Raising awareness of bowel cancer through workplace screening programs

Abstract

The current research is the first to examine the feasibility of raising awareness of bowel cancer screening in Australian workplaces. Bowel cancer is the second most common cancer in Australia and early detection of the disease can lead to improved rates of survival. Currently a National Bowel Cancer Screening Program (NBCSP) operates in Australia that involves a free faecal occult blood test (FOBT) sent to the homes of people aged 50, 55, 60 or 65 years. Since its introduction in 2006 participation rates for the NBCSP have declined due to a lack of awareness in the community about bowel cancer in general and screening with FOBT in particular. Study 1 involved a group educational intervention for hospital employees. Participants were asked to complete two surveys and were provided with a free FOBT kit. Study 2 explored the utility of a decision aid for facilitating informed choice about bowel cancer screening among employees of a car manufacturer. The Decision Aid was a booklet developed for people with low literacy that provided information about the risks and benefits of bowel cancer screening. Participants in Study 2 were asked to complete two surveys and were provided with an FOBT kit. Participants were asked to contribute $10 towards the cost of the FOBT kit. The theoretical basis of Study 1 was the salience and coherence factor, which describes the extent to which bowel cancer screening is viewed as an important, common sense action in everyday life. Both studies examined changes in perceived barriers to screening with FOBT, as well as knowledge about and attitudes towards bowel cancer screening. In addition, Study 2 examined the constructs of health literacy, preferences for involvement in health decision making, informed choice and decisional conflict. The results of Study 1 showed that the group education method was a feasible means of educating employees and the program provided participants with a convenient opportunity to screen with FOBT. Study 2 provided some evidence for the utility of the decision aid, with half the participants making an informed choice to screen with FOBT. The results of both studies provided important information concerning beliefs about bowel cancer screening that are amenable to change that could be the focus of future educational programs. In particular, improvement in perceptions that the FOBT would be embarrassing, uncomfortable, or that it would take too much time provided evidence that these barriers to screening identified in previous research can be removed through a workplace educational program. Further, improved perceptions among participants in Study 1 about the ability of FOBT screening to detect cancer highlighted the potential impact of workplace educational programs in terms of raising awareness and improving attitudes towards screening with FOBT. A major implication for future research is the need to examine the acceptability of workplace bowel cancer screening programs in different types of industries and with larger samples of employees. A further challenge is to identify the best methods for implementing decision aids for people from a range of socioeconomic and cultural backgrounds.