Factors associated with referral compliance of abnormal immunochemical faecal occult blood test

Abstract

Objective This study investigated factors associated with the referral compliance of positive immunochemical faecal occult blood test (iFOBT). Setting Data were from a subset of people who received iFOBT at Taipei county of Taiwan in 2005. Methods All subjects with positive iFOBT were referred to hospital for further diagnostic examinations. In total, 226 such subjects who did not accept referral within 60 days were identified as the non-compliant group from the record of Public Health Bureau. Frequency-matched 219 subjects were sampled from the 599 people who accepted referral within 60 days as the compliant group. Telephone interviews were performed according to questionnaire designed basically under the Health Belief Model. Multiple logistic regression was used to assess effects of possible associated factors for referral compliance. Results A total of 145 persons in the compliant group and 115 persons in the non-compliant group completed the interview. Factors including 'perceived susceptibility' and 'cue to action: information' were positively associated with, while 'casual personality' was negatively associated with referral compliance. Conclusions Three factors in Health Belief Model were associated with referral compliance after positive FOBT. INTRODUCTION Colorectal cancer is the third in cancer incidence 1 and the fourth in cancer mortality 2 in Taiwan. Mortality can be reduced by using faecal occult blood test (FOBT) 3,4 and complete diagnostic examination (CDE) after positive FOBT. [5][6][7][8] The US preventive taskforce suggested annual FOBT examination for colon cancer screening. 9People aged between 50 and 69 years can receive free immunochemical FOBT (iFOBT) every two years in Taiwan.People with positive result in FOBT should be followed with CDE to reduce the mortality of colorectal cancer. [5][6][7][8] However, most previous researches focused on factors affecting the compliance of receiving first-line screening tests. The aim of this study was to investigate factors associated with the referral compliance of people with positive iFOBT result in Taipei County of Taiwan. METHODS Model, definition of variables and questionnaire designWe defined the variables and designed our questionnaire basically according to the Health Belief Model 10 (Appendix 1). Questionnaire testing and revisionThe preliminary questionnaire was sent to five experts for content validity. The questionnaire was revised according to their comments. Six persons with positive iFOBT in Taipei City were selected to do the pre-test before starting the investigation. Questions that cannot be fully understood were further revised (Appendix 2). Subjects and sample size estimationAccording to the results of a previous study in southern Taiwan, 20 if we assumed a proportion of 0.2 as a factor in the non-compliant group, we need 95 subjects in each group for an equal-size design to test an odds ratio (OR) of 2.5 in a two-sided test at a significant level of 0.05 and power of 0.80. In Taipei County, a total of 38,504 people received i...

Factors affecting compliance with confirmatory colonoscopy after a positive fecal immunochemical test in a national colorectal screening program

“…Cues for action, including “physician's recommendation”; “family history of colorectal cancer”; “experience of bowel habit change or other's experience of undergoing colonoscopy”; and “ past history of tarry stool, bloody stool, or any bowel habit change,” had a great impact on individual's willingness to undergo colonoscopy. These findings were consistent with previous studies . In Taiwan, many physicians are not familiar with the benefits of FIT screening, are unaware of its improved performance compared with the chemical FOBT, and have a doubtful attitude about the result.…”

“…These findings were consistent with previous studies. [22][23][24][25] In Taiwan, many physicians are not familiar with the benefits of FIT screening, are unaware of its improved performance compared with the chemical FOBT, and have a doubtful attitude about the result. Because of this lack of knowledge, many FIT-positive patients are told that it is "not necessary to undergo colonoscopy" or that the FIT test was repeated by their physician, as reported by 4% of our study population.…”

Community-based infant hearing screening in a developing country: parental uptake of follow-up services

“…Socio-demographic characteristics such as maternal education, ethnicity and parity; economic status as well as infant medical history such as prematurity and hospital admission in the neonatal period have been associated with follow-up default in infant hearing screening programmes [ 11 , 13 , 14 ], similar to findings in other screening programmes [ 15 , 16 ]. For instance, one study found that socio-demographic factors such as young maternal age, having more than two children at home (parity), being non-white (race), substance abuse, late onset of prenatal care and lack of health insurance were predictive of non-compliance with hearing screening protocol [ 13 ].…”

“…Future studies addressing these issues as well as the impact of culture and beliefs should therefore be considered. For example, a study using an adapted version of the Health Belief Model would be valuable to establish the possible role of individual and community beliefs on deafness across the domains of perceived susceptibility, severity, benefits and barriers [ 15 , 29 ].…”