Skip to main content
SpringerLink
Log in

Processes of Change for Colonoscopy: Limited Support for Use Among Navigated Latinos

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

This study assessed the role of the processes of change (POC), a construct of the transtheoretical model, in colorectal cancer (CRC) screening among Latinos. Latinos participate in CRC screening less often and are diagnosed with CRC at a later stage than whites. POC items were administered to 344 English- and Spanish-speaking Latinos at average risk for CRC who had not had a colonoscopy in the past 5 years and received a colonoscopy referral. POC were measured at three timepoints: following informed consent (T1) at time of referral, 2 weeks prior to scheduled colonoscopy (T2), and 1 month after scheduled colonoscopy (T3). Participants received patient navigation as part of a randomized controlled trial to promote screening colonoscopy. POC scores were examined for changes during the course of the intervention, and logistic regression models assessed the relationship between POC scores and CRC screening adherence. Total POC scores decreased between T1 and T2 (p = 0.03) but were unchanged between T1 and T3. CRC screening adherence was not significantly associated with POC scores or change in POC scores over time. The POC instrument was not found useful for predicting colonoscopy adherence among Latinos in conjunction with patient navigation. Total POC scores did not increase during a patient navigation intervention despite high colonoscopy completion rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Cancer Society. Cancer Facts & Figures 2018. Atlanta: American Cancer Society; 2018. Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf

  2. American Cancer Society. Colorectal Cancer Facts & Figures 2017-2019. Atlanta: American Cancer Society; 2017. Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2017-2019.pdf

  3. American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2015-2017. American Cancer Society; 2015. Available from: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-hispanics-and-latinos/cancer-facts-and-figures-for-hispanics-and-latinos-2015-2017.pdf

  4. Jackson CS, Oman M, Patel AM, Vega KJ. Health disparities in colorectal cancer among racial and ethnic minorities in the United States. J Gastrointest Oncol. 2016;7:S32–43.

    PubMed Central  PubMed  Google Scholar 

  5. Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–95.

    Article  CAS  PubMed  Google Scholar 

  6. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739–50.

    Article  PubMed  Google Scholar 

  7. Pinheiro PS, Callahan KE, Gomez SL, Marcos-Gragera R, Cobb TR, Roca-Barcelo A, et al. High cancer mortality for US-born Latinos: evidence from California and Texas. BMC Cancer. 2017;17:478.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Jandorf L, Ellison J, Villagra C, Winkel G, Varela A, Quintero-Canetti Z, et al. Understanding the barriers and facilitators of colorectal cancer screening among low income immigrant Hispanics. J Immigr Minor Health. 2010;12:462–9.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Wang J, Moehring J, Stuhr S, Krug M. Barriers to colorectal cancer screening in Hispanics in the United States: an integrative review. Appl Nurs Res. 2013;26:218–24.

    Article  PubMed  Google Scholar 

  10. Efuni E, DuHamel KN, Winkel G, Starr T, Jandorf L. Optimism and barriers to colonoscopy in low-income Latinos at average risk for colorectal cancer. Psycho-Oncology. 2015;24:1138–44.

    Article  PubMed  Google Scholar 

  11. Diao DY, Lee TK. Sun-protective behaviors in populations at high risk for skin cancer. Psychol Res Behav Manag. 2013;7:9–18.

    PubMed Central  PubMed  Google Scholar 

  12. DuHamel K, Li Y, Rakowski W, Samimi P, Jandorf L. Validity of the process of change for colorectal cancer screening among African Americans. Ann Behav Med. 2011;41:271–83.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Rakowski W, Ehrich B, Goldstein MG, Rimer BK, Pearlman DN, Clark MA, et al. Increasing mammography among women aged 40-74 by use of a stage-matched, tailored intervention. Prev Med. 1998;27:748–56.

    Article  CAS  PubMed  Google Scholar 

  14. Rakowski W, Dube C, Goldstein M. Considerations for extending the transtheoretical model of behavior change to screening mammography. Health Educ Res. 1996;11:77–96.

    Article  Google Scholar 

  15. Manne S, Markowitz A, Winawer S, Meropol NJ, Haller D, Rakowski W, et al. Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer. Health Psychol. 2002;21:3–15.

    Article  PubMed  Google Scholar 

  16. Duncan A, Wilson C, Cole SR, Mikocka-Walus A, Turnbull D, Young GP. Demographic associations with stage of readiness to screen for colorectal cancer. Health Promot J Austr. 2009;20:7–12.

    Article  PubMed  Google Scholar 

  17. Kiviniemi MT, Bennett A, Zaiter M, Marshall JR. Individual-level factors in colorectal cancer screening: a review of the literature on the relation of individual-level health behavior constructs and screening behavior. Psycho-Oncology. 2011;20:1023–33.

    Article  PubMed  Google Scholar 

  18. Krok-Schoen JL, Oliveri JM, Young GS, Katz ML, Tatum CM, Paskett ED. Evaluating the stage of change model to a cervical cancer screening intervention among Ohio Appalachian women. Women Health 2015 1–19.

  19. Lipschitz JM, Yusufov M, Paiva A, Redding CA, Rossi JS, Johnson S, et al. Transtheoretical principles and processes for adopting physical activity: a longitudinal 24-month comparison of maintainers, relapsers, and nonchangers. J Sport Exerc Psychol. 2016;37:592–606.

    Article  Google Scholar 

  20. Santiago-Rivas M, Velicer WF, Redding C. Mediation analysis of decisional balance, sun avoidance and sunscreen use in the precontemplation and preparation stages for sun protection. Psychol Health. 2015;30:1433–49.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Brenes GA, Paskett ED. Predictors of stage of adoption for colorectal cancer screening. Prev Med. 2000;31:410–6.

    Article  CAS  PubMed  Google Scholar 

  22. Lawsin C, DuHamel K, Weiss A, Rakowski W, Jandorf L. Colorectal cancer screening among low-income African Americans in East Harlem: a theoretical approach to understanding barriers and promoters to screening. J Urban Health. 2007;84:32–44.

    Article  PubMed  Google Scholar 

  23. Rawl SM, Champion VL, Scott LL, Zhou H, Monahan P, Ding Y, et al. A randomized trial of two print interventions to increase colon cancer screening among first-degree relatives. Patient Educ Couns. 2008;71:215–27.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Spencer L, Pagell F, Adams T. Applying the transtheoretical model to cancer screening behavior. Am J Health Behav. 2005;29:36–56.

    Article  PubMed  Google Scholar 

  25. Surís AM, Trapp MC, DiClemente CC, Cousins J. Application of the transtheoretical model of behavior change for obesity in Mexican American women. Addict Behav. 1998;23:655–68.

    Article  PubMed  Google Scholar 

  26. Fernández ME, Gonzales A, Tortolero-Luna G, Williams J, Saavedra-Embesi M, Chan W, et al. Effectiveness of Cultivando La Salud: a breast and cervical cancer screening promotion program for low-income Hispanic women. Am J Public Health. 2009;99:936–43.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Pekmezi DW, Neighbors CJ, Lee CS, Gans KM, Bock BC, Morrow KM, et al. A culturally adapted physical activity intervention for Latinas: a randomized controlled trial. Am J Prev Med. 2009;37:495–500.

    Article  PubMed Central  PubMed  Google Scholar 

  28. de Fontes Oliveira MDC, Anderson J, Auld G, Kendall P. Validation of a tool to measure processes of change for fruit and vegetable consumption among male college students. J Nutr Educ Behav. 2005;37:2–11.

    Article  Google Scholar 

  29. Braschi CD, Sly JR, Singh S, Villagra C, Jandorf L. Increasing colonoscopy screening for Latino Americans through a patient navigation model: a randomized clinical trial. J Immigr Minor Health. 2014;16:934–40.

    Article  PubMed  Google Scholar 

  30. Jandorf L, Braschi C, Ernstoff E, Wong CR, Thelemaque L, Winkel G, et al. Culturally targeted patient navigation for increasing African Americans’ adherence to screening colonoscopy: a randomized clinical trial. Cancer Epidemiol Biomark Prev. 2013;22:1577–87.

    Article  Google Scholar 

  31. Chen LA, Santos S, Jandorf L, Christie J, Castillo A, Winkel G, et al. A program to enhance completion of screening colonoscopy among urban minorities. Clin Gastroenterol Hepatol. 2008;6:443–50.

    Article  PubMed  Google Scholar 

  32. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum; 1988.

    Google Scholar 

  33. Roberto AJ, Krieger JL, Beam MA. Enhancing web-based kidney disease prevention messages for Hispanics using targeting and tailoring. J Health Commun. 2009;14:525–40.

    Article  PubMed  Google Scholar 

  34. Skinner CS, Strecher VJ, Hospers H. Physicians’ recommendations for mammography: do tailored messages make a difference? Am J Public Health. 1994;84:43–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Stone EG, Morton SC, Hulscher ME, Maglione MA, Roth EA, Grimshaw JM, et al. Interventions that increase use of adult immunization and cancer screening services: a meta-analysis. Ann Intern Med. 2002;136:641–51.

    Article  PubMed  Google Scholar 

  36. Tilley BC, Vernon SW, Myers R, Glanz K, Lu M, Hirst K, et al. The next step trial: impact of a worksite colorectal cancer screening promotion program. Prev Med. 1999;28:276–83.

    Article  CAS  PubMed  Google Scholar 

  37. Wardle J, Williamson S, McCaffery K, Sutton S, Taylor T, Edwards R, et al. Increasing attendance at colorectal cancer screening: testing the efficacy of a mailed, psychoeducational intervention in a community sample of older adults. Health Psychol. 2003;22:99–105.

    Article  PubMed  Google Scholar 

  38. Zubarik R, Eisen G, Zubarik J, Teal C, Benjamin S, Glaser M, et al. Education improves colorectal cancer screening by flexible sigmoidoscopy in an inner city population. Am J Gastroenterol. 2000;95:509–12.

    Article  CAS  PubMed  Google Scholar 

  39. Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. J Pers Soc Psychol. 1994;67:1063–78.

    Article  CAS  PubMed  Google Scholar 

  40. Efuni E, Schofield E, Duhamel KN, Villagra C, Cohen N, Reid F, et al. Optimism, worry, and colorectal cancer screening among low-income Latinos. Health Behav Policy Rev. 2018;5:23–32.

  41. Pruitt SL, McQueen A, Tiro JA, Rakowski W, Diclemente CC, Vernon SW. Construct validity of a mammography processes of change scale and invariance by stage of change. J Health Psychol. 2010;15:64–74.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Percac-Lima S, Grant RW, Green AR, Ashburner JM, Gamba G, Oo S, et al. A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial. J Gen Intern Med. 2009;24:211–7.

    Article  PubMed  Google Scholar 

  43. Paskett ED, Harrop JP, Wells KJ. Patient navigation: an update on the state of the science. CA Cancer J Clin. 2011;61:237–49.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Reuland DS, Brenner AT, Hoffman R, McWilliams A, Rhyne RL, Getrich C, et al. Effect of combined patient decision aid and patient navigation vs usual care for colorectal cancer screening in a vulnerable patient population: a randomized clinical trial. JAMA Intern Med. 2017;177:967–74.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Carroll JK, Humiston SG, Meldrum SC, Salamone CM, Jean-Pierre P, Epstein RM, et al. Patients’ experiences with navigation for cancer care. Patient Educ Couns. 2010;80:241–7.

    Article  PubMed  Google Scholar 

Download references

Funding

This study was funded by National Cancer Institute R01 CA140737 (ClinicalTrials.gov identifier NCT01569620) and National Institutes of Health Cancer Center Support Grant P30 CA008748.

Author information

Authors and Affiliations

  1. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY, 10029, USA

    Gina Cotter & Lina Jandorf

  2. Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY, 10022, USA

    Gina Cotter, Katherine DuHamel & Elizabeth Schofield

  3. Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA, 19104, USA

    Gina Cotter

Authors
  1. Gina Cotter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine DuHamel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth Schofield
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lina Jandorf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine DuHamel.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cotter, G., DuHamel, K., Schofield, E. et al. Processes of Change for Colonoscopy: Limited Support for Use Among Navigated Latinos. J. Racial and Ethnic Health Disparities 6, 327–334 (2019). https://doi.org/10.1007/s40615-018-0528-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-018-0528-4

Keywords

Search

Navigation