Kim, Rock-Bum;Park, Ki-Soo;Hong, Dae-Yong;Lee, Cheol-Heon;Kim, Jang-Rak
Journal of Preventive Medicine and Public Health
Objectives: To identify factors associated with cancer screening intention using the Theory of Planned Behavior (TPB). Methods: Among 55,920 eligible persons for National Cancer Screening Program (NCSP) in J city, 1,100 individuals were contacted. Of these, 797 were interviewed using a structured questionnaire. Thirty-six responses were excluded due to incomplete data. The remaining 761 completed questionnaires were analyzed to find factors associated with cancer screening intention. Results: Cancer screening intention was significantly associated with behavioral attitude (p<0.01) and subjective norm (p<0.01), but not with perceived behavioral control (p=0.29) in the TPB model. These three constructs explained 29.7% of cancer screening intention in multiple linear regression analysis. External factors such as socio-demographic status, health and health behavior variables explained 8.9% of screening intention. Among them, household monthly income, past cancer screening experience, exercise and daily eating habit were significantly associated with screening intention. Conclusions: Cancer screening intention may be influenced by focusing attitude, subjective norm in TPB model and other external factors. However, further studies are warranted to identify factors influencing cancer screening intention and behavior.
Objectives: Recent studies have shown that tailoring to women's individual beliefs and stage of cancer screening adoption increase the probability that cancer screening will ensue. To identify variables associated with cancer screening behavior, many studies for cancer screening have used the Transtheoretical Model(TTM). This study was carried out to identity the cognitive and behavioral factors associated with breast cancer screening by stages of change among women, forties aged. Methods: Building on the TTM constructs, we collected the data to test the association with cognitive and behavioral factors for breast cancer screening by stage of change among women, forties aged (N=232), using the self-reported questionnaire. The stages of change were grouped according to screening participation and intention for breast cancer as precontemplation, contemplation, preparation, action, and maintenance. We found out the association between breast cancer screening and cognitive and behavioral factors, and testified the difference between stages of change by chi-square test, one-way ANOVA, and multiple comparison analysis(Duncan test). Results: Analyses of 232 women showed that participation on mammography was 68.1% within lifetime and 46.1% within last 2 years, and we found out the association with breast cancer screening participation, intention and cognitive-behavioral factors. The stages of change based on participation and intention were different from the decisional balance, the screening attitude, and the self-efficacy(p<0.01). The decisional balance was differ from stages of change because the difference on opinions about pros(positives) and cons(negative) were likely to significant by stages of change(p<0.05, p<0.01). Conclusion: To increase the screening rate for breast cancer, it should be developed the tailored message and recommend guideline. And the tailored message should be designed to increase the pros of breast cancer screening(mammography) and to decrease the cons, and considered the woman's stage of adoption.
Objectives: Recent studies have shown that tailored messages for cancer screening to the beliefs and stage of cancer screening behavior of individual women increases the take-up probability. Many studies on cancer screening have used the Transtheoretical Model (TTM) to identify variables associated with cancer screening behavior. This study was carried out to identify the cognitive-behavioral factors associated with stomach cancer screening among women aged 40 years and over, and to develop and evaluate a tailored educational program for stomach cancer screening by stages of change. Methods: Building on the TTM constructs, we conducted a quasi-experimental study(N=283) to test the effectiveness of a tailored educational program for endoscopic stomach cancer screening. We carried out pre and post tests in the experimental group(N=162) and the control group(N=121), and the experimental group was subdivided into an on-line group(N=81) and an off-line group(N=81) by educational methodology using e-mail and the postal service. We used the chi-square test, trend test, and paired t-test to test the effectiveness of the program for stomach cancer using a tailored stage-matched messages. Results: To examine the effectiveness of the program for stomach cancer screening by the tailored stage-matched messages, the stage-matched materials were offered to the experimental group(N=162) four times for 4 weeks. The stage-matched materials consisted of the four types for stomach cancer. The tailored message was effective in changing the cognitive-behavioral factors, such as experience process, behavior process, con opinion for stomach cancer, self-efficacy, and the behavioral stages for stomach cancer screening. The stomach cancer screening adherence was higher for the stage-matched materials using postal mail than for those using e-mail. Conclusion: To improve the stomach cancer screening rate, the use of tailored messages for stomach cancer screening will be generated using an expert system. Therefore the implementation of tailored educational program will be supported a partnership between public and private health organizations and increasing awareness of the necessity of community-based interventions.
Zehtab, Nooshin;Jafari, Mohammad;Barooni, Mohsen;Nakhaee, Nouzar;Goudarzi, Reza;Zadeh, Mohammad Hassan Larry
Asian Pacific Journal of Cancer Prevention
Background: Although breast cancer is the most common cancer in women, economic evaluation of breast cancer screening is not fully addressed in developing countries. The main objective of the present study was to analyze the cost-effectiveness of breast cancer screening using mammography in 35-69 year old women in an Iranian setting. Materials and Methods: This was an economic evaluation study assessing the cost-effectiveness of a population-based screening program in 35-69 year old women residing in rural areas of South east Iran. The study was conducted from the perspective of policy-makers of insurance. The study population consisted of 35- to 69-year old women in rural areas of Kerman with a population of about 19,651 in 2013. The decision tree modeling and economic evaluation software were used for cost-effectiveness and sensitivity analyses of the interventions. Results: The total cost of the screening program was 7,067.69 US$ and the total effectiveness for screening and no-screening interventions was 0.06171 and 0.00864 disability adjusted life years averted, respectively. The average cost-effectiveness ratio DALY averted US$ for screening intervention was 7,7082.5 US$ per DALY averted and 589,027 US $ for no-screening intervention. The incremental cost-effectiveness ratio DALY averted was 6,264 US$ per DALY averted for screening intervention compared with no-screening intervention. Conclusions: Although the screening intervention is more cost-effective than the alternative (noscreening) strategy, it seems that including breast cancer screening program in health insurance package may not be recommended as long as the target group has a low participation rate.
Background: The appropriate interval between negative colonoscopy screenings is uncertain, but the numbers of advanced neoplasms 10 years after a negative result are generally low. We aimed to evaluate the cost-effectiveness of colorectal neoplasm screening and management based on repeat screening colonoscopy every 10 years or single colonoscopy, compared with no screening in the general population. Methods and materials: A state-transition Markov model simulated 100,000 individuals aged 50-80 years accepting repeat screening colonoscopy every 10 years or single colonoscopy, offered to every subject. Colorectal adenomas found during colonoscopy were removed by polypectomy, and the subjects were followed with surveillance every three years. For subjects with a normal result, colonoscopy was resumed within ten years in the repeat screening strategy. In single screening strategy, screening process was terminated. Direct costs such as screening tests, cancer treatment and costs of complications were included. Indirect costs were excluded from the model. The incremental cost-effectiveness ratio was used to evaluate the cost-effectiveness of the different screening strategies. Results: Assuming a first-time compliance rate of 90%, repeat screening colonoscopy and single colonoscopy can reduce the incidence of colorectal cancer by 65.8% and 67.2% respectively. The incremental cost-effectiveness ratio for single colonoscopy (49 Renminbi Yuan [RMB]) was much lower than that for repeat screening colonoscopy (474 RMB). Single colonoscopy was a more cost-effective strategy, which was not sensitive to the compliance rate of colonoscopy and the cost of advanced colorectal cancer. Conclusion: Single colonoscopy is suggested to be the more cost-effective strategy for screening and management of colorectal neoplasms and may be recommended in China clinical practice.
Background: Cancer is a leading cause of death in Korea. To prevent cancer, it is essential to facilitate and promote appropriate cancer screening behavior in the adult population. The aim of this study was to examine health beliefs related to cancer screening intentions using the Health Belief Model (HBM). Materials and Methods: The research participants comprised 275 male health and safety managers at commercial companies in Korea. The self-administered survey explored demographic characteristics, cancer-related factors, beliefs about cancer/cancer screening (BCCS) (vulnerability to cancer, severity of cancer, benefits of screening, and barriers to screening), and cancer screening intention. Multivariate logistic regression analyses were used to identify factors associated with an intention to be screened for cancer. Results: Perceived health status and need for cancer prevention education were major factors associated with BCCS. Poorer health status was associated with greater perceived vulnerability, a perception of fewer benefits, and more barriers (p<0.05). A perceived greater need for cancer prevention education was associated with a higher perceived severity of cancer and more perceived barriers to screening (p<0.05). Marital status, cancer screening experience, and perceived vulnerability to cancer were significant influences on the cancer screening intention (p<0.05). Participants who had undergone cancer screening in the past 2 years were more likely to intend to be screened for cancer than were those who had not been screened; this was true across all degrees of intention and all types of cancer (p<0.01). Hesitant people considered themselves less vulnerable to gastric, lung, and liver cancer than did the poeple who intended to undergo cancer screening (p<0.05). Conclusions: Based on our findings, we recommend that workplace cancer prevention programs attempt to increase awareness about vulnerability to cancer among workers who hesitate to undergo cancer screening.
Background: Prospective cohort studies to determine cofactors with oncogenic HPV-infections for cervical cancer are very rare from developing countries and such data are limited to the few screening trials. Large screening trials provide such data as a by product. Some of the cases are prevented by screening and do not surface as invasive cancers at all. Also, pre-invasive lesions are detected almost entirely by screening. Screening causes selection bias if attendance in or effectiveness of screening is correlated with the risk factors. The aim of this study was to quantify the influence of screening on risk factors for cervical cancer. Materials and Methods: Our material stems from a rural cohort of 80,000 women subjected to a randomised screening trial. The effect of screening on the incidence of cervix cancer was estimated with reference to socio-demographic and reproductive risk factors of cervical cancer. We compared these risks with the incidence of cancer in the randomised control population by the same determinants of risk. Results: The results in the screening arm compared to the control arm showed that the women of low SES and young age were benefitting more than those of high SES and old age. The relative risk by age (30-39 vs 50-59) was 0.33 in the control arm and 0.24 in the screening arm. The relative risk by education (not educated vs educated) was 2.8 in the control arm and 1.8 in the screening arm. The previously married women did not benefit (incidence 113 and 115 per 100,000 women years in control vs screening arms) whereas the effect was substantial in those married (86 vs 54). Conclusions: The results in controls were consistent with the general evidence, but results in attenders and nonattenders of the screening arm showed that screening itself and self-selection in attendance and effectiveness can influence the effect estimates of risk factors. The effect of cervical cancer screening programmes on the estimates of incidence of cervical cancer causes bias in the studies on etiology and, therefore, they should be interpreted with caution.
Objectives : We wanted to identify those factors associated with stomach, colon, breast and cervix cancer screening. Methods : A population-based telephone survey was conducted for 2 weeks (the 9th-23th of July, 2004) by trained interviewers with using a questionnaire. 2,598 respondents (females aged 30 years or over, and the males aged 40 years or over) were selected by random-digit dialing that was based on the 2000 Population and Housing Census. The data on socio-demographic, health behavior and enabling factors were collected. 2,571 respondents were included in analysis. The cancer screening rate was classified into 2 categories : the life time screening rate and the screening rate with recommendations. Results : For the 2,571 respondent s, the life time screening rate was as follows: 52.0% (Stomach), 25.3% (Colon), 55.9% (Breast) and 76.8% (Cervix). The screening rate with recommendation was as follows : 3 9.2% (Stomach), 20.6% (Colon), 42.5% (Breast) and 58.3% (Cervix). On a multiple logistic regression analysis of the life time screening, statistically significant relationships were observed for the screening intention, the health exam, the disease history, the age of the patients and the cancer screening rates. On a multiple logistic regression analysis of the screening with recommendation, statistically significant relationships were observed for the screening intention, the health exam, the age of the patients, the concern about the risk of cancer, the voluntary health insurance for cancer and the cancer screening rates. Conclusions : The results of this study suggest that the cancer screening intention, the health exam and the age of the patients are the most important factors to participate in life time cancer screening and also screening with recommendations. A positive association was also observed for the concern about the risk of cancer, the voluntary health insurance for cancer. It is hoped that this study will be a base line data for suggesting the representative cancer screening rate in Korea.
Background: Worldwide, over half a million women died of breast cancer in 2011 alone. Mammography screening is associated with a reduction of 20 to 35% in breast cancer mortality. The aim of this study was to determine the awareness and practice of mammography screening and predictors of its uptake in Malaysian women attending a primary care clinic. Materials and Methods: A cross-sectional study was carried out among women aged 40 to 74 years attending a primary care clinic in Selangor, Malaysia. An assisted structured questionnaire included questions on socio-demography, source of information and level of knowledge. An adapted version of the revised Champion Health Belief Model Scale plus other associated factors for mammography screening up-take were also included as part of the questionnaire. Predictors for mammography screening uptake were only determined in those who were aware about mammography screening. Significant predictors were determined by logistic regression. Results: 447 women were recruited for this study; 99.1% of them (n: 411) were aware about breast cancer. Only 50.1% (n: 206) had knowledge about mammography screening. Prevalence of clinical breast-examination (CBE) was 23.3% (n: 104) and mammography screening up-take was 13.2% (n: 59). The predictors for the latter were those who have had clinical breast-examination (aOR=17.58, 95%CI: 7.68-39.82) and those aged between 50 to 59 years (aOR=3.94, 95%CI: 1.61-9.66) as well as those aged 60 years and above (aOR=6.91, 95%CI: 2.28-20.94). Good knowledge and positive beliefs about mammography screening were not associated with mammography screening uptake. Conclusions: Half of our Malaysian women were aware about mammography screening. However, the uptake of mammography was low. Previous CBE and older age were significant predictors of mammography screening uptake. Increasing CBE services may increase compliance with guidelines.
Objectives : We measured behavioral factors associated with Koreans receiving gastric cancer screening based on a socio-ecological model, in part to develop strategies to improve cancer screening rates. Methods : A telephone survey was conducted with 2,576 people chosen through stratified random sampling from April 1 - May 31, 2004. Collected information included gastric cancer screening, socio-demographic factors, and socio-ecological factors at intrapersonal, interpersonal, community, and public policy levels. Results : Among 985 survey respondents(380 men and 605 women), 402 had received gastric cancer screening. Logistic analysis was performed to compare those screened and unscreened. 'Age' was the only demographic factor that showed a statistically significant association with getting screening. People in their fifties (OR=1.731, 95% CI=1.190-2.520) and sixties (OR=2.098, 95% CI=1.301-3.385) showed a higher likelihood of getting screened, compared to those in the forties. 'Accessibility to a medical institution' was a significant factor related to having gastric cancer screening at the intrapersonal level. At the interpersonal level, recommendations by family members to be screened and a family practice of routine cancer screening were significantly related. People with frequent education about cancer screening or with stronger social feelings that cancer screening is necessary also demonstrated significantly higher tendencies to be screened. Conclusions : In conclusion, a socio-ecological model seems appropriate for explaining gastric cancer screening behavior and associated factors. Health planners should develop integrated strategies to improve cancer screening rates based on socio-ecological factors, especially at the interpersonal and community levels.
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