Intention to Screen for Colorectal Cancer among White Male Employees

doi:10.1006/pmed.1998.0264

Preventive Medicine

Volume 27, Issue 2, March 1998, Pages 279-287

https://doi.org/10.1006/pmed.1998.0264 Get rights and content

Abstract

Background.This study identifies factors associated with employee intention to participate in a company-sponsored program of continuous screening for colorectal cancer. Automobile industry pattern and model makers who had been offered screening for over a decade were included in the study.

Methods.Data were collected at the outset of a randomized trial of screening and nutrition interventions. A baseline survey was mailed to 4,490 white men without a history of colorectal cancer. This mailing generated complete responses from 2,693 (60%) individuals. Survey data obtained for these men, including measures of cognitive and psychological representations related to colorectal screening, social influence, and intention to screen, were supplemented by background information gathered from employment records of these men. Workplace screening services were documented via a survey of plant health care professionals.

Results.Fifty-eight percent of respondents reported a high level of intention to screen. Multivariate analyses showed that intention to screen was positively associated with employee past participation in screening, belief in the salience and coherence of screening, belief in screening efficacy, perceived self-efficacy, belief that polyp removal prevents colorectal cancer, perceived personal susceptibility to colorectal cancer or polyps, receptivity to family member support for screening, and workplace scheduling of screening examinations.

Conclusion.Factors associated with intention to screen may contribute to participation in continuous screening programs. Research is needed to assess the impact of interventions that facilitate appointment scheduling, provide tailored education about screening, and encourage lay support.

References (40)

S Heyden et al.
Industrial cancer education and screening for 19,000 Cannon Mills employees
J Chron Dis
(1981)
D Abrams et al.
Cancer control at the workplace: the working well trial
Prev Med
(1994)
R Myers et al.
Modeling adherence to colorectal cancer screening
Prev Med
(1994)
O Kronborg et al.
Randomized study of screening for colorectal cancer with fecal-occult-blood test
Lancet
(1996)
JD Hardcastle et al.
Randomized controlled trial of fecal-occult-blood for colorectal cancer
Lancet
(1996)
AR Neilson et al.
Determinants of persistent compliance with screening for colorectal cancer
Soc Sci Med
(1995)
D Lieberman et al.
Is it time to recommend screening for colorectal cancer?
Lancet
(1996)
BC Tilley et al.
Worksite cancer screening and nutrition intervention for high risk auto workers: design and baseline findings of the next step trial
Prev Med
(1997)
DP Weller et al.
Colorectal cancer and its prevention: prevalence of beliefs, attitudes, intentions and behavior
Aust J Public Health
(1995)
KD Lindsted et al.
Healthy volunteer effect in a cohort study: temporal resolution in the Adventist health study
J Clin Epidemiol
(1996)

U.S. Department of Health and Human Services, National survey of worksite health promotion activities: a summary,...

Public Health Service, U.S. Department of Health and Human Services, 1992 national survey of worksite health promotion...

L Zimmerman et al.

Cancer education and screening in the workplace: the corporate perspective

(1987)

S Johnson

Breast screening's bottom line: lives saved

Admin Radiol

(1988)

KE Warner et al.

Economic implication of workplace health promotion programs: review of the literature

J Occup Med

(1988)

K Glanz et al.

Factors associated with adherence to breast cancer screening among working women

J Occup Med

(1992)

J Heimendinger et al.

Reducing the risk of cancer through worksite intervention

J Occup Med

(1990)

MMWR

(1997)

RY Demers et al.

Prevalence of colorectal polyps among Michigan pattern and model makers

J Occup Med

(1985)

Cited by (64)

Disparities in cancer screening by occupational characteristics
2017, Preventive Medicine
Citation Excerpt :
Our findings help identify where workplace-based interventions and health systems interventions are needed. The influence of workplace-based interventions and programs on cancer screening uptake and awareness have been examined in a few studies with mixed findings (Hui et al., 2013; Lipkus et al., 2005; Allen et al., 2001; Myers et al., 1998; Paskett et al., 1999). The use of health risk assessments, including follow-up counseling, which are recommended by the CDC's community guide and the most common workplace wellness program, could be an avenue to implement cancer screening programs (Baicker et al., 2010; Community Preventive Services Task Force, 2007).
Cancer screening patterns according to occupation characteristics in the United States are not well known, but could be used to help inform cancer control efforts. We examined cervical (CC), breast (BC) and colorectal cancer (CRC) screening prevalence and prevalence ratios (PR) by occupational characteristics in 2010, 2013 and 2015 National Health Interview Surveys (NHIS) among eligible US workers (CC women 21–65 years; n = 20,997), (BC women ≥ 40 years; n = 14,258) and (CRC men and women ≥ 50 years; n = 17,333). Cervical, breast and colorectal cancer screening prevalence among US workers was 84.0%, 68.9%, and 56.8%, respectively. Unadjusted prevalence ratios for cervical (PR = 0.92, 95%CI 0.90, 0.94), breast (PR = 0.86, 95%CI 0.83, 0.90) and colorectal cancer screening (PR = 0.83, 95%CI 0.80, 0.87) were lower among workers in small (< 25 employees) compared to large organizations (≥ 500 employees). People in food service, construction, production, and sales occupations were 13–26%, 17–28% and 9–30% less likely to be up to date with cervical, breast, and colorectal cancer screening, respectively, compared to healthcare professionals. Adjustment for socioeconomic factors and insurance status eliminated most associations. Disparities in cancer screening by occupational characteristics were mostly attributed to lower socioeconomic status and lack of insurance. These findings underscore the need for innovative public health strategies to improve cancer screening in vulnerable populations.
Implementation intentions and colorectal screening: A randomized trial in safety-net clinics
2014, American Journal of Preventive Medicine
Citation Excerpt :
Self-efficacy included one question for each screening test: Do you think you could complete a colonoscopy/stool blood test? adapted from prior multi-item self-efficacy measures.42,43 Perceived self-efficacy refers to participants’ self-confidence in completing a task.
Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups.
The study aimed to test a theoretically based "implementation intentions" intervention for improving CRC screening among unscreened adults in urban safety-net clinics.
Randomized controlled trial.
Adults (N=470) aged ≥50 years, due for CRC screening, from urban safety-net clinics were recruited.
The intervention (conducted in 2009−2011) was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (Comparison group) or “implementation intentions” questions and planning (Experimental group) specific to the CRC screening test chosen (fecal immunochemical test or colonoscopy).
The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted in 2012−2013).
The study population had a mean age of 57 years and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions−based intervention had higher odds (AOR=1.83, 95% CI=1.23, 2.73) of completing CRC screening than the Comparison group. Those with higher self-efficacy for screening (AOR=1.57, 95% CI=1.03, 2.39), history of asthma (AOR=2.20, 95% CI=1.26, 3.84), no history of diabetes (AOR=1.86, 95% CI=1.21, 2.86), and reporting they had never heard that “cutting on cancer” makes it spread (AOR=1.78, 95% CI=1.16, 2.72) were more likely to complete CRC screening.
The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low-income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors.
Family Support and Colorectal Cancer Screening Among Urban African Americans
2012, Journal for Nurse Practitioners
Colorectal cancer (CRC) is the third leading cause of cancer death among African Americans. Less than 50% of African Americans have had CRC screening. This study examined the relationships between family support and influence, cultural identity, CRC beliefs, and a screening informed decision among 129 urban African Americans. Family support (P < .01) significantly predicted CRC beliefs and CRC beliefs significantly predicted informed decision (P < .01). Based on study results, practitioners should routinely assess family support and CRC beliefs with African Americans patients. This may improve patient-provider shared decision-making satisfaction and CRC screening adherence among African American patients.
Narratives that address affective forecasting errors reduce perceived barriers to colorectal cancer screening
2010, Social Science and Medicine
Citation Excerpt :
In the next two segments of the narrative, the character discussed various barriers to screening. Each of the barriers has been shown to be important in colon cancer screening decisions (Lewis & Jensen, 1996; Myers et al., 1998; Walsh & Terdiman, 2003; Wardle et al., 2000). In one segment, the character described his or her most important barrier.
Narratives from similar others may be an effective way to increase important health behaviors. In this study, we used a narrative intervention to promote colorectal cancer screening. Researchers have suggested that people may overestimate barriers to colorectal cancer screening. We recruited participants from the US, ages 49–60 who had never previously been screened for colorectal cancer, to read an educational message about screening for the disease. One-half of participants were randomly assigned to also receive a narrative within the message (control participants did not receive a narrative). The narrative intervention was developed according to predictions of affective forecasting theory. Compared to participants who received only the educational message, participants who received the message along with a narrative reported that the barriers to screening would have less of an impact on a future screening experience. The narrative also increased risk perception for colorectal cancer and interest in screening in the next year.
A multimedia patient education program on colorectal cancer screening increases knowledge and willingness to consider screening among Hispanic/Latino patients
2009, Patient Education and Counseling
To test a multimedia patient education program on colorectal cancer (CRC) screening that was designed specifically for the Hispanic/Latino community, and developed with input from community members.
A total of 270 Hispanic/Latino adults, age 50–80 years, participated in Spanish for all phases of this pretest–posttest design. Patients were randomly assigned to a version of the multimedia program that opened with either a positive or negative introductory appeal. Structured interviews assessed screening relevant knowledge (anatomy and key terms, screening options, and risk information), past screening behavior, willingness to consider screening options, intention to discuss CRC screening with the doctor, and reactions to the multimedia patient education program.
The multimedia program significantly increased knowledge of anatomy and key terms (e.g., polyp), primary screening options (FOBT, flexible sigmoidoscopy, colonoscopy), and risk information as well as willingness to consider screening (p < .001 for all). No significant differences emerged between positive and negative introductory appeals on these measures, intention to discuss CRC screening with their doctor, or rating the multimedia program.
Multimedia tools developed with community input that are designed to present important health messages using graphics and audio can reach Hispanic/Latino adults across literacy levels and ethnic backgrounds. Additional research is needed to determine effects on actual screening behavior.
Despite promising results for engaging a difficult-to-reach audience, the multimedia program should not be considered a stand-alone intervention or a substitute for communication with physicians. Rather, it is a priming mechanism intended to prepare patients for productive discussions of CRC screening.
Health literacy and self-efficacy for participating in colorectal cancer screening: The role of information processing
2009, Patient Education and Counseling
This study aimed to document the association between health literacy and willingness and ability to seek information about the new colorectal cancer (CRC) screening program in the UK.¹ We also assessed self-efficacy for screening to determine the impact of health literacy on perceived confidence to take part in screening.
Ninety-six participants aged 50–69 years completed the British version of the Test of Functional Health Literacy in Adults (TOFHLA) (UK-TOFHLA) and used an interactive information menu to select information on why and how to participate in CRC screening. We derived a measure of reading effort by calculating the average amount of time spent reading individual information links. Each participant also completed a measure of comprehension, and self-efficacy for participating in screening.
A multivariate analysis supported the hypothesis that lower health literacy would be associated with less information-seeking (b = .079, 95% confidence interval, .001–.157) greater effort in reading (b = −.965, 95% CI, −1.457 to −.473) and less self-efficacy for CRC screening (b = .61, 95% CI, .009–.131).
Lower health literacy had a direct impact on information-seeking. It was also independently associated with perceived confidence to participate in screening.
Reliance on printed communication when inviting low literate adults for screening can be problematic. The independent association between health literacy and self-efficacy further adds to the challenge of developing accessible and effective health promotion materials in this area.

View all citing articles on Scopus

^☆: Financial support for this study was provided through the National Institutes of Health, Grant CA52605.

^☆☆: We express our appreciation to Drs. Karen Glanz and Alan Kristol for their thoughtful review of and critical comments on the manuscript. We also thank Mr. Thomas Wolf and Ms. Trena Diggs for their support in preparing the text and tables.

^★: Engstrom, P, FMortenson, L, EAnderson, P, N

²: To whom reprint requests should be addressed. Fax: (215) 923-9506.

View full text

Regular ArticleIntention to Screen for Colorectal Cancer among White Male Employees☆,☆☆,★

Abstract

J Chron Dis

Prev Med

Prev Med

Lancet

Lancet

Soc Sci Med

Lancet

Prev Med

Aust J Public Health

J Clin Epidemiol

Cancer education and screening in the workplace: the corporate perspective

Breast screening's bottom line: lives saved

Admin Radiol

Economic implication of workplace health promotion programs: review of the literature

J Occup Med

Factors associated with adherence to breast cancer screening among working women

J Occup Med

Reducing the risk of cancer through worksite intervention

J Occup Med

MMWR

Prevalence of colorectal polyps among Michigan pattern and model makers

J Occup Med

Regular Article
Intention to Screen for Colorectal Cancer among White Male Employees☆,☆☆,★