Knowledge, attitudes, and practices of university students towards risk factors, screening, and perceived barriers of screening regarding colorectal cancer: A multi-country study from the eastern Mediterranean region.

Abstract

e22543 Background: Colorectal cancer (CRC) tends to be diagnosed at a younger age and at a more advanced stage. Knowledge and awareness of CRC and its screening in Middle East are suboptimal, and most countries lack national screening programs. Our objective was to assess the knowledge, attitudes and practices of university students regarding risk factors, screening and perceived barriers to CRC screening in Middle Eastern countries. Methods: A cross-sectional study using a convenience sampling method was done in different universities across ten Middle Eastern countries: Lebanon, Iraq, Syria, Palestine, Egypt, Jordan, Saudi Arabia (KSA), and others (Qatar, United Arab Emirates, Kuwait). Data were collected using a questionnaire shared with students in various universities. It comprised five main sections: socio-demographic characteristics, CRC knowledge, risk factors, symptoms and screening, attitudes, practices and barriers related to CRC screening. The questionnaire developed on the basis of a literature review, was properly translated and validated using factorial and reliability analysis. Results: A total of 4597 students participated in the study with a mean age of 24.28 ± 7.62 years. Participants’ countries of residence were Lebanon 1107 (24.1%), Jordan 811 (17.6%), Iraq 769 (16.7%), Palestine 478 (10.4%), Syria 450 (9.8%), Saudi-Arabia 438 (9.5%), Egypt 499 (10.9%) and others 45 (1.0%). Most participants had heard about CRC (87%). 2491 (54.2%) had first or second -degree relatives diagnosed with cancer. 84.2% of participants intend to undergo CRC screening in the future, however, 25.1% wouldn't pay for the screening if it is not covered by health insurance. The majority of students demonstrated good knowledge of CRC (96.5%), with Egypt demonstrating the highest level (98.2%), followed by Lebanon (97.1%) and Iraq (97.1%), and Jordan the lowest (94%). Factors associated with good knowledge were age (aOR = 1.03; 95%CI: 1.00-1.05), health-related studies (aOR = 2.80; 95%CI = 2.00-3.93), and the participant’s country of residence. The most important barrier to CRC screening in Lebanon was the lack of financial resources with high cost of test (52.6%), lack of health insurance in Syria and Jordan (50.4% and 49.3% respectively), poor counseling from doctors in KSA (52%), and the inadequacy of awareness campaigns in Iraq (57.1%), Egypt (56.1%) and Palestine (55%). Conclusions: Students in the Middle East demonstrate good knowledge of CRC. Nevertheless, they perceive barriers to CRC screening, including limited financial resources, high cost of tests not covered by health insurance, and inadequate awareness campaigns.