Characteristics of the participating medical students
A total of 581 students participated in this study. Detailed demographic characteristics of the study cohort are shown in Table 1. The majority (52.07%) of the students were females and mostly (48.36%) between the ages of 22 and 23 years. More than half (62.48%) of the sample were from Makkah while only 37.52% were from Jeddah. The highest proportion (37.07%) of the sample were in their 4th year, 34.83% were in their 5th year, and 28.10% were in their 6th year.
Medical students ‘knowledge and attitude regarding CRC
Most (60.76%) of the medical students agreed that a colonoscopy is a very effective cancer screening method and approximately 30.0% of them claimed that the fecal occult blood test is also a very effective method. Sigmoidoscopy as a screening method was thought to be effective/somewhat effective by 71.95% of this sample of medical students; 41.14% reported that double-contrast barium enema is not effective or did not know about it.
Regarding knowledge of risk factors for colorectal cancer screening, most of the participating medical students reported that family history and an increase in age are risk factors for developing CRC (77.59 and 67.76%; respectively). Also, around 61.10% believed that dietary behavior is a risk factor and 60.96% also mentioned smoking as a risk factor. Male gender, inflammatory bowel disease and a lack of physical activity were also reported as potential risk factors by 48.79, 44.14, and 34.48% of the sample, respectively. Knowledge score (regarding CRC screening methods and risk factors) was lower than average among 54.78% of this sample of medical students.
Personal attitudes regarding cancer screening varied among the medical students. Approximately 87.91% of the students strongly agreed/agreed that the early detection for CRC is favorable and 77.96% of them agreed that undergoing screening provides peace of mind. On the other hand, 56.55% of participants reported an agreement that screening is not beneficial. Slightly more than half (52.07%) of this sample agreed that colonoscopy is embarrassing. The majority of the students (77.92%) expressed a positive attitude towards paying for CRC screening themselves if not covered by health insurance. Attitude score regarding screening for CRC was poor among 57.83% of participating medical students (results for this section are presented in Table 2).
Medical students’ reported barriers regarding CRC screening
The medical students reported patient-related barriers and health system-related barriers to CRC screening. Among the reported patient-related major barriers were a fear of finding cancer (56.72%), experiencing embarrassment or anxiety (53.10%), not knowing about the disease in general (52.76%), and being asymptomatic (51.21%).
The reported health system-related major barriers regarding CRC screening were a lack of knowledge about screening guidelines (57.76%), high cost and lack of coverage (56.38%), lack of recommendations in primary healthcare (45.0%), and a shortage of healthcare providers to conduct screening other than the fecal occult blood testing (42.24%). Results for reported barriers are shown in Table 3.
Factors associated with knowledge about colorectal cancer and related screening procedures
Bivariate analysis showed that the level of knowledge related to CRC risk factors and screening among this group of medical students varied significantly by age (p < 0.001), medical school year (p < 0.001), surveyed college (p < 0.001) and attitude towards CRC (p < 0.001). There were many reported barriers to CRC screening in the participating medical students (Table 4), including patient fear of finding cancer (p = 0.018), patient embarrassment or anxiety related to screening (p < 0.001), not perceiving CRC as a serious health threat (p = 0.005), a lack of symptoms for CRC as a reason not to conduct screening (p < 0.001), a lack of knowledge about the disease in general (p < 0.001), patients procrastinating about the procedure (p = 0.004), high cost or no availability of screening (p = 0.005), a lack of recommendations for screening in primary care (p < 0.001), and a shortage of healthcare providers who can conduct screening (p < 0.001) or follow-up with invasive endoscopic procedure (p < 0.001) (Table 4).
Further analysis using univariate and multivariate logistic regression, to ascertain the effect of study variables on the level of knowledge about CRC among this sample of medical students was used. The final multivariate logistic regression, showed that being a student in year 5 (OR = 2.97, 95%CI: 1.90–4.65) or year 6 (OR = 3.23, 95%CI: 2.01–5.18), and reporting a good attitude towards CRC and related screening procedures (OR = 2.74, 95%CI:1.86–4.03), were independently associated with a higher level of knowledge. In addition, reporting patient-related barriers to screening such as not perceiving CRC screening as a serious health threat (OR = 0.74, 95%CI:0.58–0.94), asymptomatic CRC (OR = 0.71, 95%CI:0.55–0.91) and patient lack of knowledge about CRC (OR = 0.53, 95%CI:0.40–0.71) were all independently associated with a lower level of knowledge among medical students. The shortage of trained providers to conduct follow-up with invasive endoscopic procedures (OR = 0.58, 95%CI: 0.44–0.78) as a healthcare system-related barrier was also significantly associated with a lower level of knowledge about CRC risk factors and screening procedures (Tables 5 and 6).