Predicting Colonoscopy Screening Behavior and Future Screening Intentions for African Americans Older than 50 Years

Abstract

African Americans experience a disproportionate burden of morbidity and mortality from colorectal cancer, which may be due to low adherence to screening recommendations. Previous studies have found relationships between decision-making factors and screening behavior, but few have looked at both cognitive and affective factors or within a specifically African American sample. To better understand determinants that drive screening behavior, this study examines affective, cognitive, and social variables as predictors of colonoscopy in an age-eligible African American population. Participants completed surveys assessing affective associations with colonoscopy, perceived benefits and barriers, self-efficacy, knowledge, fear of colonoscopy, perceived risk, and colorectal cancer worry and fear. Regression analysis was used to model decision-making constructs as predictors of screening behavior/intentions. Affective, cognitive, and health care experience variables predicted colonoscopy completion and intentions. Provider-level factors and previous cancer screenings predicted prior screening only, but not intentions. Affective and cognitive components of perceived risk were associated with decreased likelihood of colonoscopy behavior, but increased likelihood of colonoscopy intentions. These findings suggest that colonoscopy decision making involves a complex array of both cognitive and affective determinants. This work extends our knowledge of colorectal cancer screening decision making by evaluating the effects of these multiple determinants on screening behavior in an African American sample. Future work exploring the interplay of affect and cognitions as influences on colonoscopy decision making and how health care experiences may moderate this effect is needed to develop effective intervention approaches and reduce screening disparities.

Keywords:

• affective associations
• colonoscopy
• health decision making
• health disparities

Notes

* Fifty-four programs completed a written informed consent process prior to the IRB approval of the waiver of written consent.

Additional information

Funding

This study was supported by National Institutes of Health/National Cancer Institute grant R01 CA171935. The authors kindly acknowledge the extensive support of the community members of New York and the First Ladies of Western New York (FLOW) for their contributions to the science and data collection for this study. An earlier version of this data was presented as a poster at the Ninth AACR Conference on the Science of Cancer Health Disparities, Fort Lauderdale, FL, September 2016.