Public Awareness and Barriers to Seeking Medical Advice for Colorectal Cancer in the Gaza Strip: A Cross-Sectional Study

Abstract

PURPOSE Raising awareness of colorectal cancer (CRC) symptoms for early recognition, reduction of modifiable risk factors, and removing barriers to seeking medical help could lower its mortality. This study aimed to assess the level of public awareness of CRC in the Gaza Strip. MATERIALS AND METHODS This was a cross-sectional study conducted at three hospitals and 10 high schools between September and October 2017. The Arabic version of the validated Bowel Cancer Awareness Measure (BoCAM) questionnaire was used to evaluate awareness of CRC symptoms and risk factors, and barriers to seeking medical help. Adults (age ≥ 18 years) in three major hospitals and adolescents (ages 15 to 17 years) in 10 schools were recruited for face-to-face interviews to complete the BoCAM. RESULTS Of 3,172 potential participants, 3,080 completed the BoCAM (response rate, 97.1%). Among these, 1,578 (51.2%) were adults and 1,614 (52.4%) were females. Persistent abdominal pain was the most commonly recognized CRC symptom (n = 1,899; 61.7%), whereas anorectal pain was the least common (n = 1,056; 34.3%). In total, 2,177 (70.7%) were not confident in recognizing CRC symptoms or signs. Having a bowel disease was the most frequently recognized CRC risk factor (n = 1,456; 47.3%) and diabetes the least recognized (n = 591; 19.2%). The overall mean scores ± standard deviations for recalling and recognizing CRC symptoms were 1.2 ± 1.3 and 4.3 ± 2.3, respectively (out of 9 points). The overall mean scores ± standard deviations for recalling and recognizing CRC risk factors were 0.7 ± 0.8 and 8.0 ± 3.1, respectively (out of 16 points). Emotional barriers were the most commonly reported barriers to seeking medical help, with feeling worried about what a doctor might find as the most common barrier (n = 1,522; 49.4%). CONCLUSION Public awareness of CRC is suboptimal in Gaza. Improving CRC awareness with educational interventions is needed, including in local schools.

Knowledge level of cancer symptoms and risk factors in the Gaza Strip: a cross-sectional study

“…In concordance with other studies, knowledge of cancer risk factors as well as signs and symptoms improved with age [10,11,[22][23][24][25]. This is not surprising as informal learning through experiences in life and exposure to [2].…”

“…Therefore, reducing barriers for first presentation is as important as improving knowledge and awareness of cancer symptoms [9,[32][33][34][35]. Barriers can be emotional, like being worried about possible results, embarrassment or fear to see a n number of participants tested doctor, service-related such as difficulty getting an appointment with a doctor, or practical like being too busy to see a doctor or difficulty with arranging transport [9][10][11]. However, negative beliefs also have a strong impact, such as the conviction that there is no cure for cancer or the treatment is worse than the actual disease [23,32,33,35].…”

“…Governmental hospitals are the main entry point for healthcare services in Gaza [10,11]. Therefore, adults, aged 18 years or over, admitted to or visiting those hospitals, were the target population.…”

“…All of these factors could play a major role in the high mortality rates [5][6][7][8][9]. Previous studies conducted in the Gaza Strip showed low awareness of symptoms as well as risk factors for both BC and CRC [10,11]. Some educational initiatives were held by local universities and institutions.…”

Knowledge Level of Cancer Symptoms and Risk Factors in the Gaza Strip: A Cross-sectional Study

“…Previous studies conducted in the Gaza Strip showed low awareness of symptoms as well as risk factors for both BC and CRC [10,11]. Some educational initiatives were held by local universities and institutions.…”