The Current Status Of Colorectal Cancer Screening And Its Influential Factors Among High-risk Population

ObjectiveTo assess the status of knowledge,attitude and behaviour among high-risk population of colorectal cancer and examine related influential factors;and to explore barriers and facilitators to participation in colorectal cancer screening among high-risk population of colorectal cancer and gather suggestions to increase colorectal cancer screening rate within this population.Methods(1)Status survey.Between April and September 2019,using a cluster random sampling method,684 individuals with a high risk of developing colorectal cancer were selected from 9 tertiary hospitals in Hunan province.The general information questionnaires and a pretested structured questionnaire about knowledge,attitude and behaviour of colorectal cancer screening were used to explore colorectal cancer screening knowledge and behaviour among high-risk population of colorectal cancer.(2)Qualitative research.The interview outline was formulated on the basis of relevant literature review and expert discussion.Semi-structured interviews were conducted to explore screening behaviour and influential factors among high-risk population of colorectal cancer by purposive sampling.The survey data were analyzed using SPSS 23.0.Demographic characteristics were analyzed using descriptive statistics.Liner regression was used to analyze factors associated with screening knowledge.To assess factors associated with screening behaviour,logistic regression was used.The qualitative data were analyzed using deductive analysis.Results(1)The high-risk people of colorectal cancer had deficient knowledge and the mean knowledge score was(11.86±4.84)while the total score was 24 points.Independent factors related to knowledge were education level,occupation,income,having health insurance,having seen a doctor in the past year and perceived risk(P<0.05).More than 70% of them held a positive attitude towards screening.Only 91 participants(13.3%)had undergone colorectal cancer screening.Independent factors associated with screening behaviour included personal history of colorectal disease,having seen a doctor in the past year,previous discussion of colorectal cancer screening,high perceived risk and better knowledge(P<0.05).(2)From semi-structured interview with high-risk individuals of colorectal cancer,six themes and fourteen subthemes were identified:(1)perceived susceptibility;(2)perceived severity;(3)perceived benefits;(4)perceived barriers,including seven subthemes: lack of symptom,lack of knowledge,procedural barriers,psychological barriers,cultural barriers,financial barriers and system barriers;(5)cues to action,including seven subthemes: experience symptoms,keep healthy,influence of others,increase knowledge,improve procedure,reduce cost and improve system;(6)self-efficacy.Conclusions(1)The majority of high-risk individuals had deficient knowledge of colorectal cancer screening.Education level,occupation,income,having health insurance,having seen a doctor in the past year and perceived risk are factors that influence the screening knowledge(P<0.05).Most of them held a positive attitude towards screening,however,screening rate of colorectal cancer still was low.Personal history of colorectal disease,having seen a doctor in the past year,previous discussion of screening,perceived risk and knowledge are independent factors that affect the screening behaviour(P<0.05).This has promising implications to design targeted educational campaigns and screening programmes.Health care professionals should advise high-risk individuals to participate in screening and inform them about cancer risk.(2)Colorectal cancer screening behaviour among high-risk population had cognitive,psychological,cultural and system reasons,and they offer four suggestions including provide cognitive education,cognitive education should be culturally tailored,screening method development and system improvement.Health care professionals and policy markers should develop targeted health campaigns and screening educational interventions to promote these high-risk individuals to participate in early screening.