Document Type : Original Article


1 Department of Epidemiology and Biostatistics, Social Determinants of Health Research Center, School of Health, Birjand University of Medical Sciences, Birjand, Iran

2 department of Health Education and Health Promotion, Social Determinants of Health Research Center, School of Health, Birjand University of Medical Sciences, Birjand, Iran


BACKGROUND: Colorectal cancer is the most common cancer of the gastrointestinal tract. Health 
beliefs play an important role in the development of health behaviors. In this study, the effect of 
educational intervention based on Health Belief Model on colorectal cancer screening behavior was 
MATERIALS AND METHODS: This study was performed as a randomized controlled intervention. 
The study population was 50–70‑years old in Khosf city. Initially, 120 eligible populations were 
randomly divided into intervention and control groups (60 people in each group). The data collection 
tool was a standard colorectal cancer screening questionnaire that was completed before, immediately, 
and 3 months after the intervention. The intervention consisted of eight 60‑min training sessions. 
The collected data were analyzed using SPSS19 software and statistical tests.
RESULTS: The mean age of the intervention and control groups was 63.53 ± 5.67 and 
57.73 ± 5.77 years. In terms of mean scores of knowledge, perceived susceptibility, perceived severity, 
and perceived barriers were homogeneous before intervention. After the intervention, the mean score 
of the model constructs showed significant changes, which was statistically significant (P < 0.05). 
The rate of occult blood test in stool 3 months after training reached 90% in the intervention group 
and 15% in the control group.
CONCLUSIONS: The results of this study showed that by taking measures to reduce perceived 
barriers as well as increase knowledge, perceived susceptibility, severity, benefits and self-efficacy, 
the rate of participation in occult blood testing in feces can be significantly increased.


1. Almasi SZ, Salehiniya H. Trends in colorectal cancer incidence in 
Iran. J Mazandaran Univ Med Sci 2015;24:391‑6.
2. Siegel RL, Miller KD, Goding Sauer A, Fedewa SA, Butterly LF, 
Anderson JC, et al. Colorectal cancer statistics, 2020. CA Cancer 
J Clin 2020;70:145‑64.
3. Roshandel G, Ghanbari‑Motlagh A, Partovipour E, Salavati F, 
Hasanpour‑Heidari S, Mohammadi G, et al. Cancer incidence in 
Iran in 2014: Results of the Iranian National Population‑based 
Cancer Registry. Cancer Epidemiol 2019;61:50‑8.
4. Ghanbari A, Rahmatpour P, KhaliliM, Mokhtari N. Health literacy 
and its relationship with cancer screening behaviors among the 
employees of Guilan University of Medical Sciences. J Health 
Care 2017;18:306‑15.
5. Bandi P, Cokkinides V, Smith RA, Jemal A. Trends in colorectal 
cancer screening with home‐based fecal occult blood tests in 
adults ages 50 to 64 years, 2000‐2008. Cancer 2012;118:5092‑9.
6. 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.
7. Salimzadeh H, Delavari A, Montazeri A, Mirzazadeh A. 
Knowledge and practice of iranians toward colorectal cancer, 
and barriers to screening. Int J Prev Med 2012;3:29‑35.
8. Ramazani AA, Norozi E, AmirabadiZadeh H, Ehteshampour AR, 
Salehiniya H. Predictors of colorectal cancer screening 
participation in Southern Khorasan (Iran). J Gastrointest Cancer 
9. Shin DW, Chang D, Jung JH, Han K, Kim SY, Choi KS, et al.
Disparities in the participation rate of colorectal cancer screening 
by fecal occult blood test among people with disabilities: 
A national database study in South Korea. Cancer Res Treat 
10. Tastan S, Andsoy II, Iyigun E. Evaluation of the knowledge, 
behavior and health beliefs of individuals over 50 regarding 
colorectal cancer screening. Asian Pac J Cancer Prev 
11. Rajabi R, Sharifi A, Shamsi M, Almasi Hashyani A, Dejam S. 
Investigating the effect of package theory‑based training in the 
prevention of gastrointestinal cancers. J Arak Univ Med Sci 
12. Shouri Bidgoli AR, Taheri Kharame Z, Asayesh H, Sharififard F, 
Sheydaiyan Arani M, Hajaligol A, et al. A study of knowledge attitude, and practiceoncolorectal cancer screening among 
individuals older than 50 years based on health belief model. 
Qom Univ Med Sci J 2015;9:59‑65.
13. Almadi MA, Mosli MH, Bohlega MS, Al Essa MA, AlDohan MS, 
Alabdallatif TA, et al. Effect of public knowledge, attitudes, and 
behavior on willingness to undergo colorectal cancer screening 
using the health belief model. Saudi J Gastroenterol 2015;21:71‑7.
14. Armitage CJ, Conner M. Social cognition models and health 
behaviour: A structured review. Psychol Health 2000;15:173‑89.
15. Garcés DM. Applying the health belief model to cervical cancer 
screening. CES Med 2006;20:55‑63.
16. Glanz K, Rimer BK, Viswanath K. Health Behavior and Health 
Education: Theory, Research, and Practice. San Francisco: John 
Wiley & Sons; 2008.
17. Tahmasebi R, Noroozi A, Dashdebi KG. Psychometric evaluation 
of the colorectal cancer screening belief scale based on health 
belief model’s constructs for the fecal occult blood test. Asian Pac 
J Cancer Prev 2016;17:225‑9.
18. Gholampour Y, Jaderipour A, Khani Jeihooni A, Kashfi SM, 
Afzali Harsini P. The effect of educational intervention based on 
health belief model and social support on the rate of participation 
of individuals in performing fecal occult blood test for colorectal 
cancer screening. Asian Pac J Cancer Prev 2018;19:2777‑87.
19. Alavi Langroodi S, 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.
20. Moattar M, Roozitalab M, Gholamzadeh S, Firoozi M, Zare N. 
Practical application of health belief model to enhance the uptake 
of colorectal cancer screening. J Community Med Health Educ 
21. Cameron KA, Persell SD, Brown T, Thompson J, Baker DW. 
Patient outreach to promote colorectal cancer screening among 
patients with an expired order for colonoscopy: A randomized 
controlled trial. Arch Intern Med 2011;171:642‑6.
22. Khani Jeihooni A, Kashfi SM, Shokri A, Kashfi SH, Karimi S. 
Investigating factors associated with FOBT screening for 
colorectal cancer based on the components of health belief model 
and social support. Asian Pac J Cancer Prev 2017;18:2163‑9.
23. Rakhshanderou S, Maghsoudloo M, Safari‑Moradabadi A, 
Ghaffari M. Theoretically designed interventions for colorectal 
cancer prevention: A case of the health belief model. BMC Med 
Educ 2020;20:270.
24. Saffari M, Shojaeizadeh D, Ghofranipour F, Heydarnia A, 
Pakpour A. Health Education & Promotion‑Theories, Models & 
Methods. Tehran: Sobhan Pub; 2009. p. 21‑12.
25. Champion VL, Skinner CS. The health belief model. In: Health 
Behavior and Health Education: Theory, Research, and Practice. 
Vol. 4. Jossey-Bass, San Francisco; 2008. p. 45‑65.
26. Bae N, Park S, Lim S. Factors associated with adherence to fecal 
occult blood testing for colorectal cancer screening among adults 
in the Republic of Korea. Eur J Oncol Nurs 2014;18:72‑7.
27. Hughes AG, Watanabe‑Galloway S, Schnell P, Soliman AS. 
Rural‑urban differences in colorectal cancer screening barriers 
in Nebraska. J Community Health 2015;40:1065‑74.
28. Al‑Dahshan A, Abushaikha S, Chehab M, Bala M, Kehyayan V, 
Omer M, et al. Perceived barriers to colorectal cancer screening 
among eligible adults in Qatar and the associated factors: 
A cross‑ sectional study. Asian Pac J Cancer Prev 2021;22:45‑51.