Advertisement

Journal of Cancer Education

, Volume 34, Issue 2, pp 297–303 | Cite as

Examining the Durability of Colorectal Cancer Screening Awareness and Health Beliefs Among Medically Underserved Patients: Baseline to 12 months Post-Intervention

  • Shannon M. Christy
  • Steven K. Sutton
  • Clement K. Gwede
  • Enmanuel A. Chavarria
  • Stacy N. Davis
  • Rania Abdulla
  • Ida Schultz
  • Richard Roetzheim
  • David Shibata
  • Cathy D. MeadeEmail author
Article

Abstract

The current study examines changes in awareness and health beliefs from baseline to 12 months post-intervention following receipt of one of two colorectal cancer (CRC) educational interventions that aimed to promote CRC screening among a racially and ethnically diverse and medically underserved population. Participants (N = 270) were enrolled in a randomized controlled trial to increase CRC screening and completed both baseline and 12-month follow-up assessments. Participants were aged 50–75, at average CRC risk, not up-to-date with CRC screening guidelines, and receiving care at one of three community-based clinics. Participants were randomized to receive either a targeted, low-literacy intervention informed by the Preventive Health Model [PHM] (photonovella and DVD plus fecal immunochemical test [FIT]) or a non-targeted intervention (standard educational brochure plus FIT). Changes in CRC awareness and health beliefs from baseline to 12 months were examined both within and between intervention groups using Student’s t tests. Participants in both intervention conditions demonstrated an increase in CRC awareness, PHM social influence, and trust in the healthcare system (all p’s < .0001), with no significant between-group differences. Among those receiving the targeted intervention, there also was an increase in PHM salience (p < .05). Among individuals receiving the non-targeted intervention, there was an increase in PHM response efficacy (p < .01) and PHM self-efficacy (p < .0001). Both CRC screening interventions promoted positive changes in awareness and several health beliefs from baseline to 12 months, suggesting important benefits of CRC education. Regardless of whether education was targeted or non-targeted, providing CRC screening education successfully promoted durable changes in awareness and health beliefs.

Keywords

Colorectal cancer screening Health beliefs Intervention Health disparities Preventive Health Model 

Notes

Funding Information

The study was funded by grant no. 1U54CA153509 from the Center to Reduce Cancer Health Disparities at the National Cancer Institute (PIs C.D. Meade and C.K. Gwede). The efforts of Drs. Christy, Davis, and Chavarria were supported by grant no. R25CA090314 (PI: P. B. Jacobsen [prior PI]/T. H. Brandon [current PI]) from the National Cancer Institute. This work was also supported in part by the Biostatistics Core and the Survey Methods Core at the H. Lee Moffitt Cancer Center & Research Institute, a National Cancer Institute-designated Comprehensive Cancer Center (NIH/NCI Grant Number: P30-CA076292). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute.

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    American Cancer Society (2017) Cancer facts and figures 2017. American Cancer Society, AtlantaGoogle Scholar
  2. 2.
    American Cancer Society (2017) Colorectal cancer facts and figure 2017–2019. American Cancer Society, AtlantaGoogle Scholar
  3. 3.
    Brandt HM, Dolinger HR, Sharpe PA, Hardin JW, Berger FG (2012) Relationship of colorectal cancer awareness and knowledge with colorectal cancer screening. Colorectal Cancer 1(5):383–396.  https://doi.org/10.2217/crc.12.45
  4. 4.
    McQueen A, Vernon SW, Myers RE, Watts BG, Lee ES, Tilley BC (2007) Correlates and predictors of colorectal cancer screening among male automotive workers. Cancer Epidemiol Biomark Prev 16:500–509CrossRefGoogle Scholar
  5. 5.
    Christy SM, Davis SN, Williams K, Zhao X, Govindaraju S, Quinn GP, Vadaparampil ST et al (2016) A community-based trial of educational interventions with fecal immunochemical test for colorectal cancer screening uptake among Blacks in community settings. Cancer 122(21):3288–3296.  https://doi.org/10.1002/cncr.30207. CrossRefGoogle Scholar
  6. 6.
    Rawl SM, Skinner CS, Perkins SM, Springston JK, Wang HL, Russell KM, Tong Y et al (2012) Computer-delivered tailored intervention improves colon cancer screening knowledge and health beliefs of African-Americans. Health Educ Res 27(5):868–885.  https://doi.org/10.1093/her/cys094 CrossRefGoogle Scholar
  7. 7.
    Davis SN, Christy SM, Chavarria E, Abdulla R, Sutton SK, Schmidt A, Vadaparampil ST et al (2016) A randomized controlled trial of a multi-component targeted low-literacy educational intervention compared with a non-targeted intervention to boost colorectal cancer screening with fecal immunochemical test in community clinics. Cancer 123(8):1390–1400.  https://doi.org/10.1002/cncr.30481. CrossRefGoogle Scholar
  8. 8.
    Myers RE, Ross E, Jepson C, Wolf T, Balshem A, Millner L, Leventhal H (1994) Modeling adherence to colorectal cancer screening. Prev Med 23:142–151CrossRefGoogle Scholar
  9. 9.
    National Cancer Institute (2009) Health Informational National Trends Survey (HINTS). http://cancercontrol.cancer.gov/hints/questions.jsp. Accessed January 2 2009.
  10. 10.
    Myers RE, Sifri R, Hyslop T, Rosenthal M, Vernon SW, Cocroft J, Wolf T, Andrel J, Wender R (2007) A randomized controlled trial of the impact of targeted and tailored interventions on colorectal cancer screening. Cancer 110(9):2083–2091.  https://doi.org/10.1002/cncr.23022 CrossRefGoogle Scholar
  11. 11.
    Tiro JA, Vernon SW, Hyslop T, Myers RE (2005) Factorial validity and invariance of a survey measuring psychosocial correlates of colorectal cancer screening among African Americans and Caucasians. Cancer Epidemiol Biomark Prev 14:2855–2861CrossRefGoogle Scholar
  12. 12.
    Vernon SW, Myers RE, Tilley BC, Li S (2001) Factors associated with perceived risk in automotive employees at increased risk of colorectal cancer. Cancer Epidemiol Biomark Prev 10:35–43Google Scholar
  13. 13.
    O’Connor AM (1995) Validation of a decisional conflict scale. Med Decis Mak 15(1):25–30.  https://doi.org/10.1177/0272989X9501500105
  14. 14.
    O’Connor, A.M. (1999) Decisional conflict scale: 4th edn. Ottowa Health Research Institute, OttawaGoogle Scholar
  15. 15.
    Powe BD (1994) Perceptions of cancer fatalism among African Americans: the influence of education, income, and cancer knowledge. J Natl Black Nurses Assoc 7(2):41–48Google Scholar
  16. 16.
    Powe BD (1995) Fatalism among elderly African Americans. Effects on colorectal cancer screening. Cancer Nurs 18(5):385–392CrossRefGoogle Scholar
  17. 17.
    Powe BD (1996) Cancer fatalism among African-Americans: a review of the literature. Nurs Outlook 44(1):18–21.  https://doi.org/10.1016/S0029-6554(96)80020-0 CrossRefGoogle Scholar
  18. 18.
    Rose A, Peters N, Shea JA, Armstrong K (2004) Development and testing of the health care system distrust scale. J Gen Intern Med 19(1):57–63.  https://doi.org/10.1111/j.1525-1497.2004.21146.x CrossRefGoogle Scholar
  19. 19.
    Kessler RC, Mickelson KD, Williams DR (1999) The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. J Health Soc Behav 40(3):208–230.  https://doi.org/10.2307/2676349 CrossRefGoogle Scholar
  20. 20.
    Williams DR, Yu Y, Jackson JS, Anderson NB (1997) Racial differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol 2(3):335–351.  https://doi.org/10.1177/135910539700200305 CrossRefGoogle Scholar
  21. 21.
    Braun KL, Fong M, Kaanoi ME, Kamaka ML, Gotay CC (2005) Testing a culturally appropriate, theory-based intervention to improve colorectal cancer screening among native Hawaiians. Prev Med 40(6):619–627.  https://doi.org/10.1016/j.ypmed.2004.09.005 CrossRefGoogle Scholar
  22. 22.
    Hoffman AS, Lowenstein LM, Kamath GR, Housten AJ, Leal VB, Linder SK, Jibaja-Weiss ML, Raju GS, Volk RJ (2017) An entertainment-education colorectal cancer screening decision aid for African American patients: a randomized controlled trial. Cancer 123(8):1401–1408.  https://doi.org/10.1002/cncr.30489. CrossRefGoogle Scholar
  23. 23.
    Iwelunmor J, Airhihenbuwa C (2017) Culture, a social determinant of health and risk: considerations for health and risk messaging. Health Risk Commun.  https://doi.org/10.1093/acrefore/9780190228613.013.221
  24. 24.
    Coughlin SS, Blumenthal DS, Seay SJ, Smith SA (2016) Toward the elimination of colorectal cancer disparities among African Americans. J Racial Ethn Health Disparities 3(4):555–564.  https://doi.org/10.1007/s40615-015-0174-z

Copyright information

© American Association for Cancer Education 2017

Authors and Affiliations

  • Shannon M. Christy
    • 1
    • 2
  • Steven K. Sutton
    • 1
    • 2
  • Clement K. Gwede
    • 1
    • 2
  • Enmanuel A. Chavarria
    • 1
    • 3
  • Stacy N. Davis
    • 1
    • 4
  • Rania Abdulla
    • 1
  • Ida Schultz
    • 5
  • Richard Roetzheim
    • 1
    • 2
  • David Shibata
    • 1
    • 6
  • Cathy D. Meade
    • 1
    • 2
    Email author
  1. 1.Division of Population ScienceH. Lee Moffitt Cancer Center and Research InstituteTampaUSA
  2. 2.Morsani College of MedicineUniversity of South FloridaTampaUSA
  3. 3.University of Texas Health Science Center at Houston, School of Public HealthBrownsvilleUSA
  4. 4.Department of Health Education and Behavioral ScienceRutgers School of Public HealthPiscatawayUSA
  5. 5.Premier Community HealthCare Group, Inc.Dade CityUSA
  6. 6.University of Tennessee Health Science CenterMemphisUSA

Personalised recommendations