Obstacles to Colorectal Cancer Screening in Chinese: A Study Based on the Health Belief Model

Abstract

CRC testing compliance among this Asian population is low. Knowledge of CRC symptoms and risk factors are low. Perceived health, psychological, and access barriers to CRC testing are high. The physician's recommendation and having health insurance coverage significantly increase testing, but physicians mainly recommend patients with a family history of CRC for testing, and only around one-third of the population has health insurance.

Knowledge and perception toward colorectal cancer screening in east of Iran

“…As mentioned in prior studies (2,10,13,26,33), we also realized that employment and higher income can be promoters to encourage average risk people to undergo screening and on the other hand, low socio-economic condition specially in rural areas can be a barrier in this regard. Unlike other studies that reported absence of health insurance as a threat, we did not find any correlation between health insurance and participation in screening which can be due to lack of enough coverage for the expensive screening tests by the insurance organizations in Iran (2,11,15,26,31). Although positive family history of CRC did not increase the knowledge of our population about CRC symptoms and risk factors, it could raise their awareness of screening tests that was consistent with findings in previous studies (10,15,26).…”

“…The prevalence of Colorectal Cancer (CRC) in Asia is high and the number of new cases is rapidly increasing in both genders (1)(2)(3). In Iran, CRC is the third most common cancer in women and fifth in men and is known as the fifth cause of cancer death (4).…”

“…According to American Cancer Society, the US Multi-Society Task Force on CRC and the American College of Radiology guidelines, screening of adenomatous polyps and CRC in average-risk adults should begin at age 50 years with one of the following options: 1) annual guaiac Fecal Occult Blood Test (gFOBT) or Fecal Immunochemical Test (FIT) or testing stool for exfoliated cell DNA, 2) flexible sigmoidoscopy every 5 years; 3) colonoscopy every 10 years, 4) double-contrast barium enema every 5 years, or 5) CT colonography every 5 years (7-10). Previously, several published researches from various countries with different races and cultures have reported patient barriers to CRC screening as health illiteracy and lack of knowledge, negative attitudes about prevention and cancer, financial concerns and lack of physician's recommendation for screening tests (2,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Also, in a study by Beydoun and Beydoun in US, predictors of CRC screening behaviors among average-risk older adults included older age, male gender, marriage, higher education, higher income, white race, non-Hispanic ethnicity, smoking history, presence of chronic diseases, family history of CRC, usual source of care, physician recommendation, utilization of other preventive health services, and health insurance coverage (26).…”

Colorectal Cancer Mortality Characteristics and Predictions in China, 1991-2011

“…Colorectal cancer has regional features similar to pancreatic cancers (Wang et al, 2003). Dietary and smoking factors are common risk factors to both cancers and may be relevant to the similarly increased trends of colorectal and pancreatic cancers (Jin et al, 1993;Sung et al, 2008).…”

Challenges to the adoption of risk algorithms for colorectal cancer screening programmes: perspectives for future research

“…24 Individuals at high risk of CRC who are targeted for screening should have their attitude and perception identified in a systematic manner under a theoretical framework, such as the health belief model. 25 Lastly, cost-effectiveness analysis of competing screening strategies in different patient groups should be performed in different settings. This warrants further research funding, particularly in population groups at high risk of CRC, including patients with medical conditions such as non-alcoholic fatty liver disease, diabetes, and metabolic syndrome.…”