Abstract
Background
Despite the acknowledged importance of colorectal cancer (CRC) screening and its proven prognostic benefit, African American men and women simultaneously possess the highest rates of CRC-related incidence and mortality (Swan et al. in Cancer 97(6):1528–1540, 2003) and lowest screening rates in the United States (Polite et al. in Med Clin N Am 89(4):771–793, 2005). Effective, targeted interventions that promote CRC screening for this community are therefore critical. The current study evaluated the impact of a print-based educational intervention on screening behavior and associated patient-based factors, including cancer-related knowledge, fatalism, worry, and decisional balance (pros–cons).
Methods
One hundred and eighteen individuals (mean age = 56.08, SD = 5.58) who had not undergone screening were recruited from two health clinics in New York City. Each participant received educational print materials regarding the need for screening, the process of undergoing screening, and the benefits of regular CRC screening.
Results
One in four individuals had undergone post-intervention screening at a three-month follow-up. Whereas all participants reported a decrease in cancer-related worry (p < .05), it was a decrease in fatalism (p < .05) and an increase in decisional balance (p < .05) that was associated with post-intervention screening behavior.
Discussion
These preliminary results suggest that fatalistic beliefs and an individual’s assessment of the benefits and barriers of screening may be critical in the decision to undergo CRC screening. Future interventions to increase CRC-screening rates for this community may be improved by focusing on these patient-based factors.
Similar content being viewed by others
References
Swan J, Breen N, Coates RJ, Rimer BK, Lee NC (2003) Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer 97(6):1528–1540
Polite BN, Dignam JJ, Olopade OI (2005) Colorectal cancer and race: understanding the differences in outcomes between African Americans and whites. Med Clin N Am 89(4):771–793
ACS (2008) The cancer experience: colon and rectum cancer
Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM et al (1993) Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 328(19):1365–1371
Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS (1992) A case–control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 326(10):653–657
Group USCSW (2007) United States Cancer Statistics: 2003 Incidence and Mortality: Department of Health and Human Services. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute, Atlanta
Wolff M, Bates T, Beck B, Young S, Ahmed SM, Maurana C (2003) Cancer prevention in underserved African American communities: barriers and effective strategies—a review of the literature. WMJ 102(5):36–40
Lipkus IM, Rimer BK, Lyna PR, Pradhan AA, Conaway M, Woods-Powell CT (1996) Colorectal screening patterns and perceptions of risk among African-American users of a community health center. J Community Health 21(6):409–427
Wardle J, Williamson S, McCaffery K, Sutton S, Taylor T, Edwards R et al (2003) Increasing attendance at colorectal cancer screening: testing the efficacy of a mailed, psychoeducational intervention in a community sample of older adults. Health Psychol 22(1):99–105
Cole SR, Smith A, Wilson C, Turnbull D, Esterman A, Young GP (2007) An advance notification letter increases participation in colorectal cancer screening. J Med Screen 14(2):73–75
Fitzgibbon ML, Ferreira MR, Dolan NC, Davis TC, Rademaker AW, Wolf MS et al (2007) Process evaluation in an intervention designed to improve rates of colorectal cancer screening in a VA medical center. Health Promot Pract 8(3):273–281
Myers RE, Turner B, Weinberg D, Hyslop T, Hauck WW, Brigham T et al (2004) Impact of a physician-oriented intervention on follow-up in colorectal cancer screening. Prev Med 38(4):375–381
Coughlin SS, Costanza ME, Fernandez ME, Glanz K, Lee JW, Smith SA et al (2006) CDC-funded intervention research aimed at promoting colorectal cancer screening in communities. Cancer 107(5 Suppl):1196–1204
Basch CE, Wolf RL, Brouse CH, Shmukler C, Neugut A, DeCarlo LT et al (2006) Telephone outreach to increase colorectal cancer screening in an urban minority population. Am J Public Health 96(12):2246–2253
Blumenthal DS, Fort JG, Ahmed NU, Semenya KA, Schreiber GB, Perry S et al (2005) Impact of a two-city community cancer prevention intervention on African Americans. J Natl Med Assoc 97(11):1479–1488
Ford ME, Havstad S, Vernon SW, Davis SD, Kroll D, Lamerato L et al (2006) Enhancing adherence among older African American men enrolled in a longitudinal cancer screening trial. Gerontologist 46(4):545–550
Katz ML, Tatum C, Dickinson SL, Murray DM, Long-Foley K, Cooper MR et al (2007) Improving colorectal cancer screening by using community volunteers: results of the Carolinas cancer education and screening (CARES) project. Cancer 110(7):1602–1610
Powe BD, Ntekop E, Barron M (2004) An intervention study to increase colorectal cancer knowledge and screening among community elders. Public Health Nurs 21(5):435–442
Zubarik R, Eisen G, Zubarik J, Teal C, Benjamin S, Glaser M et al (2000) Education improves colorectal cancer screening by flexible sigmoidoscopy in an inner city population. Am J Gastroenterol 95(2):509–512
Khankari K, Eder M, Osborn CY, Makoul G, Clayman M, Skripkauskas S et al (2007) Improving colorectal cancer screening among the medically underserved: a pilot study within a federally qualified health center. J Gen Intern Med 22(10):1410–1414
Ford ME, Havstad SL, Davis SD (2004) A randomized trial of recruitment methods for older African American men in the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial. Clin Trials 1(4):343–351
Guerra CE, Schwartz JS, Armstrong K, Brown JS, Halbert CH, Shea JA (2007) Barriers of and facilitators to physician recommendation of colorectal cancer screening. J Gen Intern Med 22(12):1681–1688
Kelly KM, Dickinson SL, Degraffinreid CR, Tatum CM, Paskett ED (2007) Colorectal cancer screening in 3 racial groups. American Journal of Health Behavior 31(5):502–513
Ajzen I, Fishbein M (1980) Understanding attitudes and predicting social behavior: an introduction to theory and research. Prentice-Hall, Englewood Cliffs
Fishbein M, Ajzen I (1975) Belief, attitude, intention, and behavior: an introduction to theory and research. Addison-Wesley, Reading
Prochaska JO, DiClemente CC (1983) Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 51(3):390–395
Prochaska JO, Velicer WF (1997) The transtheoretical model of health behavior change. Am J Health Promot 12(1):38–48
Rakowski W, Dube CE, Marcus BH, Prochaska JO, Velicer WF, Abrams DB (1992) Assessing elements of women’s decisions about mammography. Health Psychol 11(2):111–118
Rakowski W, Fulton JP, Feldman JP (1993) Women’s decision making about mammography: a replication of the relationship between stages of adoption and decisional balance. Health Psychol 12(3):209–214
Rakowski W, Clark MA, Pearlman DN, Ehrich B, Rimer BK, Goldstein MG et al (1997) Integrating pros and cons for mammography and Pap testing: extending the construct of decisional balance to two behaviors. Prev Med 26(5 Pt 1):664–673
Chamot E, Charvet AI, Perneger TV (2001) Predicting stages of adoption of mammography screening in a general population. Eur J Cancer 37(15):1869–1877
Costanza ME, Luckmann R, Stoddard AM, Avrunin JS, White MJ, Stark JR et al (2005) Applying a stage model of behavior change to colon cancer screening. Prev Med 41(3–4):707–719
Lauver, Henriques JB, Settersten L, Bumann MC (2003) Psychosocial variables, external barriers, and stage of mammography adoption. Health Psychol 22(6):649–653
Trauth J, Ling B, Weissfeld J et al (2003) Using the transtheoretical model to stage screening behavior for colorectal cancer. Educ Behav 30:322–336
Spencer L, Pagell F, Adams T (2005) Applying the transtheoretical model to cancer screening behavior. Am J Health Behav 29(1):36–56
McAlearney AS, Reeves KW, Dickinson SL, Kelly KM, Tatum C, Katz ML et al (2008) Racial differences in colorectal cancer screening practices and knowledge within a low-income population. Cancer 112(2):391–398
Hay JL, Buckley TR, Ostroff JS (2005) The role of cancer worry in cancer screening: a theoretical and empirical review of the literature. Psychooncology 14(7):517–534
Stark JR, Bertone-Johnson ER, Costanza ME, Stoddard AM (2006) Factors associated with colorectal cancer risk perception: the role of polyps and family history. Health Educ Res 21(5):740–749
Hay JL, McCaul KD, Magnan RE (2006) Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence. Prev Med 42(6):401–408
Brenes GA, Paskett ED (2000) Predictors of stage of adoption for colorectal cancer screening. Prev Med 31(4):410–416
Powe BD, Finnie R (2003) Cancer fatalism: the state of the science. Cancer Nurs 26(6):454–465 quiz 66–67
Niederdeppe J, Levy AG (2007) Fatalistic beliefs about cancer prevention and three prevention behaviors. Cancer Epidemiol Biomark Prevent 16(5):998–1003
Powe BD (1996) Cancer fatalism among African-Americans: a review of the literature. Nurs Outlook 44(1):18–21
Powe BD (1994) Perceptions of cancer fatalism among African Americans: the influence of education, income, and cancer knowledge. J Natl Black Nurs Assoc 7(2):41–48
Powe BD (1995) Fatalism among elderly African Americans. Effects on colorectal cancer screening. Cancer Nurs 18(5):385–392
Shankar S, Selvin E, Alberg AJ (2002) Perceptions of cancer in an African-American community: a focus group report. Ethn Dis 12(2):276–283
Farmer D, Reddick B, D’Agostino R, Jackson SA (2007) Psychosocial correlates of mammography screening in older African American women. Oncol Nurs Forum 34(1):117–123
Spurlock WR, Cullins LS, 1 (2006) Cancer fatalism and breast cancer screening in African American women. ABNF J 17(1):38–43
Remennick L (2006) The challenge of early breast cancer detection among immigrant and minority women in multicultural societies. Breast J 12(Suppl 1):S103–S110
Phillips JM, Cohen MZ, Moses G (1999) Breast cancer screening and African American women: fear, fatalism, and silence. Oncol Nurs Forum 26(3):561–571
Greiner KA, Born W, Nollen N, Ahluwalia JS (2005) Knowledge and perceptions of colorectal cancer screening among urban African Americans. J Gen Intern Med 20(11):977–983
Manne S, Markowitz A, Winawer S, Meropol NJ, Haller D, Rakowski W et al (2002) Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer. Health Psychol 21(1):3–15
Vernon SW (1997) Participation in colorectal cancer screening: a review. J Natl Cancer Inst 89(19):1406–1422
Freeman KL, Jandorf L, Thompson H, DuHamel K (2010) Colorectal cancer brochure development for African Americans. J Health Dispar Res Pract 3(3):43–56
Denberg TD, Melhado TV, Coombes JM, Beaty BL, Berman K, Byers TE et al (2005) Predictors of nonadherence to screening colonoscopy. J Gen Intern Med 20(11):989–995
Bajracharya SM (2006) An assessment of the perceived barriers and strategies to promoting early detection of colorectal cancer: a practitioners’ perspective. Int Q Community Health Educ 26(1):23–44
Ward SH, Lin K, Meyer B, Bass SB, Parameswaran L, Gordon TF et al (2008) Increasing colorectal cancer screening among African Americans, linking risk perception to interventions targeting patients, communities and clinicians. J Natl Med Assoc 100(6):748–758
Green PM, Kelly BA (2004) Colorectal cancer knowledge, perceptions, and behaviors in African Americans. Cancer Nurs 27(3):206–215 quiz 16–17
Acknowledgments
This research was supported by Grant No. R01 CA104130-01 from the National Cancer Institute.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Philip, E.J., DuHamel, K. & Jandorf, L. Evaluating the impact of an educational intervention to increase CRC screening rates in the African American community: a preliminary study. Cancer Causes Control 21, 1685–1691 (2010). https://doi.org/10.1007/s10552-010-9597-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-010-9597-3