The Impact of Socioeconomic Status on Perceived Barriers to Colorectal Cancer Testing

Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA.
American journal of health promotion: AJHP (Impact Factor: 2.37). 11/2008; 23(2):97-100. DOI: 10.4278/ajhp.07041938
Source: PubMed


Colorectal cancer (CRC) screening is effective, but only one-half of age-eligible adults adhere to national guidelines. Lower socioeconomic status (SES) groups are less likely to be screened.
Baseline data from a prospective study were, used to examine the associations among CRC screening screening barriers, and SES. A convenience sample of adults (N = 291) aged 40 years and older was recruited from a federally qualified health center. Questionnaires were administered orally and included demographics, health, health behavior, and screening barriers.
In logistic regression, having health insurance was associated with greater odds of screening Bivariate analyses detected few differences in fecal occult blood test (FOBT) barriers, but several endoscopy barriers were more common among the lowest SES groups. For example, fear of injury from endoscopy was more likely among low-income and uninsured participants.
The impact of SES on cancer screening is complex, but low-SES participants more often reported certain barriers than their higher-SES counterparts. This was more evident for endoscopy than for FOBT. Programs targeted at low-SES patients may need to focus on barriers that are not fully addressed in traditional promotion efforts.

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    • "Le revers de la médaille étant que les sujets mis au courant de tels risques liés à l'action préventive entretenaient une plus grande méfiance vis-à-vis de la recommandation (Han et al., 2006). Il est en effet montré que lorsque l'examen comporte lui-même un risque (Banks et al., 1995), un coût (Aimee et al., 2008) ou ne constitue pas un moyen de protection face au risque (Leventhal, 1971), il est indiqué de mettre l'accent sur les dangers à ne pas adopter la recommandation (Banks et al., 1995). Ainsi, on interdit à l'individu toute négation de son risque, rendant le statu quo inconfortable. "
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    ABSTRACT: The participation to colorectal cancer screening program determines the efficiency and costeffectiveness of the program. However, participation rates do not reach the expectations and decrease continuously. The goal of the present research was to test the efficiency of different communication strategies used to encourage eligible targets to colorectal cancer screening. The present study is a randomized controlled study conducted on 50 to 52 years old individuals. Two communications strategies were compared. The first was based on informed choice and exposed the pros and cons of screening. The second was based on the fear appeals. Three letters (informed choice, fear appeal and control letters) were conceived and sent to 8660 individuals who were eligible to a first time screening test. A phone interview was conducted with 40 individuals who did not receive screening, in order to measure their attitudes concerning the mail. Results indicated, first, that 25,90% of the subjects had read the mail inviting them to the screening test, and 13.70% were really screened. The three letters generated the same detection rate. However, the informed choice improved the quality of the information about the risks of the screening and aroused a bigger concern to be detected that the other mails. Results are discussed in light of the psychological models of prevention in term of health behaviors. The relevance of campaigns based on direct mailing is discussed in reference to the recent works in marketing.
    No preview · Article · Dec 2015 · Revue Internationale de Psychologie Sociale
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    • "Previous research has shown SES differences in awareness of the purpose of screening or its effects (James et al, 2008; Orbell et al, 2008; Beeken et al, 2011), but the present results, using social grade as a marker of SES, showed no evidence that this translates into differences in recommendation preferences. However, concern remains that evaluating complex information in order to reach an informed decision might be more problematic to those from socially disadvantaged backgrounds (Raffle, 2001), and there remain challenges to achieving informed decision-making across all groups. "
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    ABSTRACT: Background: Informed decision-making approaches to cancer screening emphasise the importance of decisions being determined by individuals' own values and preferences. However, advice from a trusted source may also contribute to autonomous decision-making. This study examined preferences regarding a recommendation from the NHS and information provision in the context of colorectal cancer (CRC) screening. Methods: In face-to-face interviews, a population-based sample of adults across Britain (n=1964; age 50–80 years) indicated their preference between: (1) a strong recommendation to participate in CRC screening, (2) a recommendation alongside advice to make an individual decision, and (3) no recommendation but advice to make an individual decision. Other measures included trust in the NHS and preferences for information on benefits and risks. Results: Most respondents (84%) preferred a recommendation (47% strong recommendation, 37% recommendation plus individual decision-making advice), but the majority also wanted full information on risks (77%) and benefits (78%). Men were more in favour of a recommendation than women (86% vs 81%). Trust in the NHS was high overall, but the minority who expressed low trust were less likely to want a recommendation. Conclusion: Most British adults want full information on risks and benefits of screening but they also want a recommendation from an authoritative source. An ‘expert' view may be an important part of autonomous health decision-making.
    Full-text · Article · Nov 2012 · British Journal of Cancer
    • "However, some documents show greater participation of men than women in screening programs.[32–36] The referred group in this research also showed better education and economic status, which are consistent with the results of Ching-Ti et al.[37] Ching-Ti as well as other researchers reported that poor education and low economical status result in reduced participation in this test as it influences the awareness levels.[20–41] "
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    ABSTRACT: Colorectal cancer is one of the most important and most common cancers and the second leading cause of cancer deaths worldwide. Every year, nearly 1 million new cases of colorectal cancer are recognized around the world and nearly half of them lose their lives due to the disease. The statistics reveal shocking incidence and mortality from colorectal cancer, therefore secondary prevention of this cancer is important and research has shown that by early diagnosis 90% of patients can be treated. Among the colorectal cancer screening tests, fecal occult blood test (FOBT) takes the priority because of its convenience and also low cost. But due to various reasons, the participation of people in this screening test is low. The goal of this study is to assess the factors that affect participation of population at average risk in colorectal cancer screening programs, based on health belief model structures. A cross-sectional survey of 196 individuals, more than 50 years old, was conducted in Isfahan. Ninety-eight people of the target group were selected from laboratories while they came there for doing FOBT test; the method of sampling in this group was random sampling. The method of data collection in the other 98 individuals was by home interview and they were selected by cluster sampling. The questionnaire used was based on health belief model to assess the factors associated with performing FOBT. The data collected were analyzed using descriptive and inferential statistical methods. The mean score of knowledge in the first group was 48/5 ± 11/7 and in the second group was 36/5 ± 19/3. Individuals in the first group were more likely to be married, had more years of schooling, and better financial status. There were significant relationships between knowledge (P<0.001), perceived susceptibility (P<0.001), perceived severity (P<0.001), perceived barriers (P<0.001), and self-efficacy (P<0.001) in the two groups. There was no significant association between the perceived benefits in the two groups. Those people who have had FOBT test in last year in each group reported better score of Health Belief Model model structures. According to this study, it seems that there is an urgent need to pay more attention to this disease and its prevention through screening. With a better understanding of factors affecting the test, it can be a useful step to reduce the rate of death and costs, and improve the community health outcomes.
    No preview · Article · Jul 2012
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