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09-03-2024

Colorectal cancer information avoidance is associated with screening adherence

Auteurs: Heather Orom, Nolan E. Ramer, Natasha C. Allard, Amy McQueen, Erika A. Waters, Marc T. Kiviniemi, Jennifer L. Hay

Gepubliceerd in: Journal of Behavioral Medicine | Uitgave 3/2024

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Abstract

Colorectal cancer (CRC) is the fourth most common cancer among U.S. men and women and the second deadliest. Effective screening modalities can either prevent CRC or find it earlier, but fewer than two thirds of U.S. adults are adherent to CRC screening guidelines. We tested whether people who defensively avoid CRC information have lower adherence to CRC screening recommendations and weaker intentions for being screened and whether CRC information avoidance adds predictive ability beyond known determinants of screening. Participants, aged 45–75 years, completed a survey about known structural determinants of CRC screening (healthcare coverage, healthcare use, provider recommendation), CRC information avoidance tendencies, and screening behavior (n = 887) and intentions (n = 425). Models were tested with multivariable regression and structural equation modeling (SEM). To the extent that participants avoided CRC information, they had lower odds of being adherent to CRC screening guidelines (OR = 0.55) and if non-adherent, less likely to intend to be screened (b=-0.50). In the SEM model, avoidance was negatively associated with each known structural determinant of screening and with lower screening adherence (ps < 0.01). Fit was significantly worse for nested SEM models when avoidance was not included, (i.e., the paths to avoidance were fixed to zero). Information avoidance was associated with screening behavior and other known structural determinants of screening adherence, potentially compounding its influence. Novel strategies are needed to reach avoiders, including health communication messaging that disrupts avoidance and interventions external to the healthcare system, with which avoiders are less engaged.
Voetnoten
1
In order to obtain interpretable effect sizes for paths predicting dichotomous outcomes, another model using maximum likelihood (ML) estimation was estimated. Estimation with ML provides logit coefficients for calculating odds ratios (OR). Odds ratios cannot be calculated using probit regression coefficients, and ORs are more conceptually and pragmatically appealing for interpretation compared to the complicated calculation of predicted probabilities from probit regression parameters. This model was specified identical to the “full” model using WLSMV estimation. Statistically significant ORs are reported in Fig. 1. The pattern of significant findings was identical between the two models for all paths in which an OR was reported.
 
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Metagegevens
Titel
Colorectal cancer information avoidance is associated with screening adherence
Auteurs
Heather Orom
Nolan E. Ramer
Natasha C. Allard
Amy McQueen
Erika A. Waters
Marc T. Kiviniemi
Jennifer L. Hay
Publicatiedatum
09-03-2024
Uitgeverij
Springer US
Gepubliceerd in
Journal of Behavioral Medicine / Uitgave 3/2024
Print ISSN: 0160-7715
Elektronisch ISSN: 1573-3521
DOI
https://doi.org/10.1007/s10865-024-00482-6

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