Behavioural and demographic predictors of adherence to three consecutive faecal occult blood test screening opportunities: a population study

Abstract

BackgroundSocial cognitive variables are often examined for their association with initial participation in colorectal cancer screening. Few studies have examined the association of these variables with adherence to multiple screening offers i.e., rescreening. This study aimed to describe patterns of participatory behaviour after three rounds of screening using faecal immunochemical tests (FIT) and to determine social cognitive, demographic and background variables predictive of variations in adherence.MethodsParticipants were 1,540 men and women aged 50 to 75 living in South Australia who completed a behavioural survey measuring demographic (for example, age, gender) and social cognitive variables relevant to FIT screening (for example, perceived barriers, benefits, self-efficacy). The survey was followed by three, free FIT screening offers mailed on an annual basis from 2008 to 2010. Patterns of participation after three screening rounds were described as one of five screening behaviours; 1) consistent re-participation (adherent with all screening rounds), 2) consistent refusal (adherent with no screening rounds), 3) drop out (adherent with earlier but not later rounds), 4) intermittent re-participation (adherent with alternate rounds) and 5) delayed entry (adherent with later but not initial round(s)). Univariate (Chi Square and Analysis of Variance) and multivariate (Generalised Estimating Equations) analyses were conducted to determine variables predictive of each category of non-adherence (those that did not participate in every screening offer, groups 2, 3, 4 and 5) relative to consistent re-participation.ResultsSignificant social cognitive predictors of non-adherence were; less self-efficacy (drop out and consistent refusal), greater perceived barriers (drop out) and lower levels of response efficacy (consistent refusal). Demographic predictors of non-adherence included; male gender (delayed entry), younger age (intermittent, delayed and consistent refusal), less frequent GP visits (intermittent re-participation) and 'ancillary only' private health insurance (drop out). Less satisfaction with screening at baseline predicted drop out, consistent refusal and delayed entry.ConclusionsDifferent combinations of demographic and behavioural variables predicted different patterns of rescreening adherence. Rescreening interventions may benefit from a targeted approach that considers the different needs of the population subgroups. Satisfaction with past FOBT screening measured prior to the study screening offers was an important predictor of adherence.

Longitudinal predictors of colorectal cancer screening among participants in a randomized controlled trial

“…The association between self-efficacy and CRCS has been consistently reported in both cross-sectional and longitudinal studies (DeVellis et al, 1990; Hoogewerf et al, 1990; Kremers et al, 2000; McQueen et al, 2007; Menon et al, 2003; Myers et al, 1994; Vernon and McQueen, 2010), underscoring the importance of targeting self-efficacy in CRCS interventions to increase initiation, adherence among those overdue, and maintenance. A recent population-based study of repeat FOBT in Australia similarly found that self-efficacy was the only variable able to distinguish between participants who engaged in consistent, on-schedule screening and those who were never screened (Duncan et al, 2014). Although our intervention did not moderate the effects of self-efficacy at Year 1, at Year 2 self-efficacy showed a stronger association with repeat screening in the usual care group compared with the combined intervention groups.…”

“…Receipt of a prior preventive health examination, younger age, lesser comorbidity, and a greater number of physician visits were significantly associated with repeat CRCS (Fenton et al, 2010; Liss et al, 2013; Myers et al, 1993). We found only one study that examined social cognitive factors in relation to repeat CRCS (Duncan et al, 2014). On-schedule screening is particularly important for FOBT because its effectiveness may be reduced when patients do not adhere to a regular schedule (Hardcastle et al, 1986, 1989, 1996; Mandel et al, 1999).…”

Reasons for Never and Intermittent Completion of Colorectal Cancer Screening After Receiving Multiple Rounds of Mailed Fecal Tests

“…However, without a mailed fecal testing program, provider order or provision at clinic visits is the only way to get screened. Duncan et al found that prior history of screening was a strong predictor of subsequent screening, with persistent refusers less likely to have screened prior to the mailed program [15]. Individuals with lower CRC screening self-efficacy (less confidence in their ability to complete screening) were also more likely to refuse and less likely to repeat screening.…”

“…Converters more frequently cited guilt and pleasing their doctor as reasons for screening, while non-screeners more frequently reported discomfort, disgust, or embarrassment handling stool and the belief that screening was not necessary. Duncan et al surveyed Australians offered 3 rounds of FIT screening and reported low self-efficacy and less satisfaction with screening as predictors of non-screening, with male sex and younger age as predictors of delayed screening [15]. Neither of these studies performed in-depth interviews with patients to explore factors related to late initiation or repeated refusal of CRC screening after being offered multiple rounds of fecal tests and mailed and phone information on its importance.…”

Final Results of a 3-Year Literacy-Informed Intervention to Promote Annual Fecal Occult Blood Test Screening

“…Population based screening programs abroad where FOBTs are mailed by centralized health service to eligible individuals have higher repeat FOBT screening rates (39% to 55%) [24-27]. Interestingly, in these programs which eliminate geographic and cost barriers completion rates were lower in individuals from rural areas and those of lower socioeconomic status [28].…”