Colorectal Cancer Screening Self-efficacy Research Articles

Association of Preventive Care Attitudes and Beliefs with Colorectal Cancer Screening History among African American Patients of Community Health Centers.

Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer-related death among African Americans in the United States. However, when detected early, CRC is treatable and survival rates are high. CRC health disparities for African Americans compared with other groups may be due in part to lower screening adherence and later stage diagnosis. The objective of this research phase was to test predictors of ever having received CRC screening (i.e., self-report of lifetime receipt of CRC screening) using survey measures in the domains of healthcare communication, trust in doctors, CRC perceived susceptibility, CRC worry, negative cancer beliefs, CRC screening self-efficacy, and cultural constructs for CRC screening in a sample of African American community health center patients. The study recruited 115 African American patients between the ages of 45 to 64years old from community health centers in north Florida to complete the baseline survey. Our results show significant differences in CRC screening history by age, marital status, level of mistrust of healthcare providers, and level of empowerment toward cancer screening. To increase CRC screening in this population, the study findings suggest development of intervention programs that focus on priority populations of younger, unmarried African Americans, especially given the current trend of early onset CRC. Moreover, survival rates are lower for unmarried and younger African Americans relative to older and married individuals. Such interventions should also aim to increase trust in healthcare providers and increase empowerment for CRC screening decision making to increase screening participation.

Predicting adoption of colorectal cancer screening among Korean Americans using a decision tree model

ABSTRACT Background Colorectal cancer screening (CRCS) rates remain suboptimal among Korean Americans despite recommendations from health organizations. Little is known about the mechanism underlying their CRCS adoption within complex systems. This study aimed to examine the multi-level predictors of CRCS adoption among Korean Americans using a decision tree model. Methods A cross-sectional survey was performed to assess CRCS adoption and multiple levels of influence – individual (i.e. CRCS self-efficacy, CRCS attitudes, risk of colorectal cancer, psychological distress, health status), interpersonal (i.e. social support, social networks, CRCS recommendations), and organizational/community (i.e. health insurance, primary doctor, primary clinic) factors. A total of 433 Korean Americans aged 50–75 in a metropolitan area in the Southeastern U.S. completed a self-report questionnaire. To determine the important variables that predict CRCS adoption, the study generated a decision tree predictive model using R statistical software. Results The results indicated that CRCS self-efficacy and CRCS attitudes at the individual level and CRCS recommendations and social support at the interpersonal level differentiate adopting or not adopting CRCS. Furthermore, CRCS recommendations (n = 138, 56%, prob = 0.64) and CRCS self-efficacy (n = 51, 21%, prob = 0.88) were the most powerful predictors of CRCS adoption. Conclusion The findings highlight the critical roles of CRCS recommendations from healthcare providers and family/friends and patients’ confidence in performing screening-related tasks in influencing CRCS adoption among Korean Americans. Practice efforts should target individual and interpersonal characteristics when developing interventions for promoting CRCS among Korean Americans, especially who are not adherent to screening guidelines.

Abstract D026: Correlates of lifestyle behaviors to prevent colorectal cancer among low-income Vietnamese Americans

Abstract Background Colorectal cancer (CRC) is the second most commonly diagnosed cancer and the third highest cause of mortality in Vietnamese Americans. Lifestyle behaviors including diet, physical activity, smoking, and drinking have been associated with the incidence of CRC. Despite the association between health behaviors and CRC, as well as documented non-optimal engagement in healthy lifestyle behaviors among this group, little research has been done to address health behaviors in Vietnamese Americans. Methodology We recruited 804 Vietnamese Americans aged 50 or order from 20 community-based organizations (CBOs) in the greater Philadelphia metropolitan area. As a dependent variable, lifestyle behaviors were measured as a composite score of smoking, drinking, diet, and physical activity. Measures for independent variables included knowledge on CRC risks and screening, cancer related health beliefs, CRC screening self-efficacy, and CRC related social norm. Descriptive analysis, t-test (for categorical IVs) and correlation analysis (for continuous IVs) were first conducted to select the variables to be included in the multiple regression analysis. Results Among 804 participants, 41% were men, 60% were women, and about 22% were older than 75. Approximately 62% had an annual household income below $20,000, and only 18% had a college degree or higher. We conducted a bivariate (t-test and correlation) analysis. The results showed that gender, income, knowledge on CRC risk factors, beliefs that getting cancer is determined by the fate, and two CRC-related social norms were associated with composite score of lifestyle behaviors. Multiple regression analysis showed that being female (log odds = 2.02, 95% CI 1.53–2.51) and having greater knowledge (log odds = .61, 95% CI .002–.21) on CRC risk factors are significant predictors of healthy lifestyle behaviors controlling for other variables. Conclusion Findings revealed sub-optimal levels of healthy lifestyle behaviors and knowledge of CRC risk factors among Vietnamese Americans. The study highlights the importance of educating knowledge about the risk factors of CRC to improve lifestyle behaviors, which may eventually contribute to preventing CRC in this population. Acknowledgement: This research project was supported by grant U01MD010627 (PI: Grace X. Ma, PhD) funded by National Institute on Minority Health and Health Disparities (NIMHD) of National Institute of Health (NIH), and partially supported by the grant of U54 CA221704(5) funded by the National Cancer Institute (NCI) of NIH (Contact PIs: Grace X. Ma, PhD and Olorunseun O. Ogunwobi, MD, PhD). The contents of this abstract are solely the responsibility of the authors and do not necessarily represent the official views of NIMHD or the NCI, NIH. Citation Format: Minsun Lee, Lin Zhu, Jin-Hyeok Nam, Cicely K Johnson, Carolyn Fang, Grace X Ma. Correlates of lifestyle behaviors to prevent colorectal cancer among low-income Vietnamese Americans [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D026.

The Effects of Tailoring Knowledge Acquisition on Colorectal Cancer Screening Self-Efficacy

Interventions tailored to psychological factors such as personal and vicarious behavioral experiences can enhance behavioral self-efficacy but are complex to develop and implement. Information seeking theory suggests tailoring acquisition of health knowledge (without concurrent psychological factor tailoring) could enhance self-efficacy, simplifying the design of tailored behavior change interventions. To begin to examine this issue, the authors conducted exploratory analyses of data from a randomized controlled trial, comparing the effects of an experimental colorectal cancer screening intervention tailoring knowledge acquisition with the effects of a nontailored control on colorectal cancer screening knowledge and self-efficacy in 1159 patients comprising three ethnicity/language strata (Hispanic/Spanish, 23.4%, Hispanic/English, 27.2%, non-Hispanic/English, 49.3%) and 5 recruitment center strata. Adjusted for study strata, the mean postintervention knowledge score was significantly higher in the experimental group than in the control group. Adjusted experimental intervention exposure (B = 0.22, 95% CI [0.14, 0.30]), preintervention knowledge (B = 0.11, 95% CI [0.05, 0.16]), and postintervention knowledge (B = 0.03, 95% CI [0.01, 0.05]) were independently associated with subsequent colorectal cancer screening self-efficacy (p < .001 all associations). These exploratory findings suggest that tailoring knowledge acquisition may enhance self-efficacy, with potential implications for tailored intervention design, but this implication requires confirmation in studies specifically designed to examine this issue.

Colorectal cancer screening among Latinos in three communities on the Texas-Mexico border.

To assess colorectal cancer screening (CRCS) prevalence and psychosocial correlates of CRCS among Latinos in South Texas. 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). 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. CRCS interventions in this population should focus on improving access, increasing self-efficacy and perceived norms, and decreasing negative perceptions of CRCS.

Racial/Ethnic Variations in Colorectal Cancer Screening Self-Efficacy,Fatalism and Risk Perception in a Safety-Net Clinic Population: Implications for Tailored Interventions

Ethnic and racial minority groups in the U.S. receive fewer colorectal cancer (CRC) screening tests and are less likely to be up-to-date with CRC screening than the population as a whole. Access, limited awareness of CRC and barriers may, in part, be responsible for inhibiting widespread adoption of CRC screening among racial and ethnic minority groups. The purpose of this study was to examine the role of self-efficacy, fatalism and CRC risk perception across racial and ethnic groups in a diverse sample. This study was a cross-sectional analysis from baseline measures gathered on a group of patients recruited into a trial to track colorectal cancer screening in underserved adults over 50. Out of 470 Participants, 42% were non-Hispanic; 27% Hispanic and 28% non-Hispanic White. Hispanic and non-Hispanic Blacks were more likely to have fatalistic beliefs about CRC than non-Hispanic Whites. Non-Hispanic Blacks perceived higher risk of getting colon cancer. Self-efficacy for completing CRC screening was higher among Non-Hispanic Blacks than among Hispanics. Racial and ethnic differences in risk perceptions, fatalism and self-efficacy should be taken into consideration in future CRC interventions with marginalized and uninsured populations.

A Randomized Controlled Trial of a Tailored Interactive Computer-Delivered Intervention to Promote Colorectal Cancer Screening: Sometimes More is Just the Same

There have been few studies of tailored interventions to promote colorectal cancer (CRC) screening. We conducted a randomized trial of a tailored, interactive intervention to increase CRC screening. Patients 50-70 years completed a baseline survey, were randomized to one of three groups, and attended a wellness exam after being exposed to a tailored intervention about CRC screening (tailored group), a public web site about CRC screening (web site group), or no intervention (survey-only group). The primary outcome was completion of any recommended CRC screening by 6 months. There was no statistically significant difference in screening by 6 months: 30%, 31%, and 28% of the survey-only, web site, and tailored groups were screened. Exposure to the tailored intervention was associated with increased knowledge and CRC screening self-efficacy at 2 weeks and 6 months. Family history, prior screening, stage of change, and physician recommendation moderated the intervention effects. A tailored intervention was not more effective at increasing screening than a public web site or only being surveyed.

Effects of a tailored interactive multimedia computer program on determinants of colorectal cancer screening: A randomized controlled pilot study in physician offices

Objective Screening reduces colorectal cancer (CRC) mortality and is cost-effective, yet uptake is suboptimal. We developed and evaluated a personally tailored interactive multimedia computer program (IMCP) to encourage CRC screening. Methods Randomized controlled pilot trial evaluating the effects of the personally tailored CRC screening IMCP as compared with a non-tailored IMCP (“electronic leaflet”) control. The IMCP was tailored to patient preference, self-efficacy, barriers, and readiness and deployed in busy primary care offices before scheduled doctor visits. Main outcomes were: CRC screening knowledge, self-efficacy, benefits and barriers, and stage of readiness. Results We enrolled 54 subjects; software glitches occurred in 5, leaving 49 subjects for analysis. In adjusted analyses, compared with control, the experimental group had a significant increase in CRC screening self-efficacy ( p = 0.049), a significantly greater likelihood of moving to a more advanced stage of readiness for screening ( p = 0.034), a trend toward fewer perceived barriers to screening ( p = 0.149), and no difference in perceived benefits or knowledge of screening. Conclusion Our personally tailored IMCP was significantly more effective than control in bolstering CRC screening readiness and self-efficacy. Practice implications If further streamlined, personally tailored IMCPs might be usefully deployed in busy primary care offices to improve uptake of CRC screening.