Obstacles to colorectal cancer screening in Chinese: A study based on the Health Belief Model

BACKGROUND: Colorectal cancer (CRC) has emerged as the second most common cancer in Asia. This study uses the Health Belief Model (HBM) to examine the factors associated with the uptake of CRC testing. METHODS: A population-based telephone survey in which 1,004 randomly selected Chinese residents of Hong Kong aged between 30 and 65 yr were interviewed in 2006. Instruments were developed to measure the variables pertinent to the HBM, including perceived susceptibility, severity, benefit, barriers, and cues to action. The relationships of these predictors with CRC testing were examined using bivariate and multiple logistic regression analyses. RESULTS: Ten percent of the respondents had undertaken a CRC screening test. In the multiple logistic regression analyses, knowledge factors that were positively associated with CRC testing included knowledge of CRC symptoms (adjusted odds ratio [aOR] 3.33, 95% confidence interval [CI] 1.21-9.11) and knowledge of CRC risk factors (aOR 2.61, 95% CI 1.16-5.88). Five of the variables pertaining to the HBM were significant correlates of CRC testing-perceived severity of CRC (aOR 0.28, 95% CI 0.13-0.65), perceived health and psychological barriers to CRC testing (aOR 0.42, 95% CI 0.21-0.84, 95% CI 0.21-0.85), perceived access barriers to CRC testing (aOR 0.22, 95% CI 0.05-0.85), physician's recommendation (indicator of cues to action) (aOR 23.50, 95% CI 10.66-51.80), and having health insurance (indicator of cues to action) (aOR 2.06, 95% CI 1.01-4.19). CONCLUSIONS: CRC testing compliance among this Asian population is low. Knowledge of CRC symptoms and risk factors are low. Perceived health, psychological, and access barriers to CRC testing are high. The physician's recommendation and having health insurance coverage significantly increase testing, but physicians mainly recommend patients with a family history of CRC for testing, and only around one-third of the population has health insurance.