Exploring Gender Differences in Colon Cancer Screening Knowledge and Health Beliefs among African Americans

poster abstractAfrican Americans are diagnosed with and die at higher rates from colorectal cancer (CRC) than any ethnic groups in the United States. Culturally appropriate, effective interventions are urgently needed to reduce these cancer disparities by increasing participation in CRC screening. Both men and women are at risk for CRC, but may have different perceptions of their personal risk for CRC, knowledge, and health beliefs about screening. The purpose of the study was to examine gender differences among 817 African American primary care patients who are overdue for CRC screening. A framework based on the Health Belief Model and the Transtheoretical Model was developed specifically for this study. Baseline data were analyzed from a randomized clinical trial comparing two interventions to promote screening. African American primary care patients (n=817) who were due for screening were recruited from 11 clinics. Telephone interviewers collected baseline data on demographic characteristics, CRC knowledge, CRC health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy). Comparisons between male and female participants were conducted using t-tests and chi-square. Significant differences were found between men and women on several health beliefs about CRC screening. Compared to women, men had higher perceived CRC risk scores (p=.001), higher colonoscopy benefits scores (p=.012), higher colonoscopy self-efficacy scores (p= .005), and higher FOBT self-efficacy scores (p=.000). Women had significantly higher colonoscopy barriers scores (p=.005) than men. No differences were observed between men and women on CRC knowledge scores (p=.829), FOBT benefits scores (p=.783), and FOBT barriers scores (p=.679). Results indicate there are differences between African American men and women in relation to specific CRC screening health beliefs. Knowledge of CRC screening is equally low for both groups. Health care providers should take note of this when providing recommendations for screening. In addition, these results can inform the development of effective strategies for tailoring interventions to increase CRC screening

African American Patients’ Intent to Screen for Colorectal Cancer: Do Cultural Factors, Health Literacy, Knowledge, Age and Gender Matter?

African Americans have higher colorectal cancer (CRC) mortality rates compared with all racial/ethnic groups. Research suggests that CRC screening interventions for African Americans target cultural variables. Secondary analysis of data from 817 African-Americans who had not been screened for CRC was conducted to examine: 1) relationships among cultural variables (provider trust, cancer fatalism, health temporal orientation [HTO]), health literacy, and CRC knowledge; 2) age and gender differences; and 3) relationships among cultural variables, health literacy, CRC knowledge, and CRC screening intention. Provider trust, fatalism, HTO, health literacy, and CRC knowledge demonstrated significant relationships among study variables. Stool blood test intention model explained 43% of the variance, with age and gender being significant predictors. Colonoscopy intention model explained 41% of the variance with gender a significant predictor. Results suggest when developing CRC interventions for African Americans, addressing cultural variables is important, but particular attention should be given to age and gender

Complications And Stoma Care Self-Efficacy Are Associated With Ostomy Adjustment In People With An Intestinal Or Urinary Ostomy

poster abstractMore than 120,000 new ostomies, or surgically created openings through the abdomen for bowel or urinary elimination, are created annually in North America. Up to 80% of patients with a new ostomy experience ostomy-related complications that can interfere with adjustment to living with an ostomy and diminish quality of life. The purpose of this study was to examine relationships among ostomy complications, stoma care self-efficacy, and ostomy adjustment in people living with an intestinal or urinary ostomy. Examining relationships is important to identify people at risk for poor adjustment and to allow for early intervention to improve outcomes for these patients. Data were collected from 202 participants by trained telephone interviewers. Eligible participants: 18 years of age or older, had ostomy surgery within the past 24 months, currently have an ostomy, and were able to speak English. The Ostomy Adjustment Inventory-23 was used to assess adjustment to living with an ostomy and the Stoma Self- Efficacy Scale measured confidence in caring for an ostomy. Univariate analyses were conducted using t-tests, ANOVA, and correlations using the Statistical Package for the Social Sciences. Higher ostomy adjustment scores were observed in participants with permanent versus temporary ostomies (p=.002). Compared to those who did not experience ostomy complications, participants who developed peristomal dermatitis (p=.005), parastomal hypergranulation (p=.003), stomal bleeding (p=.004), and stomal retraction (p=.015) had lower ostomy adjustment scores. Stoma care self-efficacy scores were significantly correlated with ostomy adjustment scores (r=0.534, p=.000). Ostomy complications that may be modifiable influence ostomy adjustment. Additional support and education to reduce complications and enhance stoma care self-efficacy are needed for people at risk for poor adjustment. Future research is needed to develop and test the effectiveness of interventions to enhance self-efficacy and ostomy adjustment

Integrating men's health and masculinity theories to explain colorectal cancer screening behavior

Colorectal cancer (CRC) is the third most common cause of cancer deaths among men in the United States. Although CRC screening has been found to reduce CRC incidence and mortality, current screening rates among men are suboptimal due to various practical and psychosocial barriers. One potential barrier to CRC screening identified in qualitative studies with men is the threat to masculinity that endoscopic screening methods pose. Indeed, beliefs about masculinity have been predictive of other preventive health behaviors among men. In this review article, we propose a novel conceptual framework to explain men's CRC screening behavior that integrates masculinity norms, gender role conflict, men's health care experiences, behaviors, and beliefs, and social and background variables. This framework has the potential to guide future research on men's CRC screening behaviors and other health behaviors and may inform gender-sensitive interventions that target masculinity beliefs to increase preventive health behaviors

Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research

Purpose: To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process. Methods: Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model. Results: Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented. Conclusion: This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development

Adding Natural Frequency Data to a Decision Aid for Colorectal Cancer Screening: Results of a Randomized Trial

Guidelines recommend that decision aids provide natural frequency data regarding baseline risk, risk reduction, and chances of false positives and negatives. Such quantitative information may confuse patients, especially those with low numeracy. We conducted a randomized trial to compare effects of 2 colorectal cancer (CRC) screening decision aids—one with and one without natural frequency data

Interventions to Promote Colorectal Cancer Screening: An Integrative Review

Behavior change interventions to promote colorectal cancer (CRC) screening have targeted people in community and primary care settings, health care providers, and health systems. Randomized controlled trials provide the strongest evidence of intervention efficacy. The purpose of this integrative review was to evaluate trials of CRC screening interventions published between 1997 and 2007 and to identify knowledge gaps and future directions for research. Thirty-three randomized trials that met inclusion criteria were evaluated using a modified version of the TREND criteria. Significant intervention effects were reported in 6 of 10 trials focused on increasing fecal occult blood testing, 4 of 7 trials focused on sigmoidoscopy or colonoscopy completion, and 9 of 16 trials focused on completion of any screening test. Several effective interventions to promote CRC screening were identified. Future trials need to use theory to guide interventions, examine moderators and mediators, consistently report results, and use comparable outcome measures

Psychometric evaluation of the ostomy complication severity index

PURPOSE: The purpose of this study was to evaluate the psychometric properties of a new instrument to measure incidence and severity of ostomy complications early in the postoperative period. SUBJECTS AND SETTINGS: 71 participants were enrolled, most were men (52%), white (96%), and married or partnered (55%). The mean age of participants was 57 ± 15.09 years (mean ± SD). Fifty-two participants (84%) experienced at least 1 ostomy complication in the 60-day postoperative period. The research setting was 3 acute care settings within a large healthcare system in the Midwestern United States. INSTRUMENT: We developed an evidence-based conceptual model to guide development and evaluation of a new instrument, the Pittman Ostomy Complication Severity Index (OCSI). The OCSI format includes Likert-like scale with 9 individual items scored 0 to 3 and a total score computed by summing the individual items. Higher scores indicate more severe ostomy complications. METHOD: This study consisted of 2 phases: (1) an expert review, conducted to establish content validity; and (2) a prospective, longitudinal study design, to examine psychometric properties of the instrument. A convenience sample of 71 adult patients who underwent surgery to create a new fecal ostomy was recruited from 3 hospitals. Descriptive analyses, content validity indices, interrater reliability testing, and construct validity testing were employed. RESULTS: Common complications included leakage (60%), peristomal moisture-associated dermatitis (50%), stomal pain (42%), retraction (39%), and bleeding (32%). The OCSI demonstrated acceptable evidence of content validity index (CVI = 0.9) and interrater reliability for individual items (k = 0.71-1.0), as well as almost perfect agreement for total scores among raters (ICC = 0.991, P = .001). Construct validity of the OCSI was supported by significant correlations among variables in the conceptual model (complications, risk factors, stoma care self-efficacy, and ostomy adjustment). CONCLUSION: OCSI demonstrated acceptable validity and reliability and can be used to assess incidence and severity of ostomy complications in the early postoperative period. We found the OCSI to be brief, easy-to-use, and clinically practical. It can be used to (a) identify priority areas for nursing intervention related to the ostomy, (b) determine appropriate interventions to prevent or treat complications, and (c) evaluate the effects of nursing interventions designed to improve outcomes for patients with ostomies

Masculinity Beliefs and Colorectal Cancer Screening in Male Veterans

As the third most common cause of cancer death among United States men, colorectal cancer (CRC) represents a significant threat to men's health. Although adherence to CRC screening has the potential to reduce CRC mortality by approximately half, men's current rates of adherence fall below national screening objectives. In qualitative studies, men have reported forgoing screenings involving the rectum (e.g., colonoscopy) due to concern about breaching masculinity norms. However, the extent to which masculinity beliefs predict men's CRC screening adherence has yet to be examined. The current study tested the hypothesis that greater endorsement of masculinity beliefs (i.e., self-reliance, risk-taking, heterosexual self-presentation, and primacy of work) would be associated with a lower likelihood of adherence to CRC screening with any test and with colonoscopy specifically. Participants were 327 men aged 51-75 at average risk for CRC who were accessing primary care services at a Midwestern Veterans Affairs Medical Center. Contrary to hypotheses, masculinity beliefs did not predict CRC screening outcomes in hierarchical regression analyses that controlled for demographic predictors of screening. Although results are largely inconsistent with masculinity theory and prior qualitative findings, further research is needed to determine the degree to which findings generalize to other populations and settings

Lung cancer screening: what do long-term smokers know and believe?

Objective To explore knowledge and beliefs of long-term smokers about lung cancer, associated risk factors and lung cancer screening. Design Qualitative study theoretically framed by the expanded Health Belief Model based on four focus group discussions. Content analysis was performed to identify themes of knowledge and beliefs about lung cancer, associated risk factors and lung cancer screening among long-term smokers' who had and had not been screened for lung cancer. Methods Twenty-six long-term smokers were recruited; two groups (n = 9; n = 3) had recently been screened and two groups (n = 7; n = 7) had never been screened. Results While most agreed lung cancer is deadly, confusion or inaccurate information exists regarding the causes and associated risk factors. Knowledge related to lung cancer screening and how it is performed was low; awareness of long-term smoking's association with lung cancer risk remains suboptimal. Perceived benefits of screening identified include: (i) finding lung cancer early; (ii) giving peace of mind; and (iii) motivation to quit smoking. Perceived barriers to screening identified include: (i) inconvenience; (ii) distrust; and (iii) stigma. Conclusions Perceived barriers to lung cancer screening, such as distrust and stigma, must be addressed as lung cancer screening becomes more widely implemented. Heightened levels of health-care system distrust may impact successful implementation of screening programmes. Perceived smoking-related stigma may lead to low levels of patient engagement with medical care and decreased cancer screening participation. It is also important to determine modifiable targets for intervention to enhance the shared decision-making process between health-care providers and their high-risk patients