Determinants Of Colorectal Cancer Screening Research Articles

Determinants of colorectal cancer screening among South Asian Americans

Background: Colorectal cancer screening rates among South Asian Americans are among the lowest of U.S. population groups. Few population-based studies have examined determinants of screening in this population. The purpose of this study was to identify factors associated with colorectal cancer screening among South Asian Americans.
 Methods: Data from the 2001-2009 California Health Interview Survey and multivariable logistic regression were used to examine determinants of being non-adherent with colorectal cancer screening recommendations. Independent variables include sociodemographic and healthcare access measures.
 Results: Overall, 49% of 459 South Asians were non-adherent to screening recommendations. Characteristics associated with non-adherence were absence of flu shot, absence of doctor visits, sole use of non-English language at home, and <40% life spent in US. In the multivariable model, screening non-adherence was associated with <40% life in US (odds ratio (95% confidence interval) 3.0 (1.4-6.5)), use of non-English at home (2.8 (1.0-7.8)), and no flu shot (2.5 (1.3-4.8)). Obese (BMI > 27.5 kg/m2) versus normal weight patients were less likely to be non-adherent (0.4 (0.2-0.9)).
 Conclusions: Length of time in the US and language spoken at home rather than English proficiency were associated with non-adherence to colorectal cancer screening, reflecting the importance of acculturation and retention of cultural values. Health conditions and behaviors reflecting more proactive healthcare utilization may reinforce the importance of provider recommendations and perceived efficacy of health prevention. Qualitative research would inform cultural tailoring necessary to improve colorectal cancer screening rates among the rapidly growing South Asian American population.

Determinants of colorectal cancer screening in Germany: a claims data analysis.

With an incidence of 58,000 cases per year, colorectal cancer (CRC) is the third most common type of cancer in Germany. Although guaiac-based fecal occult blood tests (gFOBT) and colonoscopy are accepted strategies for CRC screening offered for individuals aged 50 or 55 onwards, utilization rates remain low.This study examines various determinants for participation in CRC screening using claims data provided by the AOK Niedersachsen and covering the years 2014 to 2016. Using multivariate logistic regression models, we analyzed sociodemographic factors (sex, age, nationality, type of employment) associated with screening behavior, including individuals who underwent colonoscopy or gFOBT. The effect of school education and professional qualification was estimated using subgroups of employees with social insurance.The analysis consisted of 620,977 insured individuals in the study population for screening colonoscopy, while the gFOBT study population contained 845,191 individuals. With increasing age, individuals were less likely to participate in CRC screening. Participation rates for screening were higher for women than men in younger age groups. However, men in higher age groups showed increased participation rates in gFOBT screening. When compared with German citizens, Turkish citizens use the colonoscopy less often and the gFOBT more often. In contrast to employees with social insurance, unemployed individuals accept the prevention services less frequently, whereas pensioners and voluntarily insured individuals exhibit increased participation rates. In terms of education and professional qualification, we estimated a significantly lower participation rate exclusively for the least educated individuals. The results help to better understand patterns of utilization and can contribute to the development of information programs for specific groups.

Using Intervention Mapping to Develop Health Education Components to Increase Colorectal Cancer Screening in Puerto Rico.

Colorectal cancer (CRC) is a leading cause of cancer-related mortality in Puerto Rico (PR). Although largely preventable through screening and treatment of precancerous polyps, CRC screening rates in PR remain low while CRC incidence and mortality continue to increase. We used intervention mapping (IM), a systematic framework using theory and evidence to plan a health promotion intervention to increase colorectal cancer screening (CRCS) among Puerto Rican adults 50 years and older who are patients of Federally Qualified Health Centers (FQHCs) in PR. To inform the development of a logic model of the problem during the needs assessment phase, we determined the CRC incidence and mortality rates in PR using recent data from the PR Cancer Registry, conducted a literature review to better understand behavioral and environmental factors influencing CRC among Hispanics in general and in Puerto Ricans, and collected new data. We conducted seven focus groups to identify community needs and resources, specific sub-behaviors related to CRCS (performance objectives) and the determinants of CRCS. We then developed matrices of change objectives that would guide the content, behavioral change method selection, and the practical applications that would be included in the program. We selected two overarching methods: entertainment education and behavioral journalism and developed practical applications, materials, and messages containing several other methods including modeling, persuasion, information, and tailoring. We developed and pretested a Tailored Interactive Multimedia Intervention, newsletter, an action plan, and supplemental print materials for patients. We also developed a patient mediated provider prompt to increase provider recommendation and improve patient provider communication. The use of IM for systematic planning produced a detailed coherent plan for the CRCS educational intervention. Guided by IM processes, steps, and tasks, we used community level information, existing literature, theory, and new data to develop health education materials that were well received by the priority population and will likely increase CRCS among FQHC patients in PR.

Colorectal Cancer Screening: Knowledge, Perceived Benefits and Barriers, and Intentions Among College and University Employees

Background: Early detection through routine screening is critical in reducing the incidence rate of colorectal cancer (CRC). Purpose: The purpose of this study was to examine college and university employees' knowledge of CRC issues, their perceptions of the benefits of and barriers to CRC screening, and their intentions toward it. Methods: This study surveyed a targeted sample of 350 employees aged 45 and older and examined their knowledge of CRC issues and screening, their screening status, and group differences in perceptions about screening and in their intentions toward it. Results: Less than half of the participants answered correctly about CRC being one of the leading causes of cancer. The top perceived barriers were “fears,” followed by “doctor never recommended” and “preparation for the test is difficult.” A discriminant analysis revealed that individuals who had not been screened and those who did not intend to get screened perceived significantly more barriers. Discussion: Perceptions about screening appear to be a major determinant in CRC screening, regardless of knowledge. Translation to Health Education Practice: Further study using a representative sample of university employees may provide a clearer picture of the determinants of CRC screening so that specific health education interventions can be planned.

Abstract B84: Determinants of colorectal cancer screening in three Asian communities.

Abstract Objectives: While cancer screening has been shown to be effective in detecting cancer at early stages and reducing mortality, Asian-Americans are the least likely racial/ethnic group to obtain cancer screening tests. The purpose of this study is to describe colorectal cancer screening (CRS) by sigmoidoscopy or a colonoscopy across three different Asian communities (Chinese, Cambodian and Vietnamese) in Chicago. Specially, we examined determinants, such as health insurance coverage, regular facility for health care, understanding health information given by health providers, years in the U.S. and age, on CRS behavior. Methods: This was a cross-sectional study, using data collected from the Chicago Asian Community Survey (CACS). Participants were recruited from three Asian communities - Chinese, Cambodian and Vietnamese. CACS consisted of face-to-face interviews. With a three-stage random sampling of the Chinese community and Respondent Driven Sampling (RDS) of the Cambodian and Vietnamese communities, 383 Chinese, 250 Vietnamese, and 150 Cambodian community members were interviewed using cultural and language- specific survey guidelines. The survey questionnaire was developed from several validated national health surveys, including the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS), National Health and Nutrition Examination Survey (NHANES), and the National Health Interview Survey (NHIS). Results: A total of 783 participants completed the survey; 465 were aged 50 or older. The proportion of adults aged 50 or older who reported ever having a sigmoidoscopy or a colonoscopy was 27% Chinese, 36% Cambodian, and 31% Vietnamese. Overall, 83%, 91%, and 83% of Chinese, Cambodian, and Vietnamese, respectively, reported they had health insurance and nearly 86% were covered by either Medicare or Medicaid, or both. In addition, 89%, 84%% and 96% of Chinese, Cambodian and Vietnamese respectively, reported they had a regular health care facility. The majority of Chinese and Vietnamese, 84% and 87% respectively, reported they usually understood information given by their health providers. For Cambodian, only 44% reported they usually understood information given by their health providers and this subgroup was less likely to be screened before (p < .004). Vietnamese who were older (p = .037) and Chinese who were in the U.S. longer (p < .0005) were more likely to report having a sigmoidoscopy or a colonoscopy before. Conclusion: Despite access to care (health insurance and regular facility for health care), CRS rates were extremely low among these Asian communities. For Cambodians, understanding information given by health providers was negatively associated with having a sigmoidoscopy or a colonoscopy before. Older Vietnamese were more likely to report having a sigmoidoscopy or a colonoscopy before, as were Chinese who were in the U.S. longer. Citation Format: Karen Kim, Helen Vallina, Edwin Chandrasekar. Determinants of colorectal cancer screening in three Asian communities. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B84.

The influence of physicians on colorectal cancer screening behavior

Our aims were to determine clinical factors associated with colorectal cancer (CRC) screening and to evaluate the relative role of patient contact with physicians and the quality of these patient-physician interactions in affecting screening. Screening-eligible patients were identified from the Health Information National Trends Survey. Determinants of CRC screening were assessed with logistic regression, and a joint effects model that considered the frequency and quality of contact with physicians was developed to explore their influence on screening. There were 4,615 respondents of whom only 66% reported receiving CRC screening. Older age, personal history of non-CRC, family history of any cancer, high-income earners, individuals who visited their physicians ≥5 times per year, and those who rated the interactions with their physicians highly were more likely to be screened (all p<0.05). The joint effects model revealed that quality rather than frequency of physician contact was a stronger predictor of CRC screening, but the odds of screening was highest for those who experienced both frequent and high-quality interactions with their physicians. Contact with physicians and the quality of this interaction are associated with screening behavior. Interventions to improve these provider-related factors may promote CRC screening.

Individual-level factors in colorectal cancer screening: a review of the literature on the relation of individual-level health behavior constructs and screening behavior.

Compliance with colorectal cancer screening recommendations requires considerable conscious effort on the part of the individual patient, making an individual's decisions about engagement in screening an important contributor to compliance or noncompliance. The objective of this paper was to examine the effectiveness of individual-level behavior theories and their associated constructs in accounting for engagement in colorectal cancer screening behavior. We reviewed the literature examining constructs from formal models of individual-level health behavior as factors associated with compliance with screening for colorectal cancer. All published studies examining one or more constructs from the health belief model, theory of planned behavior, transtheoretical model, or social cognitive theory and their relation to screening behavior or behavioral intentions were included in the analysis. By and large, results of studies supported the theory-based predictions for the influence of constructs on cancer screening behavior. However, the evidence base for many of these relations, especially for models other than the health belief model, is quite limited. Suggestions are made for future research on individual-level determinants of colorectal cancer screening.

Determinants of Colorectal Cancer Screening in Primary Care

Colorectal cancer (CRC) is serious, yet a minority of US adults receive within-guideline screening exams. A random selection of patients attending clinics in 3 different settings completed a survey on CRC-related barriers, knowledge, and beliefs. Participants with fewer barriers, better knowledge, and more positive beliefs toward screening were significantly more likely to be within screening guidelines. A physician's screening recommendation was significantly related to screening in patients < 65 years, but was not significant for older patients. Large-scale studies are needed. Results can be used to develop multifaceted, tailored education programs to improve CRC screening in primary care.

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.

Determinants of colorectal cancer screening in women undergoing mammography.

Women who participate in screening for breast cancer are more likely to participate in screening for colorectal cancer. We studied such a motivated group of women to identify predictors of, and barriers to, participation in colorectal cancer screening by endoscopy. We distributed surveys to 551 women > or = 50 yr of age while they were awaiting mammography at four sites in and around Boston, MA from June to September, 2000. The 40-question survey assessed knowledge, attitudes, and beliefs about, and behaviors toward, breast and colorectal cancer screening. Regression models were used to determine factors associated with having had sigmoidoscopy or colonoscopy. Seventy-nine percent of the women completed all or part of the survey. Half (221/438) reported ever having had sigmoidoscopy or colonoscopy. Of these, 93% did so at the recommendation of their primary care provider. Factors associated with participation in endoscopic screening included compliance with annual fecal occult blood testing, a family history of colorectal cancer, and indifference toward the gender of the doctor performing the endoscopy. Women undergoing mammography overwhelmingly cite the recommendation of their primary care provider as the reason for participating in colorectal cancer screening by endoscopy. Women who preferred a female endoscopist were less likely to have been screened. Whenever possible, primary care providers should offer women the choice of a female endoscopist for colorectal cancer screening.

Determinants of colorectal cancer screening in women undergoing mammography

Objectives Women who participate in screening for breast cancer are more likely to participate in screening for colorectal cancer. We studied such a motivated group of women to identify predictors of, and barriers to, participation in colorectal cancer screening by endoscopy. Methods We distributed surveys to 551 women ≥ 50 yr of age while they were awaiting mammography at four sites in and around Boston, MA from June to September, 2000. The 40-question survey assessed knowledge, attitudes, and beliefs about, and behaviors toward, breast and colorectal cancer screening. Regression models were used to determine factors associated with having had sigmoidoscopy or colonoscopy. Results Seventy-nine percent of the women completed all or part of the survey. Half (221/438) reported ever having had sigmoidoscopy or colonoscopy. Of these, 93% did so at the recommendation of their primary care provider. Factors associated with participation in endoscopic screening included compliance with annual fecal occult blood testing, a family history of colorectal cancer, and indifference toward the gender of the doctor performing the endoscopy. Conclusions Women undergoing mammography overwhelmingly cite the recommendation of their primary care provider as the reason for participating in colorectal cancer screening by endoscopy. Women who preferred a female endoscopist were less likely to have been screened. Whenever possible, primary care providers should offer women the choice of a female endoscopist for colorectal cancer screening.