Elsevier

Preventive Medicine

Volume 19, Issue 5, September 1990, Pages 502-514
Preventive Medicine

General article
Adherence to colorectal cancer screening in an HMO population

https://doi.org/10.1016/0091-7435(90)90049-PGet rights and content

Abstract

This study aimed to determine factors that influence fecal occult blood test performance in colorectal cancer screening. A random sample was selected of men and women ages 50 to 74 years of age who had been mailed a fecal occult blood testing kit in a screening program in fall 1986. One year after initial test mailing, sample group members (n = 504) were surveyed by telephone. Four months later, the survey sample received a second fecal occult blood test mailing. Multivariable analysis for subjects with validated past fecal occult blood test status (n = 322) revealed that past testing was positively associated with physician encouragement of screening, age, the belief that cancer is curable, perceived test efficacy, and strong intention to do testing. It also was discovered that persons who felt that they had little control over their health were not likely to have done past testing. Preliminary analysis of prospective adherence showed that the strongest statistically significant independent predictor was past test performance. Prospective adherence among past nontesters (n = 121) was associated with expressed commitment to do fecal occult blood testing and reported presence of colorectal cancer risk factors. Analysis of adherence among past testers (n = 201) revealed that belief in colorectal cancer curability and age were significant predictors. The findings reported here indicate that factors influencing adherence among past nontesters differ from those for past testers. Overall, these results suggest that to increase participation in colorectal cancer screening, physicians and other health professionals should (a) deliver educational messages that increase awareness of risk factors for colorectal cancer and curability of the disease, and (b) elicit from potential screenees a commitment to engage in recommended preventive behaviors. It may also be well to consider “tailoring” messages for past nontesters and past testers, respectively, by emphasizing colorectal cancer risk factors and highlighting curability.

References (41)

  • VA Gilbertsen et al.

    Colon cancer control study: An interim report

  • A Hoffman et al.

    Early detection of bowel cancer at an urban public hospital: Demonstration project

    CA

    (1983)
  • HL Stewart et al.

    Hemoccult test as a routine screening procedure for colorectal disease in the private clinic setting

    Can J Surg

    (1979)
  • SJ Winawer et al.

    Progress report on controlled trial of fecal occult blood testing for the detection of colorectal neoplasia

    Cancer

    (1980)
  • SP Bralow

    Colorectal cancer screening by community programs

    Front Gastrointest Res

    (1986)
  • DP Winchester et al.

    Risks and benefits of mass screening for colorectal neoplasia with the stool guaiac test

    CA

    (1983)
  • TW Elwood et al.

    Comparative educational approaches to screening for colorectal cancer

    Am J Public Health

    (1978)
  • GR Morrow et al.

    Patient compliance with self-directed hemoccult testing

    Prev Med

    (1982)
  • PA Farrands et al.

    Factors affecting compliance with screening for colorectal cancer

    Community Med

    (1984)
  • JD Hardcastle et al.

    Screening for symptomless colon cancer by testing for occult blood in general practice

    Lancet

    (1980)
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