Factors associated with intentions for colorectal cancer screenings in a Chinese sample

Systematic Review and Meta-study Synthesis of Qualitative Studies Evaluating Facilitators and Barriers to Participation in Colorectal Cancer Screening

Screening reduces the incidence, morbidity, and mortality of colorectal cancer, yet participation tends to be low. We undertook a systematic review and meta-study synthesis of qualitative studies to identify facilitators and barriers to colorectal cancer screening participation. We searched major bibliographic databases for records published in all languages from inception to February 2015. Included primary studies that elicited views and perceptions towards colorectal cancer screening were appraised for relevance and quality. We used a two-stage synthesis to create an interpretation of colorectal cancer screening decisions grounded in primary studies; a thematic analysis to group themes and systematically compare studies and a meta-synthesis to generate an expanded theory of colorectal cancer screening participation. Ninety-four studies were included. The decision to participate in colorectal cancer screening depended on an individual's awareness of colorectal cancer screening. Awareness affected views of cancer, attitudes towards colorectal cancer screening modalities, and motivation for screening. Factors mediating awareness included public education to address misconceptions, primary care physician efforts to recommend screening, and the influence of friends and family. Specific barriers to participation in populations with lower participation rates included language barriers, logistical challenges to attending screening tests, and cultural beliefs. This study identifies key barriers, facilitators, and mediators to colorectal cancer screening participation. Cancer Epidemiol Biomarkers Prev; 25(6); 907-17. ©2016 AACR.

Sociodemographic predictors of recall and recognition of colorectal cancer symptoms and anticipated delay in help- seeking in a multiethnic Asian population

BACKGROUND

Colorectal cancer is the second most common cancer in Malaysia. The prognosis of the disease is excellent if detected at an early stage, but the majority of Malaysian patients present at late stages. We aimed to assess the awareness of cancer warning signs and anticipated delay in help-seeking as possible contributors to this phenomenon.

MATERIALS AND METHODS

A population-based cross-sectional survey using the Colorectal Cancer Awareness Measure was initiated in Perak, Malaysia. A total of 2,379 respondents aged 18 years and above were recruited using a multi-stage sampling in five locations. Analysis of covariance was used to examine independent sociodemographic predictors of scores for symptom awareness.

RESULTS

Younger age, being female, a higher education, and higher income were significantly associated with better scores for both recall and recognition of warning symptoms. Among the ethnic groups, Malays had better recognition of symptoms whereas Chinese recalled the most symptoms. Passing bloody stool was associated with the least anticipated delay and unexplained anal pain had the highest anticipated delay.

CONCLUSIONS

The level of awareness across all ethnicities in Malaysia is generally low, especially among minorities. Targeted public education, which is culturally and linguistically appropriate, should be developed to encourage early help-seeking and improve clinical outcomes.

Cervical cancer screening and chinese women: insights from focus groups

OBJECTIVE

Despite extensive efforts to raise awareness, Papanicolaou (Pap) testing rates among Chinese women living in North America remain low compared with Euro-American women. Although the lower Pap testing rate and ensuing health repercussions among Chinese women are well characterized, mechanisms underlying such health disparities are not. The aim of this study was to use a qualitative approach to delineate such mechanisms. Qualitative approaches to understand constructs within the domain of sexual and reproductive health have been shown to be particularly appropriate, and offer a nuanced view of sexuality that is not afforded by traditional quantitative methods.

METHOD

We carried out two focus groups aimed at exploring how Mandarin-speaking and English-speaking Chinese women experience Pap testing (N = 12). The women were invited to partake in the focus groups from having participated in a large-scale quantitative study. Participants were all first-generation immigrants and their average age was 53-years-old. We used content analyses to analyze transcripts and extract themes.

RESULTS AND DISCUSSION

The women heavily endorsed traditional Chinese medicine philosophy, conceptualizing physical health holistically, and valuing preventative measures over screening and interceptive measures. Pap testing was described as qualitatively different from other screening procedures, such that women assigned a sexually charged meaning to Pap testing, often discussing it in relation to sexual activity and promiscuity. Women expressed their preference for the compulsory and depersonalized manner that Pap tests are performed in their home country of China, as this lessens the embarrassment associated with undergoing Pap testing.

CONCLUSION

Three mechanisms may contribute to lower Pap testing among middle-aged first-generation Chinese immigrants: preference for Chinese medicine philosophy, perceived sexualization of Pap testing, and the institutionalization of medical care. Implications for improving the reproductive health of Chinese women are discussed.

Colorectal cancer screening behavior and willingness: an outpatient survey in China

AIM

To identity the factors influencing colorectal cancer (CRC) screening behavior and willingness among Chinese outpatients.

METHODS

An outpatient-based face-to-face survey was conducted from August 18 to September 7, 2010 in Changhai Hospital. A total of 1200 consecutive patients aged ≥ 18 years were recruited for interview. The patient's knowledge about CRC and screening was pre-measured as a predictor variable, and other predictors included age, gender, educational level, monthly household income and health insurance status. The relationship between these predictors and screening behavior, screening willingness and screening approach were examined using Pearson's χ(2) test and logistic regression analyses.

RESULTS

Of these outpatients, 22.5% had undergone CRC screening prior to this study. Patients who had participated in the screening were more likely to have good knowledge about CRC and screening (OR: 5.299, 95% CI: 3.415-8.223), have health insurance (OR: 1.996, 95% CI: 1.426-2.794) and older in age. Higher income, however, was found to be a barrier to the screening (OR: 0.633, 95% CI: 0.467-0.858). An analysis of screening willingness showed that 37.5% of the patients would voluntarily participated in a screen at the recommended age, but 41.3% would do so under doctor's advice. Screening willingness was positively correlated with the patient's knowledge status. Patients with higher knowledge levels would like to participate in the screening (OR: 4.352, 95% CI: 3.008-6.298), and they would select colonoscopy as a screening approach (OR: 3.513, 95% CI: 2.290-5.389). However, higher income level was, again, a barrier to colonoscopic screening (OR: 0.667, 95% CI: 0.505-0.908).

CONCLUSION

Patient's level of knowledge and income should be taken into consideration when conducting a feasible CRC screening.

Development of a Population-based Questionnaire to Explore Psychosocial Determinants of Screening for Memory Loss and Alzheimer Disease

Alzheimer disease research has focused on detecting the earliest signs of cognitive decline and efforts are ongoing to develop biomarkers and cognitive measures that reliably distinguish between nondemented and demented individuals. However, little is known about factors that may directly or indirectly influence screening behavior of older community-dwelling adults. We describe an iterative process for the development and formative evaluation of a questionnaire about dementia knowledge and screening behaviors in older adults to understand the psychosocial factors underlying intention to obtain dementia screening to profile individuals manifesting intention to undergo dementia screening compared to those who will not. The Behavioral Model of Health Services Use was used as a conceptual framework for a questionnaire with constructs from the Health Belief Model, Theory of Reasoned Action and Self-Efficacy. After pretesting, we used a random dialing strategy to test our questionnaire on a final sample of 1024 older Missourians. Internal consistency and construct validity were examined. Pretesting identified several potential problems that were improved with rewording. Cronbach alpha was greater than 0.6 (range 0.62 to 0.92) in all but one construct testing dementia knowledge, suggesting good to excellent internal consistency. Convergent (construct) validity was assessed using confirmatory factor analysis. All constructs but 3 demonstrated good validity. Addressing these issues will allow researchers to identify unique characteristics based on age, race, sex, socioeconomic differences and geographic location, and characterize barriers to screening programs to more effectively develop targeted community-based interventions.

Experience of colorectal cancer screening using a home-administered kit for fecal occult blood tests among a Chinese worksite population in Taiwan

This study examined the experience of fecal occult blood test (FOBT) using a home-administered kit that requires no stool handling for colorectal cancer screening among Chinese people age 40 and older. 304 participants were recruited from 10 worksites in Taiwan. Both oral and written instructions on how to use the test kit were provided. After participants completed the screening test, their experiences were documented through structured open-ended probing survey questions. Although analysis showed some challenges for Chinese participants as first time users, the overall reactions and perceived advantages towards the kit were promising. Interventions should consider the participant's stage of adaptation to new screening strategies, literacy, and environmental conditions. Since no known research has been conducted among Chinese people with a kit, experience provides valuable qualitative insights for planning intervention.