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Mediators of screening uptake in a colorectal cancer screening intervention among Hispanics
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Mediators of screening uptake in a colorectal cancer screening intervention among Hispanics
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Journal Article
Mediators of screening uptake in a colorectal cancer screening intervention among Hispanics
2022
Overview
Background
Colorectal cancer (CRC) is the second leading cause of cancer deaths in the USA. Although a number of CRC screening tests have been established as being effective for CRC prevention and early detection, rates of CRC screening test completion in the US population remain suboptimal, especially among the uninsured, recent immigrants and Hispanics. In this study, we used a structural equation modelling approach to identify factors influencing screening test completion in a successful CRC screening program that was implemented in an uninsured Hispanic population. This information will enhance our understanding of influences on CRC screening among historically underscreened populations.
Methods
We used generalized structural equation models (SEM) utilizing participant reported information collected through a series of surveys. We identified direct and indirect pathways through which cofactors, CRC knowledge and individual Health Belief Model constructs (perceived benefits, barriers, susceptibility, fatalism and self-efficacy) and a latent psychosocial health construct mediated screening in an effective prospective randomized CRC screening intervention that was tailored for uninsured Hispanic Americans.
Results
Seven hundred twenty-three participants were eligible for inclusion; mean age was 56 years, 79.7% were female, and 98.9% were Hispanic. The total intervention effect was comparable in both models, with both having a direct and indirect effect on screening completion (
n
= 715, Model 1: RC = 2.46 [95% CI: 2.20, 2.71,
p
< 0.001];
n
= 699, Model 2 RC =2.45, [95% CI: 2.18, 2.72,
p
< 0.001]. In Model 1, 32% of the overall effect was mediated by the latent psychosocial health construct (RC = 0.79,
p
< 0.001) that was in turn mainly influenced by self-efficacy, perceived benefits and fatalism. In Model 2, the most important individual mediators were self-efficacy (RC = 0.24,
p
= 0.013), and fatalism (RC = 0.07,
p
= 0.033).
Conclusion
This study contributes to our understanding of mediators of CRC screening and suggests that targeting self-efficacy, perceived benefits and fatalism could maximize the effectiveness of CRC screening interventions particularly in Hispanic populations.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
Subject
/ Analysis
/ Biomedical and Life Sciences
/ Cancer
/ Colorectal Neoplasms - diagnosis
/ Colorectal Neoplasms - prevention & control
/ Early Detection of Cancer - psychology
/ Female
/ Health Promotion and Disease Prevention
/ Hispanic or Latino - psychology
/ Humans
/ Male
/ Medically Uninsured - ethnology
/ Medically Uninsured - psychology
/ Oncology
