C, Baldwin AS, Tiro J, Bowen ME. Evaluating the Validity of the Risk Perception Survey for Developing Diabetes Scale in a Safety-Net Clinic Population of English and Spanish Speakers. DIABETES EDUCATOR 2019; 46:73-82. [PMID: 31747830 DOI: 10.1177/0145721719889068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to examine the factor structure of the Risk Perception Survey for Developing Diabetes (RPS-DD) and test for factorial invariance by language (English, Spanish) and gender (males, females) in a clinically engaged, racially diverse, low-education population. METHODS Adult patients seen in a safety-net health system (N = 641) answered an interviewer-administered survey via telephone in their preferred language (English: 42%, Spanish: 58%). Three constructs in the RPS-DD were assessed-personal control (2 items for internal control and 2 for external control), optimistic bias (2 items), and worry (2 items). Single and multigroup confirmatory factor analyses (CFAs) were performed using maximum-likelihood estimation to determine the factor structure and test for invariance. RESULTS Contrary to previous psychometric analyses in white, educated populations, CFAs supported a 4-factor measurement model with internal and external control items loading onto separate factors. The 4-factor structure was equivalent between males and females. However, the structure varied by language, with the worry subscale items loading more strongly for English than Spanish speakers. CONCLUSIONS The RPS-DD can be used to investigate group differences across gender and language and to help understand if interventions have differential effects for subgroups at high risk for diabetes. Given the increasing prevalence of diabetes among Spanish speakers, researchers should continue to examine the psychometric properties of the RPS-DD, particularly the worry subscale, to improve its validity and clinical utility.
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Affiliation(s)
| | - Austin S Baldwin
- Department of Psychology, Southern Methodist University, Dallas, Texas
| | - Jasmin Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michael E Bowen
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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28
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Green BB, Anderson ML, Cook AJ, Chubak J, Fuller S, Kimbel KJ, Kullgren JT, Meenan RT, Vernon SW. Financial Incentives to Increase Colorectal Cancer Screening Uptake and Decrease Disparities: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e196570. [PMID: 31276178 PMCID: PMC6789432 DOI: 10.1001/jamanetworkopen.2019.6570] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Importance Colorectal cancer screening rates are suboptimal, particularly among sociodemographically disadvantaged groups. Objective To examine whether guaranteed money or probabilistic lottery financial incentives conditional on completion of colorectal cancer screening increase screening uptake, particularly among groups with lower screening rates. Design, Setting, and Participants This parallel, 3-arm randomized clinical trial was conducted from March 13, 2017, through April 12, 2018, at 21 medical centers in an integrated health care system in western Washington. A total of 838 age-eligible patients overdue for colorectal cancer screening who completed a questionnaire that confirmed eligibility and included sociodemographic and psychosocial questions were enrolled. Interventions Interventions were (1) mail only (n = 284; up to 3 mailings that included information on the importance of colorectal cancer screening and screening test choices, a fecal immunochemical test [FIT], and a reminder letter if necessary), (2) mail and monetary (n = 270; mailings plus guaranteed $10 on screening completion), or (3) mail and lottery (n = 284; mailings plus a 1 in 10 chance of receiving $50 on screening completion). Main Outcomes and Measures The primary outcome was completion of any colorectal cancer screening within 6 months of randomization. Secondary outcomes were FIT or colonoscopy completion within 6 months of randomization. Intervention effects were compared across sociodemographic subgroups and self-reported psychosocial measures. Results A total of 838 participants (mean [SD] age, 59.7 [7.2] years; 546 [65.2%] female; 433 [52.2%] white race and 101 [12.1%] Hispanic ethnicity) were included in the study. Completion of any colorectal screening was not significantly higher for the mail and monetary group (207 of 270 [76.7%]) or the mail and lottery group (212 of 284 [74.6%]) than for the mail only group (203 of 284 [71.5%]) (P = .11). For FIT completion, interventions had a statistically significant effect (P = .04), with a net increase of 7.7% (95% CI, 0.3%-15.1%) in the mail and monetary group and 7.1% (95% CI, -0.2% to 14.3%) in the mail and lottery group compared with the mail only group. For patients with Medicaid insurance, the net increase compared with mail only in FIT completion for the mail and monetary or the mail and lottery group was 37.7% (95% CI, 11.0%-64.3%) (34.2% for the mail and monetary group and 40.4% for the mail and lottery group) compared with a net increase of only 5.6% (95% CI, -0.9% to 12.2%) among those not Medicaid insured (test for interaction P = .03). Conclusions and Relevance Financial incentives increased FIT uptake but not overall colorectal cancer screening. Financial incentives may decrease screening disparities among some sociodemographically disadvantaged groups. Trial Registration ClinicalTrials.gov identifier: NCT00697047.
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Affiliation(s)
- Beverly B Green
- Kaiser Permanente Washington, Seattle
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Family Medicine, University of Washington School of Medicine, Seattle
| | | | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Family Medicine, University of Washington School of Medicine, Seattle
| | - Sharon Fuller
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Kilian J Kimbel
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Jeffrey T Kullgren
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Richard T Meenan
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Sally W Vernon
- Department of Health Promotion and Behavior Sciences, University of Texas School of Public Health, Houston
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29
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Interactivity in a Decision Aid: Findings From a Decision Aid to Technologically Enhance Shared Decision Making RCT. Am J Prev Med 2019; 57:77-86. [PMID: 31128959 DOI: 10.1016/j.amepre.2019.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Colorectal cancer screening (CRCS) remains underutilized. Decision aids (DAs) can increase patient knowledge, intent, and CRCS rates compared with "usual care," but whether interactivity further increases CRCS rate remains unknown. STUDY DESIGN A two-armed RCT compared the effect of a web-based DA that interactively assessed patient CRC risk and clarified patient preference for specific CRCS test to a web-based DA with the same content but without the interactive tools. SETTING/PARTICIPANTS The study sites were 12 community- and three university-based primary care practices (56 physicians) in southeastern Michigan. Participants were men and women aged 50-75 years not current on CRCS. INTERVENTION Random allocation to interactive DA (interactive arm) or non-interactive DA (non-interactive arm). MAIN OUTCOME MEASURES Primary outcome was medical record documentation of CRCS 6 months after the intervention. Secondary outcome was patient decision quality (i.e., knowledge, preference clarification, and intent) measured immediately before and after DA use, and immediately after the office visit. To determine that either DA had a positive effect on CRCS adherence, usual care CRCS rates were determined from the three university-based practices among patients eligible for but not participating in the study. RESULTS Data were collected between 2012 and 2014; analysis began in 2015. At 6 months, CRCS rate was 36.1% (95% CI=30.5%, 42.2%) in the interactive arm (n=284) and 40.5% (95% CI=34.7%, 46.6%) in the non-interactive arm (n=286, p=0.29). Usual care CRCS rate (n=440) was 18.6% (95% CI=15.2%, 22.7%), significantly lower than both arms (p<0.001). Knowledge, attitude, self-efficacy, test preference, and intent increased significantly within each arm versus baseline, but the rate was not significantly different between the two arms. CONCLUSIONS The interactive DA did not improve the outcome compared to the non-interactive DA. This suggests that the resources needed to create and maintain the interactive components are not justifiable. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01514786.
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Gwede CK, Sutton SK, Chavarria EA, Gutierrez L, Abdulla R, Christy SM, Lopez D, Sanchez J, Meade CD. A culturally and linguistically salient pilot intervention to promote colorectal cancer screening among Latinos receiving care in a Federally Qualified Health Center. HEALTH EDUCATION RESEARCH 2019; 34:310-320. [PMID: 30929015 PMCID: PMC7868960 DOI: 10.1093/her/cyz010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/24/2019] [Indexed: 06/09/2023]
Abstract
Despite established benefits, colorectal cancer (CRC) screening is underutilized among Latinos/Hispanics. We conducted a pilot 2-arm randomized controlled trial evaluating efficacy of two intervention conditions on CRC screening uptake among Latinos receiving care in community clinics. Participants (N = 76) were aged 50-75, most were foreign-born, preferred to receive their health information in Spanish, and not up-to-date with CRC screening. Participants were randomized to either a culturally linguistically targeted Spanish-language fotonovela booklet and DVD intervention plus fecal immunochemical test [FIT] (the LCARES, Latinos Colorectal Cancer Awareness, Research, Education and Screening intervention group); or a non-targeted intervention that included a standard Spanish-language booklet plus FIT (comparison group). Measures assessed socio-demographic variables, health literacy, CRC screening behavior, awareness and beliefs. Overall, FIT uptake was 87%, exceeding the National Colorectal Cancer Roundtable's goal of 80% by 2018. The LCARES intervention group had higher FIT uptake than did the comparison group (90% versus 83%), albeit not statistically significant (P = 0.379). The LCARES intervention group was associated with greater increases in CRC awareness (P = 0.046) and susceptibility (P = 0.013). In contrast, cancer worry increased more in the comparison group (P = 0.045). Providing educational materials and a FIT kit to Spanish-language preferring Latinos receiving care in community clinics is a promising strategy to bolster CRC screening uptake to meet national targets.
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Affiliation(s)
- Clement K Gwede
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Steven K Sutton
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Enmanuel A Chavarria
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Brownsville Regional Campus, Brownsville, TX, USA
| | - Liliana Gutierrez
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Rania Abdulla
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Shannon M Christy
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Diana Lopez
- Suncoast Community Health Centers, Inc., Brandon, FL, USA
| | - Julian Sanchez
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Cathy D Meade
- Department of Health Behavior and Outcomes, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Carcioppolo N, John KK, Jensen JD, King AJ. Joking about cancer as an avoidance strategy among US adults. Health Promot Int 2019; 34:420-428. [PMID: 29253126 DOI: 10.1093/heapro/dax087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Findings from years of research on fear appeals suggest that individuals with low efficacy utilize avoidance strategies when they perceive a significant threat-a process called fear control. Some research suggests that joking could be an avoidance strategy. The current study identifies conditions in which people are more likely to joke about colorectal cancer and explores how this behavior may be associated with screening avoidance. Older adults (N = 209) recruited from eight different worksites completed a survey measuring fear appeal constructs and enactment of colorectal cancer-related joking. Results of a moderated mediation analysis suggest that men were more likely to joke about colorectal cancer than women, particularly if they perceived significant threat but had limited self-efficacy, signifying fear control. Results support prior fear appeal research, suggesting that an increase in joking behavior concerning colorectal cancer may be indicative of screening avoidance, and describe belief-based mechanisms that explain differences between biological sex and joking.
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Affiliation(s)
- Nick Carcioppolo
- Department of Communication Studies, Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, FL 33146, USA
| | - Kevin K John
- School of Communications, Brigham Young University, Provo, UT 84602, USA
| | - Jakob D Jensen
- Department of Communication, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Andy J King
- College of Media and Communication, Texas Tech University, Lubbock, TX 79409, USA
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Christy SM, Sutton SK, Gwede CK, Chavarria EA, Davis SN, Abdulla R, Schultz I, Roetzheim R, Shibata D, Meade CD. Examining the Durability of Colorectal Cancer Screening Awareness and Health Beliefs Among Medically Underserved Patients: Baseline to 12 months Post-Intervention. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:297-303. [PMID: 29177920 PMCID: PMC6873805 DOI: 10.1007/s13187-017-1301-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The current study examines changes in awareness and health beliefs from baseline to 12 months post-intervention following receipt of one of two colorectal cancer (CRC) educational interventions that aimed to promote CRC screening among a racially and ethnically diverse and medically underserved population. Participants (N = 270) were enrolled in a randomized controlled trial to increase CRC screening and completed both baseline and 12-month follow-up assessments. Participants were aged 50-75, at average CRC risk, not up-to-date with CRC screening guidelines, and receiving care at one of three community-based clinics. Participants were randomized to receive either a targeted, low-literacy intervention informed by the Preventive Health Model [PHM] (photonovella and DVD plus fecal immunochemical test [FIT]) or a non-targeted intervention (standard educational brochure plus FIT). Changes in CRC awareness and health beliefs from baseline to 12 months were examined both within and between intervention groups using Student's t tests. Participants in both intervention conditions demonstrated an increase in CRC awareness, PHM social influence, and trust in the healthcare system (all p's < .0001), with no significant between-group differences. Among those receiving the targeted intervention, there also was an increase in PHM salience (p < .05). Among individuals receiving the non-targeted intervention, there was an increase in PHM response efficacy (p < .01) and PHM self-efficacy (p < .0001). Both CRC screening interventions promoted positive changes in awareness and several health beliefs from baseline to 12 months, suggesting important benefits of CRC education. Regardless of whether education was targeted or non-targeted, providing CRC screening education successfully promoted durable changes in awareness and health beliefs.
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Affiliation(s)
- Shannon M Christy
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Steven K Sutton
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Clement K Gwede
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Enmanuel A Chavarria
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- University of Texas Health Science Center at Houston, School of Public Health, Brownsville, TX, USA
| | - Stacy N Davis
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- Department of Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Rania Abdulla
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
| | - Ida Schultz
- Premier Community HealthCare Group, Inc., Dade City, FL, USA
| | - Richard Roetzheim
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - David Shibata
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cathy D Meade
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, USA.
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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Understanding Cancer Worry Among Patients in a Community Clinic-Based Colorectal Cancer Screening Intervention Study. Nurs Res 2018; 67:275-285. [PMID: 29870517 DOI: 10.1097/nnr.0000000000000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To reduce colorectal cancer (CRC) screening disparities, it is important to understand correlates of different types of cancer worry among ethnically diverse individuals. OBJECTIVES The current study examined the prevalence of three types of cancer worry (i.e., general cancer worry, CRC-specific worry, and worry about CRC test results) as well as sociodemographic and health-related predictors for each type of cancer worry. METHODS Participants were aged 50-75, at average CRC risk, nonadherent to CRC screening guidelines, and enrolled in a randomized controlled trial to increase CRC screening. Participants completed a baseline questionnaire assessing sociodemographics, health beliefs, healthcare experiences, and three cancer worry measures. Associations between study variables were examined with separate univariate and multivariable logistic regression models. RESULTS Responses from a total of 416 participants were used. Of these, 47% reported experiencing moderate-to-high levels of general cancer worry. Predictors of general cancer worry were salience and coherence (aOR = 1.1, 95% CI [1.0, 1.3]), perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3), and social influence (aOR = 1.1, 95% CI [1.0, 0.1]). Fewer (23%) reported moderate-to-high levels of CRC-specific worry or CRC test worry (35%). Predictors of CRC worry were perceived susceptibility (aOR = 1.4, 95% CI [1.3, 1.6]) and social influence (aOR = 1.1, 95% CI [1.0, 1.2]); predictors of CRC test result worry were perceived susceptibility (aOR = 1.2, 95% CI [1.1, 1.3) and marital status (aOR = 2.0, 95% CI [1.1, 3.7] for married/partnered vs. single and aOR = 2.3, 95% CI [1.3, 4.1] for divorced/widowed vs. single). DISCUSSION Perceived susceptibility consistently predicted the three types of cancer worry, whereas other predictors varied between cancer worry types and in magnitude of association. The three types of cancer worry were generally predicted by health beliefs, suggesting potential malleability. Future research should include multiple measures of cancer worry and clear definitions of how cancer worry is measured.
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Myers RE, Leader AE, Censits JH, Trabulsi EJ, Keith SW, Petrich AM, Quinn AM, Den RB, Hurwitz MD, Lallas CD, Hegarty SE, Dicker AP, Zeigler-Johnson CM, Giri VN, Ayaz H, Gomella LG. Decision Support and Shared Decision Making About Active Surveillance Versus Active Treatment Among Men Diagnosed with Low-Risk Prostate Cancer: a Pilot Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:180-185. [PMID: 27418065 DOI: 10.1007/s13187-016-1073-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study aimed to explore the effects of a decision support intervention (DSI) and shared decision making (SDM) on knowledge, perceptions about treatment, and treatment choice among men diagnosed with localized low-risk prostate cancer (PCa). At a multidisciplinary clinic visit, 30 consenting men with localized low-risk PCa completed a baseline survey, had a nurse-mediated online DS session to clarify preference for active surveillance (AS) or active treatment (AT), and met with clinicians for SDM. Participants also completed a follow-up survey at 30 days. We assessed change in treatment knowledge, decisional conflict, and perceptions and identified predictors of AS. At follow-up, participants exhibited increased knowledge (p < 0.001), decreased decisional conflict (p < 0.001), and more favorable perceptions of AS (p = 0.001). Furthermore, 25 of the 30 participants (83 %) initiated AS. Increased family and clinician support predicted this choice (p < 0.001). DSI/SDM prepared patients to make an informed decision. Perceived support of the decision facilitated patient choice of AS.
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Affiliation(s)
- Ronald E Myers
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Amy E Leader
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA.
| | - Jean Hoffman Censits
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Edouard J Trabulsi
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Scott W Keith
- Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Anett M Petrich
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Anna M Quinn
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Robert B Den
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Mark D Hurwitz
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Costas D Lallas
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Sarah E Hegarty
- Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Charnita M Zeigler-Johnson
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Veda N Giri
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Hasan Ayaz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, USA
| | - Leonard G Gomella
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
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Crawford J, Beaton D, Ahmad F, Bierman AS. Cross-cultural survey development: The Colon Cancer Screening Behaviors Survey for South Asian populations. BMC Res Notes 2017; 10:770. [PMID: 29282127 PMCID: PMC5745603 DOI: 10.1186/s13104-017-3098-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/15/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The objective of this work was to develop a survey that considered cultural relevance and diversity of South Asian populations, with the aim of describing or predicting factors that influence colorectal cancer screening intention and adherence. The scientifically rigorous approach for survey development informed the final phase of an exploratory mixed method study. This initial survey was later cross-culturally translated and adapted into the Urdu language, and thereafter, items were cognitively tested for conceptual relevance among South Asian immigrants. RESULTS The initial development of the Colon Cancer Screening Behaviours Survey for South Asian populations was completed using a number of steps. Development involved: the identification of key concepts and conceptual model; literature search for candidate measures and critical appraisal; and, expert consultation to select relevant measures. Five published surveys included measures that covered concepts relevant to South Asians and colorectal cancer screening behaviours. However, measures from these surveys missed content that emerged through parallel field work with South Asians, and additions were required along with item modifications. In the final stage, cross-cultural translation and adaptation into Urdu, and cognitive testing were completed. Future research will require an examination of proposed relationships, and psychometric testing of measures in the survey.
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Affiliation(s)
- Joanne Crawford
- Faculty of Applied Health Sciences, Department of Nursing, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1 Canada
| | - Dorcas Beaton
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Measurement Stream, Institute for Work & Health, Toronto, ON Canada
- Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, and the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
| | - Farah Ahmad
- School of Health Policy and Management, Faculty of Health, York University, 4700 Keele Street, Toronto, ON Canada
| | - Arlene S. Bierman
- Center for Evidence and Practice Improvement (CEPI), Agency for Health Care Research and Quality, Washington DC, USA
- University of Toronto, Toronto, ON Canada
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Crawford J, Ahmad F, Bierman AS, Beaton D. Cognitive testing of the Colon Cancer Screening Behaviours Survey with South Asian immigrants in Canada. J Patient Rep Outcomes 2017. [PMCID: PMC6091743 DOI: 10.1186/s41687-017-0007-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Methods Results Conclusions Electronic supplementary material
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Christy SM, Gwede CK, Sutton SK, Chavarria E, Davis SN, Abdulla R, Ravindra C, Schultz I, Roetzheim R, Meade CD. Health Literacy among Medically Underserved: The Role of Demographic Factors, Social Influence, and Religious Beliefs. JOURNAL OF HEALTH COMMUNICATION 2017; 22:923-931. [PMID: 29125435 PMCID: PMC6278594 DOI: 10.1080/10810730.2017.1377322] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The current study examined the sociodemographic and psychosocial variables that predicted being at risk for low health literacy among a population of racially and ethnically diverse patients accessing primary care services at community-based clinics. Participants (N = 416) were aged 50-75 years, currently not up-to-date with colorectal cancer (CRC) screening, at average CRC risk, and enrolled in a randomized controlled trial (RCT) aimed at promoting CRC screening. Participants completed a baseline interview that assessed health literacy as measured by Rapid Estimate of Adult Literacy in Medicine-Revised, sociodemographic factors, and psychosocial variables (e.g., health beliefs) prior to randomization and receipt of an intervention. Thirty-six percent of the participants were found to be at risk for low health literacy. Sociodemographic and psychosocial variables were assessed as predictors of being at risk for low health literacy using logistic regression. In the final model, predictors were male gender, being from a racial/ethnic minority group, being unable to work, having higher social influence scores, and having higher religious belief scores. These findings suggest several patient characteristics that may be associated with low health literacy, and highlight the importance of supporting all patients through simplified and clear communications and information to improve understanding of CRC screening information.
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Affiliation(s)
- Shannon M. Christy
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Clement K. Gwede
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Steven K. Sutton
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Enmanuel Chavarria
- University of Texas Health Science Center at Houston, School of Public Health, Department of Health Promotion and Behavioral Sciences, Brownsville, Texas, USA
| | - Stacy N. Davis
- Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Rania Abdulla
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Chitra Ravindra
- Florida Department of Health Pinellas County, St. Petersburg, Florida, USA
| | - Ida Schultz
- Premier Community HealthCare Group, Inc., Dade City, Florida, USA
| | - Richard Roetzheim
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Cathy D. Meade
- Division of Population Science, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Jimbo M, Sen A, Plegue MA, Hawley ST, Kelly-Blake K, Rapai M, Zhang M, Zhang Y, Ruffin MT. Correlates of Patient Intent and Preference on Colorectal Cancer Screening. Am J Prev Med 2017; 52:443-450. [PMID: 28169019 DOI: 10.1016/j.amepre.2016.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 10/18/2016] [Accepted: 11/18/2016] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Information is limited on patient characteristics that influence their preference among screening options and intent to be screened for colorectal cancer (CRC). A mechanistic pathway to intent and preference was examined through a formal mediation analysis. METHODS From 2012 to 2014, a total of 570 adults aged 50-75 years were recruited from 15 primary care practices in Metro Detroit for a trial on decision aids for CRC screening. Confirmatory factor, regression, and mediation analyses were performed in 2015-2016 on baseline cross-sectional data. Main outcomes were patient intent and preference. Perceived risk and self-efficacy were secondary outcomes. Covariates included demographic information, health status, previous CRC screening experience, patient attitudes, and knowledge. RESULTS Mean age was 57.7 years, 56.1% were women, and 55.1% white and 36.6% black. Women had 32% and 41% lower odds than men of perceiving CRC to be high/moderate risk (OR=0.68, 95% CI=0.47, 0.97, p=0.03) and having high self-efficacy (OR=0.59, 95% CI=0.42, 0.85, p=0.006), respectively. Whites had 63% and 47% lower odds than blacks of having high self-efficacy (OR=0.37, 95% CI=0.25, 0.57, p<0.001) and intent to undergo CRC screening (OR=0.53, 95% CI=0.34, 0.84, p=0.007), respectively. Younger age, higher knowledge, lower level of test worries, and medium/high versus low self-efficacy increased the odds of intent of being screened. Self-efficacy, but not perceived risk, significantly mediated the association between race, attitude, and test worries and patient screening intent. CONCLUSIONS Self-efficacy mediated the association between race, attitude, and test worries and patient intent.
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Affiliation(s)
- Masahito Jimbo
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sarah T Hawley
- Department of Medicine, University of Michigan and Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Karen Kelly-Blake
- Center for Ethics and Humanities in the Life Sciences and Department of Medicine, Michigan State University, East Lansing, Michigan
| | - Mary Rapai
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Minling Zhang
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yuhong Zhang
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Mack T Ruffin
- Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania
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Davis SN, Christy SM, Chavarria EA, Abdulla R, Sutton SK, Schmidt AR, Vadaparampil ST, Quinn GP, Simmons VN, Ufondu CB, Ravindra C, Schultz I, Roetzheim RG, Shibata D, Meade CD, Gwede CK. A randomized controlled trial of a multicomponent, targeted, low-literacy educational intervention compared with a nontargeted intervention to boost colorectal cancer screening with fecal immunochemical testing in community clinics. Cancer 2016; 123:1390-1400. [PMID: 27906448 DOI: 10.1002/cncr.30481] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The objective of the current study was to improve colorectal cancer (CRC) screening uptake with the fecal immunochemical test (FIT). The current study investigated the differential impact of a multicomponent, targeted, low-literacy educational intervention compared with a standard, nontargeted educational intervention. METHODS Patients aged 50 to 75 years who were of average CRC risk and not up-to-date with CRC screening were recruited from either a federally qualified health center or a primary care community health clinic. Patients were randomized to the intervention condition (targeted photonovella booklet/DVD plus FIT kit) or comparison condition (standard Centers for Disease Control and Prevention brochure plus FIT kit). The main outcome was screening with FIT within 180 days of delivery of the intervention. RESULTS Of the 416 participants, 54% were female; the participants were racially and ethnically diverse (66% white, 10% Hispanic, and 28% African American), predominantly of low income, and insured (the majority had county health insurance). Overall, the FIT completion rate was 81%, with 78.1% of participants in the intervention versus 83.5% of those in the comparison condition completing FIT (P = .17). In multivariate analysis, having health insurance was found to be the primary factor predicting a lack of FIT screening (adjusted odds ratio, 2.10; 95% confidence interval, 1.04-4.26 [P = .04]). CONCLUSIONS The multicomponent, targeted, low-literacy materials were not found to be significantly different or more effective in increasing FIT uptake compared with the nontargeted materials. Provision of a FIT test plus education may provide a key impetus to improve the completion of CRC screening. The type of educational material (targeted vs nontargeted) may matter less. The findings of the current study provide a unique opportunity for clinics to adopt FIT and to choose the type of patient education materials based on clinic, provider, and patient preferences. Cancer 2017;123:1390-1400. © 2016 American Cancer Society.
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Affiliation(s)
- Stacy N Davis
- Health Education and Behavioral Science, Rutgers School of Public Health, Piscataway, New Jersey.,Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Shannon M Christy
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Enmanuel A Chavarria
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Rania Abdulla
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Steven K Sutton
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Alyssa R Schmidt
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Susan T Vadaparampil
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Gwendolyn P Quinn
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Vani N Simmons
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | | | - Ida Schultz
- Premier Community HealthCare Group Inc, Dade City, Florida
| | - Richard G Roetzheim
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - David Shibata
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Cathy D Meade
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Clement K Gwede
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
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Hodges NL, Shoben AB, Paskett ED, Katz ML. Impact of a literacy-sensitive intervention on CRC screening knowledge, attitudes, and intention to screen. JOURNAL OF COMMUNITY AND SUPPORTIVE ONCOLOGY 2016; 14:420-426. [PMID: 31179350 DOI: 10.12788/jcso.0209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Colorectal cancer (CRC) screening rates remain low, especially among low-income populations. Objective To determine if a CRC screening intervention (video, brochure) improves knowledge about CRC and CRC screening, attitudes toward screening, and intention to complete CRC screening among average-risk adults with different health literacy skills, seeking medical care at a Federally Qualified Health Center (FQHC). Methods Average-risk adults (50 years or older) who were not within CRC screening guidelines completed face-to-face pre-and post-intervention interviews that focused on knowledge about CRC and CRC screening, attitudes toward CRC screening, and intention to complete CRC screening. Results Of the 270 participants, 64% were women, 72% were black/African American, 86% were not married, 79% had an annual household income of <$20,000, and 57% did not have health insurance. Reading levels by Rapid Estimate of Adult Literacy in Medicine health literacy test were: 3rd grade or lower, 17 participants (6.3%); 4th-6th grade, 27 (10.0%); 7th-8th grade, 101 (37.4 %); and high school, 125 (46.3%). CRC screening knowledge mean score improved, and perceived CRC susceptibility and self-efficacy to complete screening significantly increased, irrespective of health literacy (all P < .01). There were no significant changes in other attitudes or intention to complete screening. Limitations The study was conducted in a single FQHC, so the results may not be generalizable to other health centers or populations of low-income and minority patients. Conclusion A CRC screening intervention improved CRC screening knowledge and attitudes across levels of health literacy and may be an important strategy for improving CRC screening in the primary care setting. Funding National Cancer Institute K07 CA107079 (Ohio State University) and P30 CA016058 (Behavioral Measurement Shared Resource at The Ohio State University).
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Affiliation(s)
- Nichole L Hodges
- Division of Health Behavior and Health Promotion, College of Public Health, at The Ohio State University, Columbus, Ohio
| | - Abigail B Shoben
- Division of Biostatistics, College of Public Health, at The Ohio State University, Columbus, Ohio.,Comprehensive Cancer Center, at The Ohio State University, Columbus, Ohio
| | - Electra D Paskett
- Comprehensive Cancer Center, at The Ohio State University, Columbus, Ohio.,Division of Cancer Prevention and Control, College of Medicine, at The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, at The Ohio State University, Columbus, Ohio
| | - Mira L Katz
- Division of Health Behavior and Health Promotion, College of Public Health, at The Ohio State University, Columbus, Ohio.,Comprehensive Cancer Center, at The Ohio State University, Columbus, Ohio.,Division of Cancer Prevention and Control, College of Medicine, at The Ohio State University, Columbus, Ohio
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Smith SG, McGregor LM, Raine R, Wardle J, von Wagner C, Robb KA. Inequalities in cancer screening participation: examining differences in perceived benefits and barriers. Psychooncology 2016; 25:1168-1174. [PMID: 27309861 PMCID: PMC5082500 DOI: 10.1002/pon.4195] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Inequalities exist in colorectal cancer (CRC) screening uptake, with people from lower socioeconomic status backgrounds less likely to participate. Identifying the facilitators and barriers to screening uptake is important to addressing screening disparities. We pooled data from 2 trials to examine educational differences in psychological constructs related to guaiac fecal occult blood testing. METHODS Patients (n = 8576) registered at 7 general practices in England, within 15 years of the eligible age range for screening (45-59.5 years), were invited to complete a questionnaire. Measures included perceived barriers (emotional and practical) and benefits of screening, screening intentions, and participant characteristics including education. RESULTS After data pooling, 2181 responses were included. People with high school education or no formal education reported higher emotional and practical barriers and were less likely to definitely intend to participate in screening, compared with university graduates in analyses controlling for study arm and participant characteristics. The belief that one would worry more about CRC after screening and concerns about tempting fate were strongly negatively associated with education. In a model including education and participant characteristics, respondents with low emotional barriers, low practical barriers, and high perceived benefits were more likely to definitely intend to take part in screening. CONCLUSIONS In this analysis of adults approaching the CRC screening age, there was a consistent effect of education on perceived barriers toward guaiac fecal occult blood testing, which could affect screening decision making. Interventions should target specific barriers to reduce educational disparities in screening uptake and avoid exacerbating inequalities in CRC mortality.
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Affiliation(s)
- S G Smith
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - L M McGregor
- Department of Epidemiology and Public Health, University College London, London, UK
| | - R Raine
- Department of Applied Health Research, University College London, London, UK
| | - J Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - C von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - K A Robb
- Department of Epidemiology and Public Health, University College London, London, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Christy SM, Davis SN, Williams KR, Zhao X, Govindaraju SK, Quinn GP, Vadaparampil ST, Lin HY, Sutton SK, Roethzeim RR, Shibata D, Meade CD, Gwede CK. A community-based trial of educational interventions with fecal immunochemical tests for colorectal cancer screening uptake among blacks in community settings. Cancer 2016; 122:3288-3296. [PMID: 27420119 DOI: 10.1002/cncr.30207] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/03/2016] [Accepted: 05/27/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Intervention studies among individuals in diverse community settings are needed to reduce health disparities in colorectal cancer (CRC) screening and mortality rates. The current study compared the efficacy of 2 intervention conditions promoting CRC screening among black individuals. METHODS Black individuals ages 50 to 75 years (N = 330) were recruited in community settings in 4 Tampa Bay counties. After obtaining consent and conducting a baseline interview to assess sociodemographic and health-related variables, participants received either a culturally targeted CRC photonovella booklet plus a fecal immunochemical test (FIT) kit or a standard CRC screening brochure plus an FIT kit. The primary outcome was FIT kit screening uptake. RESULTS FIT screening uptake at 6 months was 86.7% overall (90.3% in the brochure group and 81.9% in the photonovella group). Controlling for baseline between-group differences, there was no influence of intervention on FIT kit uptake (P = .756). Significant predictors of not returning an FIT kit included being unable to work (P = .010), having higher religious belief scores (P = .015), and living farther from the cancer center (P = .015). CONCLUSIONS Providing FIT kits and educational print materials to black individuals in community settings resulted in high rates of CRC screening. The study also identified subgroups of participants who were less likely to return an FIT kit and provides insight for future interventions. Cancer 2016;122:3288-3296. © 2016 American Cancer Society.
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Affiliation(s)
- Shannon M Christy
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida.,Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Stacy N Davis
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kimberly R Williams
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Xiuhua Zhao
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Swapomthi K Govindaraju
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Gwendolyn P Quinn
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida.,Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Susan T Vadaparampil
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Hui-Yi Lin
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida.,School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Steven K Sutton
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida.,Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Richard R Roethzeim
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida.,Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - David Shibata
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida.,Morsani College of Medicine, University of South Florida, Tampa, Florida.,Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Cathy D Meade
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida.,Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Clement K Gwede
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, Florida. .,Morsani College of Medicine, University of South Florida, Tampa, Florida.
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Psychometric properties of a Chinese version of the Colorectal Cancer Perceptions Scale in a sample of older Chinese people. Cancer Nurs 2016; 37:E53-60. [PMID: 25140640 DOI: 10.1097/ncc.0000000000000107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older adults are more susceptible to colorectal cancer (CRC). Psychosocial constructs in the Health Belief Model are targets for interventional studies. No tool to measure these beliefs of older Chinese people has been validated. OBJECTIVE The present study aimed to examine the preliminary psychometric properties of the Chinese version of the Colorectal Cancer Perceptions Scale (CRCPS). METHODS The CRCPS was translated to Chinese language, validated by an expert panel, and tested. Interviewer-administered surveys were carried out with a convenience sample of 219 community-dwelling Chinese adults 60 years or older and were included in the analysis. RESULTS Six factors were retained, with items on susceptibility and benefits remaining as designed, whereas those on severity formed 2 factors, labeled severity-fear and severity-life impact, and those on barriers again formed 2 factors, labeled psychological barriers and knowledge barriers. Cronbach's α values ranged from .74 to .88, and test-retest reliability correlations ranged from .38 for psychological barriers to .69 for knowledge barriers. Respondents who had undergone CRC screening had significantly lower mean scores on severity-fear, severity-life impact, psychological barriers, and knowledge barriers compared with those who had not. CONCLUSIONS The results provide preliminary support for the reliability and validity of the Chinese version of the CRCPS. Further psychometric testing is recommended. IMPLICATIONS FOR PRACTICE The survey provides a useful tool to assess CRC health beliefs, which interventions should address to improve screening rates among older Chinese adults.
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Colorectal cancer prevention and intentions to use low-dose aspirin: A survey of 1000 U.S. adults aged 40–65. Cancer Epidemiol 2016; 41:99-105. [DOI: 10.1016/j.canep.2016.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 12/29/2022]
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Ely JW, Levy BT, Daly J, Xu Y. Patient Beliefs About Colon Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:39-46. [PMID: 25619196 PMCID: PMC7712459 DOI: 10.1007/s13187-015-0792-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Only about half of eligible individuals undergo colon cancer screening. We have limited knowledge about the patient beliefs that adversely affect screening decisions and about which beliefs might be amenable to change through education. As part of a clinical trial, 641 rural Iowans, aged 52 to 79 years, reported their beliefs about colon cancer screening in response to a mailed questionnaire. Consenting subjects were randomized into four groups, which were distinguished by four levels of increasingly intensive efforts to promote screening. Two of the groups received mailed educational materials and completed a follow-up questionnaire, which allowed us to determine whether their beliefs about screening changed following the education. We also completed a factor analysis to identify underlying (latent) factors that might explain the responses to 33 questions about readiness, attitudes, and perceived barriers related to colon cancer screening. The strongest predictors of a patient's stated readiness to be screened were a physician's recommendation to be screened (1 point difference on 10-point Likert scale, 95 % confidence interval [CI], 0.5 to 1.6 point difference), a family history of colon cancer (0.85-point Likert scale difference, 95 % CI, 0.1 to 1.6), and a belief that health-care decisions should be mostly left to physicians rather than patients (Spearman correlation coefficient 0.21, P < .001). Of the 33 questionnaire items about screening beliefs, 11 (33 %) changed favorably following the educational intervention. In the factor analysis, the 33 items were reduced to 8 underlying factors, such as being too busy to undergo screening and worries about screening procedures. We found a limited number of underlying factors that may help explain patient resistance to colon cancer screening.
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Affiliation(s)
- John W Ely
- Department of Family Medicine, Joy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | - Barcey T Levy
- Department of Family Medicine, Joy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jeanette Daly
- Department of Family Medicine, Joy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Yinghui Xu
- Department of Family Medicine, Joy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Tahmasebi R, Noroozi A, Dashdebi KG. Psychometric Evaluation of the Colorectal Cancer Screening Belief Scale Based on Health Belief Model's Constructs for the Fecal Occult Blood Test. Asian Pac J Cancer Prev 2016; 17:225-9. [DOI: 10.7314/apjcp.2016.17.1.225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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47
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Gordon NP, Green BB. Factors associated with use and non-use of the Fecal Immunochemical Test (FIT) kit for Colorectal Cancer Screening in Response to a 2012 outreach screening program: a survey study. BMC Public Health 2015; 15:546. [PMID: 26062732 PMCID: PMC4462185 DOI: 10.1186/s12889-015-1908-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/04/2015] [Indexed: 12/11/2022] Open
Abstract
Background The one-sample fecal immunochemical test (FIT) is gaining popularity for colorectal cancer (CRC) screening of average-risk people. However, uptake and annual use remain suboptimal. Methods In 2013, we mailed questionnaires to three groups of nonHispanic White, Black, and Latino Kaiser Permanente Northern California (KPNC) members ages 52–76 who received FIT kits in 2010–2012: Continuers did the FIT all 3 years; Converts in 2012, but not 2010 or 2011; and Nonusers in none of the 3 years. The questionnaires covered social influences, perceived CRC risk, reasons for using (Continuers, Converts) or avoiding using (Nonusers) the FIT, and recommendations for improving the kit. Results Continuers (n = 607, response rate 67.5 %), Converts (n = 317, response rate 35.6 %), and Nonusers (n = 215, response rate 21.1 %) did not differ in perceived risk or family history of CRC, but Nonusers were less likely than Continuers and Converts to know someone who had polyps or CRC. Continuers, Converts, and Nonusers did not differ in social network encouragement of CRC screening, but did differ in believing that it was very important that they be screened (88.3 %, 68.4 %, 47.7 %) and that their medical team thought it very important that they be screened (88.6 %, 79.9 %, 53.9 %). Approximately half of Continuers and Converts completed the FIT to please their doctor. Converts were less likely than Continuers to use the FIT to “make sure they were OK” (53.7 % vs. 72.6 %) or “protect their health” (46.1 % vs. 76.4 %). Nearly half of Converts completed the FIT out of guilt. Approximately half of FIT kit users suggested adding a disposable glove, extra paper, and wider-mouth tube to the kit. Nonusers’ reasons for not using the FIT included discomfort, disgust, or embarrassment (59.6 %); thinking it unnecessary (32.9 %); fatalism/fear (15.5 %); and thinking it too difficult to use (14.5 %), but <10 % did not want CRC screening at all. Conclusions Nonusers and irregular users of the FIT are less intrinsically motivated to get CRC screening than long-term users and more averse to preparing their stool sample. Changes to the FIT kit to address discomfort and difficulty factors might improve uptake and continued use. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1908-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nancy P Gordon
- Division of Research, Kaiser Permanente Medical Care Program, 2000 Broadway, Oakland, CA, 94611, USA.
| | - Beverly B Green
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA. greenb.@ghc.org
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Murphy CC, Lewis CL, Golin CE, Sandler RS. Underuse of surveillance colonoscopy in patients at increased risk of colorectal cancer. Am J Gastroenterol 2015; 110:633-41. [PMID: 25384901 PMCID: PMC4422764 DOI: 10.1038/ajg.2014.344] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Colorectal cancer incidence and mortality have declined over the past two decades, and much of this improvement is attributed to increased use of screening. Approximately 25% of patients who undergo screening colonoscopy have premalignant adenomas that require removal and follow-up colonoscopy. However, there are few studies of the use of surveillance colonoscopy in increased risk patients with previous adenomas. METHODS We conducted a cross-sectional study to examine factors associated with underuse of surveillance colonoscopy among patients who are at increased risk for colorectal cancer. The study population consisted of patients with previously identified adenomatous polyps and who were due for follow-up colonoscopy. Patients were categorized as attenders (n=100) or non-attenders (n=104) on the basis of completion of follow-up colonoscopy. Telephone surveys assessed the use of surveillance colonoscopy across domains of predisposing patient characteristics, enabling factors, and patient need. Mutlivariable logistic regression was used to identify factors associated with screening completion. RESULTS Perceived barriers, perceived benefits, social deprivation, and cancer worry were associated with attendance at colonoscopy. Higher benefits (odds ratio (OR) 2.37, 95% confidence interval (CI) 1.04-5.41) and cancer worry (OR 1.73, 95% CI 1.07-2.79) increased the odds of attendance at follow-up colonoscopy, whereas greater barriers (OR 0.49, 95% CI 0.28-0.88) and high social deprivation (≥2; OR 0.09, 95% CI 0.01-0.76) were associated with lower odds. CONCLUSIONS Our results suggest that multilevel factors contribute to the use of surveillance colonoscopy in higher risk populations, many of which are amenable to intervention. Interventions, such as patient navigation, may help facilitate appropriate use of surveillance colonoscopy.
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Affiliation(s)
- Caitlin C Murphy
- Department of Epidemiology, Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carmen L Lewis
- Department of Medicine, Division of General Internal Medicine, University of Colorado, Boulder, Colorado, USA
| | - Carol E Golin
- Department of Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Department of Health Behavior, Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert S Sandler
- Department of Epidemiology, Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Center for Gastrointestinal Biology and Disease, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Center for Gastrointestinal Biology and Disease The University of North Carolina at Chapel Hill, CB# 7555, 4157 Bioinformatics Building Chapel Hill, Chapel Hill, North Carolina 27599-7555, USA. E-mail:
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Wilson CJ, Flight IH, Turnbull D, Gregory T, Cole SR, Young GP, Zajac IT. A randomised controlled trial of personalised decision support delivered via the internet for bowel cancer screening with a faecal occult blood test: the effects of tailoring of messages according to social cognitive variables on participation. BMC Med Inform Decis Mak 2015; 15:25. [PMID: 25886492 PMCID: PMC4403749 DOI: 10.1186/s12911-015-0147-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 03/17/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In Australia, bowel cancer screening participation using faecal occult blood testing (FOBT) is low. Decision support tailored to psychological predictors of participation may increase screening. The study compared tailored computerised decision support to non-tailored computer or paper information. The primary outcome was FOBT return within 12 weeks. Additional analyses were conducted on movement in decision to screen and change on psychological variables. METHODS A parallel, randomised controlled, trial invited 25,511 people aged 50-74 years to complete an eligibility questionnaire. Eligible respondents (n = 3,408) were assigned to Tailored Personalised Decision Support (TPDS), Non-Tailored PDS (NTPDS), or Control (CG) (intention-to-treat, ITT sample). TPDS and NTPDS groups completed an on-line baseline survey (BS) and accessed generic information. The TPDS group additionally received a tailored intervention. CG participants completed a paper BS only. Those completing the BS (n = 2270) were mailed an FOBT and requested to complete an endpoint survey (ES) that re-measured BS variables (per-protocol, PP sample). RESULTS FOBT return: In the ITT sample, there was no significant difference between any group (χ (2)(2) = 2.57, p = .26; TPDS, 32.5%; NTPDS, 33%; and CG, 34.5%). In the PP sample, FOBT return in the internet groups was significantly higher than the paper group (χ (2)(2) = 17.01, p < .001; TPDS, 80%; NTPDS, 83%; and CG, 74%). FOBT completion by TPDS and NTPDS did not differ (χ (2)(1) = 2.23, p = .13). Age was positively associated with kit return. Decision to screen: 2227/2270 of the PP sample provided complete BS data. Participants not wanting to screen at baseline (1083/2227) and allocated to TPDS and NTPDS were significantly more likely to decide to screen and return an FOBT than those assigned to the CG. FOBT return by TPDS and NTPDS did not differ from one another (OR = 1.16, p = .42). Change on psychosocial predictors: Analysis of change indicated that salience and coherence of screening and self-efficacy were improved and faecal aversion decreased by tailored messaging. CONCLUSIONS Online information resources may have a role in encouraging internet-enabled people who are uncommitted to screening to change their attitudes, perceptions and behaviour. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12610000095066.
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Affiliation(s)
- Carlene J Wilson
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia. .,Cancer Council South Australia, Eastwood, South Australia, Australia.
| | - Ingrid Hk Flight
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia.,Cancer Council South Australia, Eastwood, South Australia, Australia.,Commonwealth Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia
| | - Deborah Turnbull
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Tess Gregory
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,School of Population Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen R Cole
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Ian T Zajac
- Commonwealth Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia
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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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