Document Type : Original Article

Authors

1 Department of Public Health, Asadabad School of Medical Sciences, Asadabad, Iran,

2 Department of Health Services and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran

3 Department of Public Health, Asadabad School of Medical Sciences, Asadabad, Iran

Abstract

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in men and the fourth
most common cancer in women in Iran. Therefore, the aim of this study was to determine the effect
of educational intervention based on the theory of planned behavior (TPB) on the improvement of
CRC screening intention among average‑risk individuals.
MATERIALS AND METHODS: This quasi‑experimental study was performed on the 50–69‑year‑old
individuals referred to Asadabad city clinics in 2020. The individuals were randomly assigned to
multistage cluster sampling in each intervention and control group. The instrument used in this
research was a researcher‑made questionnaire based on TPB. Educational intervention was
conducted for the intervention group, one of their family members, and staff of clinic under intervention.
Finally, the data were entered into SPSS and analyzed utilizing descriptive and analytical statistics.
Results were considered significantly <0.05.
RESULTS: There were no significant differences between two intervention and control groups in the
preintervention phase in terms of the mean scores of attitude (P = 0.58), subjective norms (P = 0.59),
and behavioral intention (P = 0.66). However, in the postintervention phase, these differences were
significant. Furthermore, regarding the mean score of perceived behavioral control, there was a
significant difference between the two groups in the preintervention phase (P < 0.02), while in the
postintervention phase, this difference was not significant (P = 0.29).
CONCLUSION: Educational intervention based on the TPB has been effective in improving the CRC
screening intention among average‑risk individuals. Therefore, using the results of this research
and developing appropriate educational programs at the community level can be increased the
participation of community members in CRC screening programs.

Keywords

1. Fleming M, Ravula S, Tatishchev SF, Wang HL. Colorectal
carcinoma: Pathologic aspects. J Gastrointest Oncol
2012;3:153‑73.
2. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A,
Bray F. Global patterns and trends in colorectal cancer incidence
and mortality. Gut 2017;66:683‑91.
3. Marley AR, Nan H. Epidemiology of colorectal cancer. Int J Mol
Epidemiol Genet 2016;7:105‑14.
4. Kolligs FT. Diagnostics and Epidemiology of Colorectal Cancer.
Visc Med 2016;32:158‑64.
5. Meza R, Jeon J, Renehan AG, Luebeck EG. Colorectal cancer
incidence trends in the United States and United kingdom:
Evidence of right‑ to left‑sided biological gradients with
implications for screening. Cancer Res 2010;70:5419‑29.
6. Zubero MB, Arana‑Arri E, Pijoan JI, Portillo I, Idigoras I,
López‑Urrutia A, et al. Population‑based colorectal cancer
screening: Comparison of two fecal occult blood test. Front
Pharmacol 2014;4:175.
7. Binefa G, Rodríguez‑Moranta F, Teule À, Medina‑Hayas M.
Colorectal cancer: From prevention to personalized medicine.
World J Gastroentero 2014;20:6786‑808.
8. Farhood B, Geraily G, Alizadeh A. Incidence and mortality of
various cancers in iran and compare to other countries: A review
article. Iran J Public Health 2018;47:309‑16.
9. Rafiemanesh H, Pakzad R, Abedi M, Kor Y, Moludi J, Towhidi F,
et al. Colorectal cancer in Iran: Epidemiology and morphology
trends. EXCLI J 2016;15:738‑44.
10. Javadzade SH, Reisi M, Mostafavi F, Hasanzade A, Shahnazi H,
Sharifirad G. Factors associated with the fecal occult blood testing
for colorectal cancer screening based on health belief model
structures in moderate risk individuals, Isfahan, 2011. J Educ
Health Promot 2012;1:18.
11. Javadzade M, Reisi M, Sharifirad GH, Mostafavi F, Tavassoli E.
Perceived barriers related to fecal occult blood test for colorectal
cancer screening in moderate risk individuals, Isfahan, Iran.
J Educ Health Promot 2014;3:1‑12.
12. Heiken JP. Screening for colon cancer. Cancer Imaging
2006;6:S13‑21.
13. Bresalier RS. Early detection of and screening for colorectal
neoplasia. Gut Liver 2009;3:69‑80.
14. Alavi Langroodi SM, Fallahzadeh H, Mostafavi F. The effect of
education based on health belief model on knowledge and attitude
of health care workers towards colon cancer screening in Yazd,
Iran. J Health Syst Res 2019;15:177‑83.
15. Shouri Bidgoli AR, Taheri Kharame Z, Asayesh H, Sharififard F,
Sheydaiyan Arani M, Hajaligol A, et al. Study of knowledge,
attitude, and practice on colorectal cancer screening among
individuals older than 50 years based on health belief model.
Qom Univ Med Sci J 2015;9:59‑65.
16. Ghodsi M, Maheri M, Joveini H, Rakhshani MH, Mehri A.
Designing and Evaluating Educational Intervention to Improve
Preventive Behavior Against Cutaneous Leishmaniasis in
Endemic Areas in Iran. Osong Public Health Res Perspect
2019;10:253‑62.
17. Glanz K, Bishop DB. The role of behavioral science theory in
development and implementation of public health interventions.
Annu Rev Public Health 2010;31:399‑418.
18. Baghianimoghadam MH, Ardakani MF, Akhoundi M,
Mortazavizadeh MR, Fallahzadeh MH, Baghianimoghadam B.
Effect of education on knowledge, attitude and behavioral
intention in family relative with colorectal cancer patients
based on theory of planned behavior. Asian Pac J Cancer Prev
2012;13:5995‑8.
19. Ajzen I. Consumer attitudes and behavior: The theory of planned
behavior applied to food consumption decisions. Ital Rev Agric
Econ 2015;70:121‑38.
20. Abuadas FH, Abuadas MH. An interventional study to improve
colorectal cancer screening knowledge and health perceptions
among Jordanians’ average risk population. Open Nurs J
2019;13:237‑48.
21. Mazloomy Mahmoodabad SS, Sadeghi R, Fallahzadeh H,
Rezaeian M, Bidaki R, Khanjani N. Validity and reliability
of the Preventing Hookah Smoking (PHS) questionnaire in
adolescents based on the protection motivation theory. Int J
Pediatr 2018;6:8327‑37.
22. Khani Jeihooni A, Darvishi N, Harsini PA. The effect of
educational intervention based on the theory of planned behavior
on mammography screening in Iranian Women. J Cancer Educ
2020;35:264‑73.
23. Sargazi M, Mohseni M, Safar‑Navade M, Iran‑Pour A, Mirzaee M,
Jahani Y. Effect of an educational intervention based on the theory
of planned behavior on behaviors leading to early diagnosis of
breast cancer among women referred to health care centers in
Zahedan in 2013. Iran J Brest Dis 2014;7:45‑55.
24. Baghianimoghadam H, Fattahi Ardakani M, Akhondi M,
Mortazavizadeh M. Intention of colorectal cancer patients‘ first
degree relatives to screening based on pblanned behavior theory.
Tolooebehdasht 2012;10:13‑22.
25. Fernández ME, Gonzales A, Tortolero‑Luna G, Williams J,
Saavedra‑Embesi M, Chan W, et al. Effectiveness of Cultivando la
Salud: A breast and cervical cancer screening promotion program
for low‑income Hispanic women. Am J Public Health 2009;99:936‑43.
26. Keshavarz Z, Simbar M, Ramezankhani A, Alavi Majd H.
Factors influencing the behavior of female‑workers in the
reproductive age regarding breast and cervical cancer
screening based on the Integrated Model of Planned Behavior
and Self‑Efficacy: A qualitative approach. J Sch Public Health Inst Public Health Res 2012;9:23‑36.
27. LevenduskyMS, Druckman JN, McLainA. How group discussions
create strong attitudes and strong partisans. Res Polit 2016;3:1‑6.
28. Nurdin TA, Japar M, Bachtiar IG. Improving social attitudes
and knowledge through role playing method. Am Educ Res J
2018;6:1040‑5
29. Zareipour MA, Mahmoodi H, Valizadeh R, Ghorooji MG,
Moradali MR, Zare F . I m p a c t o f a n e d u c a t i o n a l
intervention based on the BASNEF model on skin cancer
preventive behavior of college students. Asian Pac J
Cancer Prev 2018;19:2717‑22.
30. Manne SL, Coups EJ, Winkel G, Markowitz A, Meropol NJ,
Lesko SM, et al. Identifying cluster subtypes for intentions
to have colorectal cancer screening among non‑compliant
intermediate‑risk siblings of individuals with colorectal cancer.
Health Educ Res. 2009;24:897‑908.
31. Hardin‑Fanning F, Ricks JM. Attitudes, social norms and
perceived behavioral control factors influencing participation in a
cooking skills program in rural Central Appalachia. Glob Health
Promot 2017;24:43‑52.