Beliefs Associated With Fecal Occult Blood Test and Colonoscopy Use at a Worksite Colon Cancer Screening Program

Abstract

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Although regular screening can decrease morbidity and mortality from CRC, screening rates nationwide are very low. This descriptive study assessed beliefs associated with fecal occult blood test and colonoscopy use among participants of a worksite colon cancer screening program. Randomly selected employees, aged 40 and older, were mailed a survey on CRC screening-related beliefs. Instruments were tested for reliability and validity. Results indicated that fecal occult blood test use was significantly associated with being female, Caucasian, having low perceived barriers, and provider recommendation. Colonoscopy use was significantly associated with higher knowledge, lower barriers, higher benefits, higher self-efficacy, and provider recommendation. Findings may be used to develop interventions designed to improve CRC screening rates.In recent years, colorectal cancer (CRC) has been recognized as a significant health problem. It is the second leading cause of cancer death in the United States and until recently, largely ignored. Although there has been a decreasing trend in mortality from CRC, over 56,000 deaths are estimated in 2003. 1 In addition, the American Cancer Society (ACS) estimates that over 147,500 new cases of CRC will be diagnosed in 2003. 1 Early detection and removal of polyps can lead to decreased mortality as well as decreased morbidity from the disease. 2 Survival from CRC is inversely related to stage of diagnosis. Those diagnosed with localized disease have higher 5-year survival rates: 90% for colon cancer and 80% for rectal cancer. 3 Polyps are precursors to CRC, taking about 7 to 12 years to progress to cancer. 4,5 Despite the promising prognosis for early-stage diagnosis, only about 37% of CRC is diagnosed at an early stage. 6 Inadequate use of screening tests is a major contributing factor to CRC mortality. Because there is enough evidence to support the use of regular screening to aid in early detection, the National Cancer Institute and ACS are among the major organizations calling for more research into ways to increase early detection. 7,8 Women were slightly less likely to have had an FOBT than men (34% versus 36%); women were, however, much less likely to have had a sigmoidoscopy (33% versus 43%). 10 These rates are well below the Healthy People 2010 goals to achieve screening rates of at least 50% for both screening behaviors. 11 It is also important to remember that these screening rates were collected through self-report. There is some evidence in the literature that selfreport for CRC screening overestimates actual use when compared with medical record data. 12,13 Therefore, CRC screening rates may be even lower than reported.A more recent study assessing the correlates of CRC screening reported that under use of CRC screening tests was highest among those aged 50 to 64 years, those with lower education, and lack of health insurance and preventive services. 14 Such findings unders...

Does Health Insurance Coverage of Office Visits Influence Colorectal Cancer Testing?

“…This finding is consistent with a prior study which showed that the use of cancer screening services among women in this same population was lower due to differences in health insurance coverage for office visits (16). Potential barriers to CRC screening may include low consumer acceptance and beliefs, low provider recommendations, poor provider reimbursement, and lack of provider skill (3,21,22). Our study suggests another barrier to CRC screening: office visit cost-sharing.…”

Factorial Validity and Invariance of a Survey Measuring Psychosocial Correlates of Colorectal Cancer Screening among African Americans and Caucasians

“…Four items were included that addressed two key references-family and doctor or health professional. For the current study, we substituted health professional for friends [used in the Vernon et al study (26)] as a key referent because several studies have shown physician recommendation to be one of the most important predictors of colorectal cancer screening adherence (13,18,22,24,(46)(47)(48)(49)(50)(51)(52)(53)(54) and because we wanted to show that the influence of the family and health professional forms one factor as hypothesized by Ajzen and Fishbein (42,55) and Cialdini and Trost (56).…”

Cross-cultural Validation of Instruments Measuring Health Beliefs about Colorectal Cancer Screening among Korean Americans

“…The reliability and validity of belief scales used in this study had previously been established [13,14]; hence, few changes in the scales were needed for Korean cultural appropriateness. These findings are consistent with scale development and modification guidelines [8], which indicate that scale adaptation and modification rather than scale development are appropriate if constructs or item contents overlap but are slightly different.…”

“…Health belief scales used to measure susceptibility, benefits, barriers, and self-efficacy in the present study were adapted from Menon et al [13] after obtaining permission from the author. These scales have demonstrated good reliability, with Cronbach's alpha above .70.…”

“…The primary investigator (PI) drafted initial items for the health belief scales from existing instruments [13,14] and conducted a thorough literature review on Korean culture and cancer screening behaviors. Items were added to the scales in English based on previous studies [6,9].…”