Factors Associated with Adherence to Colorectal Cancer Screening among Moderate Risk Individuals in Iran

Abstract

in health-screening programs. If attitudes related to health behavior can be identified, health protection interventions for attitude change can be developed, and an increase in desirable health behavior would result (Champion 1984). The HBM is composed of six concepts: 1) perceived susceptibility (a person's opinion regarding the chances of developing a condition). 2) Perceived Severity (one's belief regarding the seriousness of a condition), 3) barriers (one's beliefs regarding the total barrier costs of implementing the recommended action), 4) benefits (the opinion of the effectiveness of actions to reduce the risks of a condition), 5) health motivation related to performing the health behaviors, 6) self efficacy (one's beliefs about their capabilities to take the recommended action) (Ueland et al., 2006). The HBM-based research studies have determined these components of HBM as correlates of cancer prevention and screening behaviors (Janz et al., 2003;Palmer et al., 2007; McFarland 2013; Ebu et al., 2015). 8372Various studies have sought to identify psychosocial factors associated with participation in CRC screening (Gili et al., 2006; Cole et al., 2011; Gonzalez et al., 2012; Jorgensen et al., 2013). But few studies have examined beliefs and behaviours related to CRC screening in Iranian population. A previous study about beliefs associated with CRC screening in an Iranian adult population based on preventive health model, showed that subjects mostly reported poor attitude about CRC screening (Salimzadeh et al., 2011). Javadzadeh et al found a significant relationships between knowledge and all domains of HBM excepting perceived benefits among individuals more than 50 years old (Javadzade et al., 2012).It is necessary to identify the factors associated with colorectal cancer screening adherence to increase this adherence (Gimeno García, 2011). As well, since adherence to CRC screening could be influenced by culture (Wang et al., 2006), identifying these factors in different cultures is useful to better understanding of people's beliefs which assist us in developing ways to increase use of CRC screening procedure (Brennenstuhl et al., ). Also effective cancer screening programs depends on accurate assessing patients' needs and designing helpful educational strategies. The purpose of this study was to determine the predictive factors of CRC screening adherence among Iranians aged 50 and older based on the HBM. Materials and Methods Design and participantsThis cross sectional study has been performed in June 2012 to May 2013 in Qom City, a provincial city in the central region of Iran. A convenience sample of 200 individuals aged 50 and older was recruited from population at outpatient clinics in three teaching hospitals. The inclusion criteria were being 50 years or older, not having had CRC and ability to communicate in Persian language. Verbal informed consent was obtained from the participants after the purpose of the study was explained to them. The questionnaire's items were read for those individual...

The health belief model and colorectal cancer screening in the general population: A systematic review

“…al., 2013 and Champion et. al., 2014 Sociodemographics HBM constructs (Perceived severity, perceived susceptibility, perceived barriers, perceived benefits) Fear of CRC Past CRC screening behaviour Perceived barriers negatively associated with past CRC screening ( Sohler et al, 2015 ) USA 1101 50–75 (Mean age 57 years) 112 Hispanic, 67 Black, 60 Non-hispanic White, 11 Other Cross-sectional Convenience sampling from primary care clinics in four states; study comprised baseline measure for CRC screening RCT 13-item Instrument based on EHBM Sociodemographics Knowledge of CRC risk factors and screening HBM constructs (Perceived barriers, cues to action, self-efficacy) CRC screening uptake (at 12-month follow-up in RCT) Cues to action and self-efficacy positively associated with CRC screening uptake (colonoscopy only) ( Taheri-Kharameh et al, 2016 ) Iran 200 50 and above (Mean age 62 years) 200 Iranians Cross-sectional Convenience sampling from outpatient clinics in three teaching hospitals 36-item Champion's Health Belief Model Scale using a 5-point Likert scale Sociodemographics Family history of CRC Knowledge of CRC and screening HBM constructs (Perceived severity, perceived susceptibility, perceived barriers, perceived benefits) Health motivation Past CRC screening behaviour Knowledge of CRC and screening positively associated with past CRC screening Perceived barriers negatively associated with past CRC screening ( Taş et al, 2019 ) Turkey 235 50–70 (Mean age 59 years) 235 Turks Cross-sectional Convenience sampling from one family health center 33-item instrument based on Health Belief Model Scale for Protection from Colorectal Cancer, evaluated in Tureky by Ozsoy et. al., 2007, using a 5-point Likert scale Sociodemographics Family and personal history of CRC Knowledge of CRC risk factors, symptoms, screening HBM constructs (Perceived severity, perceived susceptibility, perceived barriers, perceived benefits) Health motivation Past CRC screening behaviour Knowledge of CRC screening positively associated with past CRC screening ( Tastan et al, 2013 ) Turkey 160 50 and above (Mean age 61 years) …”

“…Participants’ knowledge of colorectal cancer (e.g. risk factors, symptoms, screening modalities) was directly associated with screening intention or behaviour in six articles ( Almadi et al, 2015 , Khani Jeihooni et al, 2017 , Ng et al, 2007 , Koo et al, 2012 , Taheri-Kharameh et al, 2016 , Taş et al, 2019 ). The next most common modifying factors with a direct association were the age of the participant (in three articles) ( Azaiza and Cohen, 2008 , Janz et al, 2003 , Lee et al, 2019 ), and a family or personal history of colorectal cancer (in three articles) ( Azaiza and Cohen, 2008 , Ben Natan et al, 2019 , Wong et al, 2013 ).…”

Factors affecting compliance with confirmatory colonoscopy after a positive fecal immunochemical test in a national colorectal screening program

“…). This is a psychological model that attempts to explain and predict health behaviors and has been widely used in research related to CRC screening . The major components of this HBM included perceived susceptibility and severity (perceived threat), defined as belief about the chances of experiencing a risk or getting a condition or disease; perceived benefits, defined as belief in efficacy of the advised action to reduce risk or seriousness of impact; perceived barriers, defined as belief about the tangible and psychological costs of the advised action, and self‐efficacy, defined as confidence in one's ability to take action.…”

Black Americans’ Perspectives of Barriers and Facilitators of Community Screening for Kidney Disease

“…However, there is limited information specific to black Americans and their participation in kidney disease community screening. The Health Belief Model is a sociopsychologic theoretic framework that is widely and effectively used to explain health-seeking behavior influencing participation in screening tests (18)(19)(20). It posits that the motivation to undertake health behavior is informed by six critical elements of patients' health beliefs: perceived seriousness, perceived susceptibility, perceived barriers versus benefits, perceived threat, self-efficacy, and cues to action.…”