Mediators of screening uptake in a colorectal cancer screening intervention among Hispanics

Abstract

Background Colorectal cancer (CRC) is the second leading cause of cancer deaths in the USA. Although a number of CRC screening tests have been established as being effective for CRC prevention and early detection, rates of CRC screening test completion in the US population remain suboptimal, especially among the uninsured, recent immigrants and Hispanics. In this study, we used a structural equation modelling approach to identify factors influencing screening test completion in a successful CRC screening program that was implemented in an uninsured Hispanic population. This information will enhance our understanding of influences on CRC screening among historically underscreened populations. Methods We used generalized structural equation models (SEM) utilizing participant reported information collected through a series of surveys. We identified direct and indirect pathways through which cofactors, CRC knowledge and individual Health Belief Model constructs (perceived benefits, barriers, susceptibility, fatalism and self-efficacy) and a latent psychosocial health construct mediated screening in an effective prospective randomized CRC screening intervention that was tailored for uninsured Hispanic Americans. Results Seven hundred twenty-three participants were eligible for inclusion; mean age was 56 years, 79.7% were female, and 98.9% were Hispanic. The total intervention effect was comparable in both models, with both having a direct and indirect effect on screening completion (n = 715, Model 1: RC = 2.46 [95% CI: 2.20, 2.71, p < 0.001]; n = 699, Model 2 RC =2.45, [95% CI: 2.18, 2.72, p < 0.001]. In Model 1, 32% of the overall effect was mediated by the latent psychosocial health construct (RC = 0.79, p < 0.001) that was in turn mainly influenced by self-efficacy, perceived benefits and fatalism. In Model 2, the most important individual mediators were self-efficacy (RC = 0.24, p = 0.013), and fatalism (RC = 0.07, p = 0.033). Conclusion This study contributes to our understanding of mediators of CRC screening and suggests that targeting self-efficacy, perceived benefits and fatalism could maximize the effectiveness of CRC screening interventions particularly in Hispanic populations.

Screening Intention Prediction of Colorectal Cancer among Urban Chinese Based on the Protection Motivation Theory

“…Notably, findings of this research suggested that self-efficacy was the most powerful predictor of the six subconstructs of PMT, similar to research findings of other investigators [ 32 , 35 , 36 ]. This positive connection showed that those individuals with greater perceptions of self-efficacy tended to overcome more obstacles, and had much more confidence to participate in CRC screening [ 37 , 38 ]. Hence, it is necessary to emphasize self-efficacy when designing and carrying out various health education interventions to further improve screening uptake and mitigate the threat of CRC [ 39 , 40 ].…”

Delays in Colorectal Cancer Screening for Latino Patients: The Role of Immigrant Healthcare in Stemming the Rising Global Incidence of Colorectal Cancer

“…However, a study showed that most epidemiologic patterns of GI cancer including CRC in Chinese American immigrants were closer to those of the people of their new country of residence compared to those of their original country, indicating a shift in environmental exposures which may change cancer risk [59]. Fatalistic beliefs present in cultures of origin persist and affect adherence to screening [47,[60][61][62][63]. In addition, many cultures have a bias towards first seeking complementary and alternative medicine, where screening does not feature as prominently [47,64].…”

Assessment of Psychosocial Correlates and Associated Factors of Colorectal Cancer Screening among Southwestern Saudi Population: A Cross-Sectional Study

“…Using an instrument adapted from the preventive health paradigm, Salimzadeh et al concluded that most respondents reported poor attitudes toward CRC screening [18]. Shokar et al, inspired by the Health Belief Model, found that self-efficacy, perceived advantages, and fatalism may be targeted to enhance the effectiveness of CRC screening initiatives [19]. Significantly lower degrees of response efficacy, higher perceived barriers, and poorer levels of self-efficacy were all social cognitive determinants of non-adherence to CRC screening, as mentioned by a study detecting behavioral and demographic predictors of adherence to CRC screening tests [20].…”