Document Type : Original Article
Authors
- . Seyed Homamodin Javadzade
- . Firoozeh Mostafavi 1
- . Akbar Hasanzade 2
- . Mahnoosh Reisi
- . Hossein Shahnazi
- . Gholamreza Sharifirad
1 Departments of Health Education and Promotion
2 Biostatistics and Epidemiology, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Colorectal cancer is one of the most important and most common cancers and the
second leading cause of cancer deaths worldwide.Every year, nearly 1million new cases of colorectal
cancer are recognized around the world and nearly half of them lose their lives due to the disease.The
statistics reveal shocking incidence and mortality from colorectal cancer, therefore secondary
prevention of this cancer is important and research has shown that by early diagnosis 90% of patients
can be treated.Among the colorectal cancer screening tests, fecal occult blood test(FOBT)takes the
priority because of its convenience and also low cost. But due to various reasons, the participation of
people in this screening test is low. The goal of this study is to assess the factors that affect participation
of population at average risk in colorectal cancer screening programs, based on health belief model
structures. Materials and Methods: A cross‑sectional survey of 196 individuals, more than 50 years
old, was conducted in Isfahan. Ninety‑eight people of the target group were selected from laboratories
while they came there for doing FOBT test; the method of sampling in this group was random sampling.
The method of data collection in the other 98 individuals was by home interview and they were selected
by cluster sampling. The questionnaire used was based on health belief model to assess the factors
associated with performing FOBT. The data collected were analyzed using descriptive and inferential
statistical methods. Results: The mean score of knowledge in the first group was 48/5 ± 11/7 and in
the second group was 36/5 ± 19/3. Individuals in the first group were more likely to be married, had
more years of schooling, and better financial status. There were significant relationships between
knowledge (P<0.001), perceived susceptibility (P<0.001), perceived severity (P<0.001), perceived
barriers (P<0.001), and self‑efficacy (P<0.001) in the two groups. There was no significant association
between the perceived benefits in the two groups. Those people who have had FOBT test in last
year in each group reported better score of Health Belief Model model structures. Conclusion:
According to this study, it seems that there is an urgent need to pay more attention to this disease
and its prevention through screening. With a better understanding of factors affecting the test, it can
be a useful step to reduce the rate of death and costs, and improve the community health outcomes.
Keywords
- Available from: http://www.who.int/mediacentre/news/releases/
2005/pr_wha05/en, [Last accessed on 2005].
2. Boyle P, Langman J S. ABC of colorectal cancer: Epidemiology.
BMJ 2000;321:805‑8.
3. Available from: http://www.who.int/mediacentre/factsheets/fs297/
en, [Last accessed on 2006].
4. Chu KC, Tarone RE, Chow WH. Temporal pattern in colorectal cancer
incidence, survival and mortality. JNCI 1994;86:997.
5. Stone WL, Krishnan K, Campbell SE, Qui M, Whaley SG, Yang H,
et al. Tocopherols and the treatment of colon cancer. Ann NY Acad
Sci 2004;1031:223‑33.
6. Favsy AS, Brvnvald S, Kasper DL, Havsr SS. Harrison Principles of
Internal Medicine. S Khalvat, M. S. Montazeri, translators. 15th ed.
Tehran: Arjomand Publication; 1380.
7. James AS, Campbell MK, Hudson MA. Perceived barriers and
benefits to colon cancer screening among African Americans in
North Carolina: How does perception relate to screening behavior?
Cancer Epidemiol Biomarkers Prev 2002;11:529‑34.
8. Alizade M. The age‑adjusted rates of cancer in Fars province cancer
registry. Thesis, Shiraz University of Medical Sciences, School of
Health, 2000.
9. Sadjadi A, Nouraie M, Mohagheghi MA, Mousavi‑Jarrahi A,
Malekzadeh R, Parkin DM. Cancer Occurrence in Iran in 2002, an
International perspective. Asian Pac J Cancer Prev 2005;6:359‑63.
10. Mehdi khabazkhoob, Mohammad Ali Mohagheghi, Alireza Mosavi
Jarrahi, Ali Javaher Foroushzadeh, Mohsen Pedram Far, Ali Moradi,
et al. Incidence rate of gastrointestinal tract cancers in Tehran – Iran
(1998-2001). Journal of Gorgan University of Medical Sciences.
2010;11(4):44-50.
11. Fyps VJ, Sandoz KJ, Mark FJ. Gastroenterologists. Nursing‑Surgery.
Namavar H, L front, translators . 6th ed. Tehran: Chehr publication;
1379.
12. Masner J, Kramer S. Introduction to Epidemiology. Janghorbani M,
Translator. 2nd ed. Kerman: Kerman Farhangi Publications; 1997.
13. American Cancer Society. Cancer Facts and Figures, 2000, American
Cancer Society Atlanta 2000.
14. Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, SternergSS,
et al. Prevention of colorectal cancer by colonoscopic polypectomy.
The National Polyp Study Workgroup. N Engl J Med 1993;329:1977‑81.
15. Bandi P, Brooks D, Calle J, Cokkinides V, et al. Colorectal Cancer
Facts and Figures 2008‑2010.
16. Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ,
et al. The effect of fecal occult‑blood screening on the incidence of
colorectal cancer. N Engl J Med 2000;343:1603‑7.
17. Brouse CH, Basch CE, Wolf RL, Shmukler C, Neugut AI, Shea S.
Barriers to colorectal cancer screening with fecal occult blood
testing in a predominately minority urban population: A qualitive
study. Am J Public Health 2003;93:1268‑71.
18. Saito H, Soma Y, Koeda J, Wada T, Kawaguchi H, Sobue T, et al.
Reduction in risk of mortality from colorectal cancer by fecal occult
blood screening with immunochemical hemagglutination test.
A case‑control study. Int J Cancer 1995;61:465‑9.
19. Shafayan B, Keyhani M. Epidemiological evaluation of colorectal
cancer. Acta Med Iran 2003;41:156‑60.
20. Satia JA, Galanko JA. Demographic, behavioral, psychosocial, and
dietary correlates of cancer screening in African Americans. J Health
Care Poor Underserved 2007;18(4 Suppl):146‑64.
21. Meissner HI, Yabroff R, Dodd KW, Leader AE, Ballard‑Barbash R,
Berrigan D. Are patterns of health behavior associated with cancer
screening? Am J Health Promot 2009;23:168‑75.
22. Sheffet AM, Ridlen S, Louria DB. Baseline behavioral assessment
for the New Jersey health Wellness Promotion Act. Am J Health
Promot 2006;20:401‑10.
23. Shokar NK, Carlson CA, Weller SC. Factors Associated with
racial/ethnic differences in colorectal cancer screening. J Am Board
Fam Med 2008;21:414‑26.
24. Grenier KA, James AS, Born W, Hall S, Engelman KK, Okuyemi KS,
et al. Predictors of fecal occult blood test (FOBT) completion among
low‑income adults. Prev Med 2005;41:676‑84.
25. Patel P, Forjuoh SN, Avots‑Avotins A, Patel T. Identifying
opportunities for improved colorectal cancer screening in primary
care. Prev Med 2004;39:239‑46.
26. Weinberg DS, Turner BJ, Wang H, Myers RE, Miller S. A survey
of women regarding factors affecting colorectal cancer screening
compliance. Prev Med 2004;38:669‑75.
27. Chen C, Basch CE, Yamada T. An evaluation of colonoscopy use:
implications for health education. J Cancer Educ 2010;25:160‑5.
28. Griffith KA. Biological, psychological and behavioral, and social
variables influencing colorectal cancer screening in African
Americans. Nurs Res 2009;58:312‑20.
29. Ananthakrishnan AN, Schellhase KG, Sparapani RA, Laud PW,
Neuner JM. Disparities in colon cancer screening in the medicare
population. Arch Intern Med 2007;167:258‑64.
30. McGregor SE, Hilsden RJ, Li FX, Bryant HE, Murray A. Low
uptake of colorectal cancer screening 3 yr after release of
national recommendations for screening. Am J Gastroenterol
2007;102:1727‑35.
31. Singh SM, Paszat LF, Li C, He J, Vinden C, Rabeneck L. Association of
socioeconomic status and receipt of colorectal cancer investigations:
A population based retrospective cohort study. CMAJ 2004;171:461‑5.
32. Glenn BA, Chawla N, Surani Z, Bastani R. Rates and sociodemographic
correlates of cancer screening among South Asians. J Community
Health 2009;34:113‑21.
33. Gorin SS, Heck JE. Cancer screening among latino subgroups in
the United States. Prev Med 2005;40:515‑26.
34. Brennenstuhl S, Fuller‑Thomson E, Popova S. Prevalence and
factors associated with colorectal cancer screening in Canadian
women. J Womens Health (Larchmt) 2010;19:775‑84. - 35. Janz NK, Wren PA, Schottenfeld D, Guire KE. Colorectal cancer
screening attitudes and behavior: A population‑based study. Prev
Med 2003;37:627‑34.
36. Gwede CK, William CM, Thomas KB, Tarver WL, Quinn GP,
Vadaparampil ST, et al. Exploring disparities and variability
in perceptions and self‑reported colorectal cancer screening
among three ethnic subgroups of U. S. Blacks. Oncol Nurs Forum
2010;37:581‑91.
37. Tseng TS, Holt CL, Shipp M, Eloubeidi M, Britt K, Norena M, et al.
Predictors of colorectal cancer knowledge and screening among
church‑attending African Americans and Whites in the Deep South.
J Community Health 2009;34:90‑7.
38. Green PM, Kelly BA. Colorectal cancer knowledge, perceptions,
and behaviors in African Americans. Cancer Nurs 2004;27:206‑15;
quiz 216‑7.
39. Wee CC, McCarthy EP, Phillips RS. Factors associated with colon
cancer screening: The role of patient factors and physician
counseling. Prev Med 2005;41:23‑9.
40. Whynes DK, Frew EJ, Manghan CM, Scholefield JH, Hardcastle JD.
Colorectal cancer, screening and survival: The influence of
socio‑economic deprivation. Public Health 2003;117:389‑95.
41. James AS, Hall S, Greiner KA, Buckles D, Born WK, Ahluwalia JS.
The impact of socioeconomic status on perceived barriers to
colorectal cancer testing. Am J Health Promot 2008;23:97‑100.
42. Bazargan M, Ani C, Bazargan‑Hejazi S, Baker RS, Bastani R.
Colorectal cancer screening among underserved minority
population: Discrepancy between physicians’ recommended,
scheduled, and completed tests. Patient Educ Couns 2009;76:240‑7.
43. O’Malley AS, Beaton E, Yabroff KR, Abramson R, Mandelblatt J.
Patient and provider barriers to colorectal cancer screening in the
primary care safety‑net. Prev Med 2004;39:56‑63.
44. Buki LP, Jamison J, Anderson CJ, Cuadra AM. Differences in
predictors of cervical and breast cancer screening by screening
need in uninsured Latina Women. Cancer 2007;110:1578‑85.
45. Busch S. Elderly African American Women’s knowledge and belief
about colorectal cancer. ABNF J 2003;14:99‑103.
46. Stacy R, Torrence WA, Mitchell CR. Perceptions of knowledge,
beliefs, and barriers to colorectal cancer screening. J Cancer Educ
2008;23:238‑40.
47. Menon U, Champion VL, Larkin GN, Zollinger TW, Gerde PM,
Vernon SW. Beliefs associated with fecal occult blood test and
colonoscopy use at a worksite colon cancer screening program.
J Occup Environ Med 2003;45:891‑8.
48. Lawsin C, DuHamel K, Weiss A, Rakowski W, Jandorf L. Colorectal
cancer screening among Low‑Income African Americans in East
Harlem: A theoretical approach to understanding barriers and
promoters to screening. J Urban Health 2007;84:32‑44.
49. Ruffin MT 4th, Creswell JW, Jimbo M, Fetters MD. Factors influencing
choices for colorectal cancer screening among previously unscreened
African and Caucasian Americans: Findings from a triangulation
mixed methods investigation. J Community Health 2009;34:79‑89.
50. Nguyen BH, McPhee SJ, Stewart SL, Doan HT. Colorectal cancer
screening in Vietnamese Americans. J Cancer Educ 2008;23:37‑45.
51. Powe BD, Cooper DL, Harmond L, Ross L, Mercado FE,
Faulkenberry R. Comparing knowledge of colorectal and prostate
cancer among African American and Hispanic Men. Cancer Nurs
2009;32:412‑7.
52. Dassow P. Setting educational priorities for women’s preventive
health: Measuring beliefs about screening across disease states.
J Women’s Health 2005;14:324‑30.
53. Sun WY, Basch CE, Wolf RL, Li XJ. Factors associated with
colorectal cancer screening among Chinese‑Americans. Prev Med
2004;39:323‑9.
54. Friedemann‑Sánchez G, Griffin JM, Partin MR. Gender differences in
colorectal cancer screening barriers and information needs. Health
Expect 2007;10:148‑60.
55. Henry KA, Sherman R, Roche LM. Colorectal cancer stage at
diagnosis and area socioeconomic characteristics in New Jersey.
Health Place 2009;15:505‑13.
56. Farmer MM, Bastani R, Kwan L, Belman M, Ganz PA. Predictors of
colorectal cancer screening from patients enrolled in a managed
care health plan. Cancer 2008;112:1230‑8.
57. Shokar NK, Carlson CA, Shokar GS. Physician and patient influences
on the rate of colorectal cancer screening in a primary care clinic.
J Cancer Educ 2006;21:84‑8.
58. Von Wanger C, Semmler C, Good A, Wardle J. Health Literacy
and self‑efficacy for participating in colorectal cancer screening:
The role of information processing. Patient Educ Couns 2009;
75:352‑7.
59. Post DM, Katz ML, Tatum C, Dickinson SL, Lemeshow S, Paskett ED.
Determinants of colorectal cancer screening in primary care J
Cancer Educ 2008;23:241‑7.
)