Geographic variation in compliance With FOBT colorectal cancer screening programs: the role of attitudes toward health and help seeking

Goodwin, Belinfda C. and March, Sonja and Ireland, Michael and Crawford-Williams, Fiona and Manski, Donna and Ford, Martelle and Dunn, Jeff (2019) Geographic variation in compliance With FOBT colorectal cancer screening programs: the role of attitudes toward health and help seeking. Rural and Remote Health, 19 (3 (4957)). pp. 1-10.

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Abstract

Introduction: Colorectal cancer (CRC) patients in regional and rural areas tend to be diagnosed at a more advanced stage than metropolitan patients and have poorer 5-year survival rates. Environmental and cultural factors in non-metropolitan areas often facilitate a more reactive approach to health care, which can result in lower participation in preventative health measures such as screening for early signs of cancer. Individual differences in attitudes and cognitive styles can also act as barriers to cancer screening. Currently, evidence regarding geographical disparity in CRC screening is inconclusive and based largely on test return in nationwide screening programs as opposed to compliance with program guidelines. This study investigates the effect of attitudinal and cognitive traits on compliance with, as opposed to participation in, population CRC screening programs in rural, regional and metropolitan environments. Methods: A representative cross-section of recipients (n=371, 71% female) of a faecal occult blood test as part of the National Bowel Cancer Screening Program were surveyed in 2017 (mean age = 61.26, standard deviation = 7.05). Participants were asked if they completed and returned the kit or had a valid reason not to (ie prior screening). Postcodes were used to identify participants as metropolitan, regional or rural using the Australian Standard Geographical Classification system. Fatalism, minimisation of problems and resignation (MPR), need for control and selfreliance, and consideration of future consequences (CFC) were measured as traits known to effect health-related help-seeking behaviour. Program compliance rates were compared between rural, regional and metropolitan areas, and logistic regression models with interaction terms were applied to test the differential effects of attitudinal and cognitive factors on program compliance across metropolitan, regional and rural groups. Results: Compliance was significantly lower in regional compared to metropolitan areas (odds ratio (OR)=0.49, 95% confidence interval (CI)=0.29–0.84). Rural status significantly moderated the effect of MPR (OR=0.28, 95%CI=0.11–0.71) and CFC (OR=6.66, 95%CI=1.80–24.63) on compliance and regional status significantly moderated the effect of CFC on compliance (OR=3.41, 95%CI=1.37–8.44). Simple slopes analyses showed that high MPR was associated with lower bowel screening program compliance in rural (OR=0.26, 95%CI=0.11–0.59) and regional (OR=0.60, 95%CI=0.38–0.95) areas, but not in metropolitan areas. High CFC was associated with higher bowel screening program compliance in rural (OR=4.46, 95%CI=1.39–14.47) and regional (OR=2.30, 95%CI=1.19–4.43), but not metropolitan, areas. Conclusions: Sub-optimal compliance rates are evident in nonmetropolitan areas with intervention most needed in regionalvareas where compliance is lowest, leaving residents at a potentially higher risk of CRCs going undetected. Efforts to increase CRC screening in rural and regional areas should promote the consideration of one’s future and discourage attitudes that minimise health issues. This research highlights the way in which individual attitudes and thinking styles may impact preventive health behaviours differently in non-metropolitan communities.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Published version made available in accordance with a Creative Commons Attribution 4.0 International Licence.
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Psychology and Counselling (1 Jan 2015 -)
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Psychology and Counselling (1 Jan 2015 -)
Date Deposited: 14 Oct 2019 01:43
Last Modified: 15 Oct 2019 02:34
Uncontrolled Keywords: attitudes, Australia, cancer screening, colorectal cancer, compliance, healthcare disparity, participation rates
Fields of Research : 11 Medical and Health Sciences > 1112 Oncology and Carcinogenesis > 111299 Oncology and Carcinogenesis not elsewhere classified
17 Psychology and Cognitive Sciences > 1701 Psychology > 170106 Health, Clinical and Counselling Psychology
Socio-Economic Objective: C Society > 92 Health > 9204 Public Health (excl. Specific Population Health) > 920499 Public Health (excl. Specific Population Health) not elsewhere classified
Identification Number or DOI: doi:10.22605/RRH4957
URI: http://eprints.usq.edu.au/id/eprint/37076

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