Shannon M. Christy

Promoting colorectal cancer screening discussion: A randomized controlled trial

BACKGROUND Provider recommendation is a predictor of colorectal cancer (CRC) screening. PURPOSE To compare the effects of two clinic-based interventions on patient-provider discussions about CRC screening. DESIGN Two-group RCT with data collected at baseline and 1 week post-intervention. SETTING/PARTICIPANTS African-American patients that were non-adherent to CRC screening recommendations (n=693) with a primary care visit between 2008 and 2010 in one of 11 urban primary care clinics. INTERVENTION Participants received either a computer-delivered tailored CRC screening intervention or a nontailored informational brochure about CRC screening immediately prior to their primary care visit. MAIN OUTCOME MEASURES Between-group differences in odds of having had a CRC screening discussion about a colon test, with and without adjusting for demographic, clinic, health literacy, health belief, and social support variables, were examined as predictors of a CRC screening discussion using logistic regression. Intervention effects on CRC screening test order by PCPs were examined using logistic regression. Analyses were conducted in 2011 and 2012. RESULTS Compared to the brochure group, greater proportions of those in the computer-delivered tailored intervention group reported having had a discussion with their provider about CRC screening (63% vs 48%, OR=1.81, p<0.001). Predictors of a discussion about CRC screening included computer group participation, younger age, reason for visit, being unmarried, colonoscopy self-efficacy, and family member/friend recommendation (all p-values <0.05). CONCLUSIONS The computer-delivered tailored intervention was more effective than a nontailored brochure at stimulating patient-provider discussions about CRC screening. Those who received the computer-delivered intervention also were more likely to have a CRC screening test (fecal occult blood test or colonoscopy) ordered by their PCP. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT00672828.

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.

Predictors of stage of adoption for colorectal cancer screening among African American primary care patients.

Background: Compared with other racial groups, African Americans have the highest colorectal cancer (CRC) incidence and mortality rates coupled with lower screening rates. Objective: Our study examined the predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy among African American primary care patients who were nonadherent to published screening guidelines. Methods: Baseline data (N = 815) in a randomized clinical trial were analyzed. Participants were categorized into precontemplation, contemplation, and preparation stages for FOBT and colonoscopy. Predictor variables were demographics, clinical variables, CRC health beliefs and knowledge, and social support. Hierarchical modeling was to identify significant predictors of stage of adoption. Results: Older, male, Veterans Affairs participants and those with higher perceived self-efficacy, family/friend encouragement, and a provider recommendation had higher odds of being at a more advanced stage of adoption for FOBT. Patients with a history of cancer and higher perceived barriers had higher odds of being at an earlier stage of adoption for FOBT. Predictors of more advanced stage of adoption for colonoscopy included higher perceived benefits, higher perceived self-efficacy, family/friend encouragement, and a provider recommendation for colonoscopy. Higher income (>30 000 vs <15 000) was predictive of earlier stage of adoption for colonoscopy. Conclusions: Enhancing self-efficacy, encouragement from family and friends, and provider recommendations are important components of interventions to promote CRC screening. Implications for Practice: Nurses can use knowledge of the characteristics associated with stage of adoption to educate and motivate their African American primary care patients to complete CRC screening tests.

Shared decision-making about colorectal cancer screening: A conceptual framework to guide research

OBJECTIVE To develop a conceptual framework to guide research on shared decision-making about colorectal cancer (CRC) screening among persons at average risk and their providers. METHODS Based upon a comprehensive review of empirical literature and relevant theories, a conceptual framework was developed that incorporated patient characteristics, cultural beliefs, provider/health care system variables, health belief/knowledge/stage of adoption variables, and shared decision-making between patients and providers that may predict behavior. Relationships among concepts in the framework, shared decision-making process and outcomes, and CRC screening behavior were proposed. Directions for future research were presented. RESULTS Many of the concepts in the proposed framework have been examined in prior research. However, these elements have not been combined previously to explain shared decision-making about CRC screening. CONCLUSION Research is needed to test the proposed relationships and hypotheses and to refine the framework. PRACTICE IMPLICATIONS Findings from future research guided by the proposed framework may inform clinical practice to facilitate shared decision-making about CRC screening.

Associations of health behaviors with human papillomavirus vaccine uptake, completion, and intentions among female undergraduate students

This study explored associations between health behaviors and human papillomavirus vaccine receipt/intentions among female undergraduates. Participants (N = 286) completed a survey assessing human papillomavirus vaccine uptake (receiving 1–3 shots vs no shots), completion (receiving 3 shots vs 1–2 shots), and intentions as well as various health behaviors. Human papillomavirus vaccine uptake and completion were associated with receipt of other preventive medical care; completion was associated with having a regular healthcare provider. Among unvaccinated students (n = 115), increased human papillomavirus vaccine intentions were associated with flu shot and human immunodeficiency virus test receipt. Findings suggest promoting human papillomavirus vaccination with other preventive medical care might improve vaccine receipt.

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.

Tailored telephone counseling increases colorectal cancer screening

To compare the efficacy of two interventions to promote colorectal cancer screening participation and forward stage movement of colorectal cancer screening adoption among first-degree relatives of individuals diagnosed with adenomatous polyps. One hundred fifty-eight first-degree relatives of individuals diagnosed with adenomatous polyps were randomly assigned to receive one of two interventions to promote colorectal cancer screening. Participants received either a tailored telephone counseling plus brochures intervention or a non-tailored print brochures intervention. Data were collected at baseline and 3 months post-baseline. Group differences and the effect of the interventions on adherence and stage movement for colorectal cancer screening were examined using t-tests, chi-square tests, and logistic regression. Individuals in the tailored telephone counseling plus brochures group were significantly more likely to complete colorectal cancer screening and to move forward on stage of change for fecal occult blood test, any colorectal cancer test stage and stage of the risk-appropriate test compared with individuals in the non-tailored brochure group at 3 months post-baseline. A tailored telephone counseling plus brochures intervention successfully promoted forward stage movement and colorectal cancer screening adherence among first-degree relatives of individuals diagnosed with adenomatous polyps.

Masculinity beliefs and colorectal cancer screening in male veterans.

As the third most common cause of cancer death among U.S. 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 foregoing 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 ages 51–75 years 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.

Does Self-Efficacy Mediate the Relationships Between Social-Cognitive Factors and Intentions to Receive HPV Vaccination Among Young Women?

Drawing upon health behavior change theories, the current study examined whether self-efficacy mediated relationships between social-cognitive factors (i.e., perceived risk, perceived benefits, perceived barriers, perceived severity, and cue to action) and human papillomavirus (HPV) vaccination intentions among college women. Unvaccinated women (N = 115) aged 18 to 25 years attending a Midwestern university completed an anonymous web-based survey assessing study variables. Correlational analyses and mediation analyses were conducted. Self-efficacy mediated relationships between two social-cognitive factors (i.e., perceived barriers to HPV vaccination—indirect effect = −.16, SE = .06, 95% confidence interval [CI] = [−.31, −.06]—and perceived risk of HPV-related conditions—indirect effect = .16, SE = .09, 95% CI = [.01, .37]) and HPV vaccination intentions but was unrelated to the other three social-cognitive factors. Based on these findings, future research should test whether increasing self-efficacy through education on risk of HPV-related conditions and reducing barriers to HPV vaccination improves vaccine uptake in college women.

Abstract A63: Changes in health beliefs among medically-underserved patients enrolled in a community-based randomized controlled trial to promote colorectal cancer screening

Marked health disparities exist in colorectal cancer (CRC) screening, incidence, and mortality among medically-underserved communities. Literature suggests certain health beliefs (e.g., perceived risk) may be related to screening behavior. This study examined changes in CRC health beliefs following receipt of one of two educational interventions aimed at promoting CRC screening uptake among a medically-underserved population. We compared changes in CRC health beliefs at baseline and 12 months later both within and between the two intervention groups. Enrolled participants were aged 50-75, at average CRC risk, not up-to-date with CRC screening guidelines, enrolled in a randomized controlled trial to increase CRC screening that was conducted at community clinics in the Tampa Bay area, and completed both the baseline and 12 month follow-up assessments. Participants were randomized to receive either a culturally-targeted photonovella and DVD plus fecal immunochemical test (FIT) intervention (titled Colorectal Cancer Awareness, Research, Education and Screening, or CARES, intervention group condition) or a Centers for Disease Control and Prevention (CDC) standard educational brochure plus FIT intervention (comparison group condition). At both time points, participants completed a questionnaire that included multiple health-related beliefs including Preventive Health Model (PHM) constructs (i.e., perceived susceptibility, perceived salience, self-efficacy, response efficacy, cancer worry, social influence, and religious beliefs), CRC awareness, decisional conflict regarding CRC screening, cancer fatalism, trust in the healthcare system, and perceived discrimination. Changes in health belief scores and group differences in change were examined using Student9s t-tests. The majority of participants (n=270) were: female (58%); white (67%) or black (26%); insured (59%) including county health insurance; had a household income Both CRC screening interventions promoted positive changes in multiple health beliefs from baseline to 12 months which suggests clear benefits of educational interventions. The interventions had common positive effects (i.e., CRC awareness, PHM social influence, and trust in the healthcare system), but also unique effects on PHM salience (CARES condition) and PHM self-efficacy and PHM response efficacy (comparison condition). However, between-group intervention comparisons were not significant suggesting that both educational interventions are beneficial. Given that individuals in both intervention groups were provided with access to CRC screening via FIT kit, future analyses will examine whether changes in health beliefs were associated with higher CRC screening uptake. Citation Format: Shannon M. Christy, Steven K. Sutton, Enmanuel Chavarria, Stacy N. Davis, Rania Abdulla, Gwendolyn P. Quinn, Susan T. Vadaparampil, Chitra Ravindra, Ida Schultz, Richard Roetzheim, David Shibata, Cathy D. Meade, Clement K. Gwede. Changes in health beliefs among medically-underserved patients enrolled in a community-based randomized controlled trial to promote colorectal cancer screening. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A63.