Original article
Perceived barriers and benefits in the participation in faecal occult blood test colorectal cancer screening programmeBarreras y beneficios percibidos en la participación en el cribado de cáncer de colon mediante test de sangre oculta en heces

https://doi.org/10.1016/j.gastrohep.2022.05.003Get rights and content

Abstract

Background

Colorectal cancer is the second cancer-related cause of death in the world. Tumour stage at diagnosis is the principal prognosis factor of survival. However, the participation in the programme is around 50%. The aim of the study was to identify the benefits and barriers perceived by the population when participating in a colorectal cancer screening programme with faecal occult blood test.

Methods

We carried out a cases–controls study with 408 participants. We analyzed epidemiological and social variables associated with lifestyle and behavioural factors based in the Health Belief Model. We conducted a descriptive analysis, and identified variables associated to adherence by a logistic regression.

Results

Variables independently associated with the participation in a colorectal cancer screening programme were age (OR 1.06; 95% CI: 1.01–1.11), having a stable partner (OR 1.96; 95% CI: 1.20–3.18), the level of education (OR 1.59; 95% CI: 1.02–2.47) and two of the barriers to participate in the faecal occult blood test screening: “you don’t know how to do one” (OR = 0.46; 95% CI: 0.23–0.93) and “it is not that important right now” (OR = 0.43; 95% CI: 0.24–0.78).

Conclusion

The existing barriers for screening with faecal occult blood test are the best factor predicting. This is relevant when designing the intervention programmes, as they should focus on reducing perceived barriers to increase the participation in colorectal cancer screening, thereby reducing colorectal cancer mortality.

Resumen

Antecedentes

El cáncer colorrectal constituye la segunda causa de muerte por cáncer en el mundo. El estadio del tumor al diagnóstico es el principal factor pronóstico de supervivencia. Sin embargo, la participación en el programa está en torno al 50%. El objetivo de este estudio fue identificar los beneficios y las barreras percibidos por la población al participar en un programa de cribado de cáncer de colon mediante el test de sangre oculta en heces.

Métodos

Estudio de casos y controles con 408 participantes en el que analizamos variables sociodemográficas, variables asociadas al estilo de vida y factores conductuales basados en el Modelo de Creencias en Salud. Realizamos un análisis descriptivo y, para identificar las variables asociadas a la adhesión al programa de cribado de cáncer colorrectal, una regresión logística.

Resultados

Las variables que se asociaron de forma independiente a la participación en el programa fueron la edad (OR 1,06; IC 95% 1,01-1,11), tener pareja estable (OR 1,96; IC 95% 1,20-3,18), el nivel de estudios (OR 1,59; IC 95% 1,02-2,47) y 2 de las barreras para participar en el cribado mediante test de sangre oculta en heces: «no sabe cómo hacerlo» (OR 0,46; IC 95% 0,23-0,93) y «no es un problema importante en el momento actual» (OR 0,3; IC 95% 0,24-0,78).

Conclusión

Las barreras existentes para el cribado mediante test de sangre oculta en heces son el mejor factor predictivo de participación. Esto es importante a la hora de diseñar los programas de cribado de cáncer colorrectal, ya que la reducción de las barreras percibidas aumentará la participación en los mismos, reduciendo así la mortalidad por cáncer de colon.

Section snippets

Background

Colorectal cancer (CRC) is the second most common cause of cancer-related deaths in the world, accounting 935.173 deaths in 2020. The incidence of this neoplasm, irrespective of gender, is the third highest after breast and lung cancer, with an estimated 1.931.590 new cases in 2020.1

Five-year relative survival rate for patients with CRC in Spain is just 57%. Survival of CRC patients detected in a screening programme is higher than that of patients diagnosed for symptoms.2 The screening strategy

Methods

We designed a case–control study performed in three primary health centres in Valencia, Spain: Chile, Argentina and Serrería II. We performed a simple random sampling among individuals invited to participate in the colorectal cancer screening programme. Data were collected by previously trained researchers from March to September 2019. The individuals agreeing to participate in the study were scheduled for an in-person appointment on the invitation of the researchers.

We included subjects

Results

A total of 1017 individuals were invited to participate in the study. As shown in Fig. 2, 358 individuals could not be contacted; 128 did not want to participate; 80 were unable to attend the interviews; and 43 did not meet the criteria for inclusion.

Out of 408 individuals included, 237 participated in the screening programme (cases) and 171 did not participate (controls). No statistically significant differences were found between the individuals included/excluded with regard to age and

Discussion

Our study found that the theoretical HBM model is consistent with CRC screening in the Spanish population. The perceived barriers stated by individuals with regard to the collection of FOBT samples appear as the most powerful cognitive concept of the Model, unlike the benefits of the screening. This has to be taken into account when planning educational interventions in the population.

Mean age of participants was around 60 years, in line with the age of similar studies, as it is the usual age

Conclusions

As a conclusion, we can say that the existing barriers for screening with FOBT are the factor best predicting participation in CRC screening programmes. This is significant when designing the intervention programmes, as they should focus on reducing perceived barriers and improving accessibility to the test to increase the participation in CRC screening, thereby reducing CRC mortality. Longitudinal studies in different populations are necessary to make further progress in the understanding of

Ethics approval

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the General Directorate for Public Health and Higher Centre for Public Health Research of Valencia (protocol code 20190301/04 and date of approval 01/03/2019).

Funding

This work received funding from the Spanish Society of Family and Community Medicine – semFYC – by being the winner of a grant for the completion of doctoral theses Isabel Fernández 2021.

Conflict of interest

The authors declare no conflicts of interest.

Acknowledgements

To all my promotion colleagues, tutors, and especially my father for his unconditional support. To semFYC for financing this project with one of its grants.

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