Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening in Aydın central region

Abstract

Objective: Colorectal cancer (CRC), which ranks third in cancer morbidity and second in cancer deaths worldwide, can be detected early and prevented with mass screening programs. Improving community awareness of CRC is crucial for the success of these programs. This study investigated the association of screening test participation with knowledge of, attitudes toward, and barriers to CRC and screening tests in Aydın central region.

Methods: In a one-month period in 2012 (March) person-to-person interviews by using a standardized survey instrument were conducted with 562 subjects aged 50 years and older who were randomly recruited from eight family medicine centers (FHCs) in Aydın central region. Eight family health centers were randomly determined among 24 FHCs in the region. The study questionnaire included items questioning the screening participation status, knowledge of, attitudes toward, and barriers to CRC and screening tests, and intent to participate.

Results: The mean age of the participants was 59.8±7.4 years (range, 50–80 years), and 66.9% (376 participants) were male. One hundred forty six participants (25.8%) had knowledge about CRC and 68 participants (12.1%) knew that CRC could be diagnosed early. Of the participants, 32 (5.7%) knew colonoscopy and 13 (2.3%) fecal occult blood testing (FOBT) as a screening method. A total of 66 (11.9%) of participants had undergone previous CRC testing (FOBT 7.7%; sigmoidoscopy 3.6% and colonoscopy 5.4%). Only 25.9% (145 subjects) of the respondents received physician recommendations to undergo CRC testing and 67.3% (105 subjects) of them obeyed the recommendation. Age (p=0.009), health insurance (p=0.009), being diagnosed with any kind of cancer (p<0.001), having a relative with any kind of cancer (p=0.01) and receiveing physician recommendation of screening tests (p<0.001) were correlated with screening test participation. While having general knowledge of CRC had no effect on the screening participation (p>0.05), those participants knowing colonoscopy as a screening test underwent more screening (p<0,01). Although 39.3% (221 respondents) perceived need for screening, most respondents responded (66.0%; 371 subjects) positively to undergo future CRC testing. The most frequently reported barriers to getting CRC screening tests were not knowing CRC and screening tests (182 subjects, 32.4%) and not seeing themselves at high risk (164 subjects, 29.2%).

Conclusion: Our results demonstrate that people applying to regional FHCs lack of knowledge of CRC and screening tests recommended for those older than 50 years are neither sufficiently known nor used. Physicians do not sufficiently recommend for the screening tests, whereas the recommendations are practiced well. General knowledge of CRC don’t seem to affect behaviours, however more specific knowledge effects them positively.