Effectiveness of the extended parallel process model in promoting colorectal cancer screening

Abstract

Objective: Relatives of colorectal cancer (CRC) patients are at increased risk for the disease, yet screening rates still remain low. Guided by the Extended Parallel Process Model, we examined the impact of a personalized, remote risk communication intervention on behavioral intention and colonoscopy uptake in relatives of CRC patients, assessing the original additive model and an alternative model in which each theoretical construct contributes uniquely.Methods: We collected intention-to-screen and medical record-verified colonoscopy information on 218 individuals who received the personalized intervention.Results: Structural equation modeling showed poor main model fit (root mean square error of approximation (RMSEA) = 0.109; standardized root mean residual (SRMR) = 0.134; comparative fit index (CFI) = 0.797; Akaike information criterion (AIC) = 11,601; Bayesian information criterion (BIC) = 11,884). However, the alternative model (RMSEA = 0.070; SRMR = 0.105; CFI = 0.918; AIC = 11,186; BIC = 11,498) showed good fit. Cancer susceptibility (B = 0.319, p < 0.001) and colonoscopy self-efficacy (B = 0.364, p < 0.001) perceptions predicted intention to screen, which was significantly associated with colonoscopy uptake (B = 0.539, p < 0.001).Conclusions: Our findings provide support of the utility of Extended Parallel Process Model for designing effective interventions to motivate CRC screening in persons at increased risk when individual elements of the model are considered. Copyright © 2015 John Wiley & Sons, Ltd. Average lifetime risk for developing colorectal cancer (CRC) is approximately 5%; having a first-degree relative (FDR) with CRC increases risk twofold to eightfold [1,2]. Colonoscopy has the potential to reduce both CRC incidence and mortality through early detection and removal of precancerous polyps. The American Cancer Society and the National Comprehensive Cancer Network recommend individuals with an intermediate risk of familial CRC (i.e., CRC diagnosis in an FDR <age 60 years or two or more FDR or second-degree relatives with CRC) to begin CRC screening at age 40 years or 10 years earlier than the youngest age at diagnosis in the family, whichever comes first [3,4], and to repeat screening every 3-5 years. Because colonoscopy is effective at cancer prevention through early detection and removal of polyps, it is the standard of care for most individuals considered to be at an increased familial risk [5].Colorectal cancer incidence and mortality rates have been declining in the USA since the mid-1980s, largely attributed to the increase in detection and removal of precancerous polyps through colonoscopy [6], yet screening rates among relatives of CRC patients remain low [7]. Less than half of individuals at increased familial risk are up-to-date with colonoscopy [8]. Low adherence to Psycho-Oncology 24: 1265-1278(2015 Published online 20 July 2015 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3899 screening recommendations may be related to lack of a clear understand...

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“…This result does not support the finding from Birmingham et al (2015) whose results indicated that motivation to screen was significantly associated with colonoscopy uptake. However, the result from the current study is similar to previous research which has suggested that people with positive intentions often fail to actually perform the behaviour (Webb & Sheeran, 2006).…”

“…Guided by the EPPM, Birmingham et al (2015) examined the impact of a personalised, remote risk communication intervention on behavioural intention and colonoscopy uptake in relatives of CRC patients, assessing the original additive EPPM model and an alternative model in which each theoretical construct contributed uniquely. The intervention involved participants receiving tailored print materials and a cancer risk assessment and counselling telephone call by a genetic counsellor.…”

“…If the perceived threat is determined to be low, the individual is unlikely to process the message further. However, if the perceived threat is high, the individual will enter the efficacy appraisal stage to evaluate response efficacy and self-efficacy (Birmingham et al, 2015). In response, efficacy of the individual assesses how effective the recommended behaviour will be in averting the threat.…”

“…This process is likely to lead to maladaptive responses such as defensive avoidance (e.g., 'I'm not going to think about that!') (Birmingham et al, 2015;Grasso & Bell, 2015).…”

“…Personalised interventions in which the message is based on an individual's beliefs about a disease, personal risk factors, and knowledge of the effectiveness of screening for a particular disease may be viewed as more salient and lead to the desired behaviour (Birmingham et al, 2015;Noar, Benac, & Harris, 2007).…”