Huang Jia-Yan, Shi Lu
Fudan University, Shanghai, China.
Asian Pac J Cancer Prev. 2011;12(12):3323-9.
Colorectal cancer (CRC) is the third most prevalent cancer in China, and the fifth most lethal among all cancers. Community-based health education is helpful for health planners to promote cancer screening, yet relatively few studies tapped the temporal pattern of intervention effectiveness in a multiyear CRC education program. Using data from a two-year CRC community education, this study was aimed at exploring whether the health education intervention effectiveness differs between first-year and the second-year participants.
A two-year health education intervention was carried out in four communities in Shanghai, China. The health education focused on raising awareness about CRC, the principles of fecal occult blood test (FOBT) screening, and instruction about use of the FOBT kit. Local community health service centers conducted the lectures once a month. All adult residents were invited to attend these lectures. At the end of the first year and the second year, structured in-person interviews were conducted for the residents who attended the lectures. There were 205 enrollees who completed the first-year interviews and 836 enrollees who completed the second- year interviews. Logistic regression was used to compare the attitudinal and behavioral outcomes of enrollees in years 1 and 2.
Of the 1041 respondents, 24.5% had received FOBT during the program period, while 12% had received colonoscopy check, both substantially higher than the background screening rate in Shanghai. Respondents in year 2 were less willing to take FOBT than those in year 1 (O.R.=0.618, p<0.01), but there was no significant difference in terms of willingness to take colonoscopy after adjustment for covariates in logistic regression. Multiple logistic regression also showed that respondents in year 2 were significantly less likely to take FOBT than those in year 1 (O.R. = 0.263, p<0.01) and a similar tendency was noted for colonoscopy (O.R.=0.600, p=0.074).
The CRC screening rate after the health education compared favorably with the background screening rate, yet the decline in screening rate in year 2 indicates that further study is needed to understand the determinants of intervention effectiveness.
结直肠癌（CRC）是中国第三大常见癌症，在所有癌症中致死率排名第五。基于社区的健康教育有助于健康规划者推广癌症筛查，但相对较少的研究探讨了多年期结直肠癌教育项目中干预效果的时间模式。本研究利用一项为期两年的结直肠癌社区教育数据，旨在探讨第一年和第二年参与者的健康教育干预效果是否存在差异。
在中国上海的四个社区开展了一项为期两年的健康教育干预。健康教育的重点是提高对结直肠癌的认识、粪便潜血试验（FOBT）筛查的原则以及FOBT试剂盒的使用说明。当地社区卫生服务中心每月举办一次讲座。邀请所有成年居民参加这些讲座。在第一年和第二年末，对参加讲座的居民进行结构化的面对面访谈。有205名参与者完成了第一年的访谈，836名参与者完成了第二年的访谈。采用逻辑回归比较第一年和第二年参与者的态度和行为结果。
在1041名受访者中，24.5%在项目期间接受了FOBT检查，12%接受了结肠镜检查，两者均显著高于上海的背景筛查率。第二年的受访者比第一年的受访者更不愿意接受FOBT检查（比值比=0.618，p<0.01），但在逻辑回归中对协变量进行调整后，接受结肠镜检查的意愿没有显著差异。多元逻辑回归还显示，第二年的受访者接受FOBT检查的可能性显著低于第一年的受访者（比值比 = 0.263，p<0.01），结肠镜检查也有类似趋势（比值比=0.600，p=0.074）。
健康教育后的结直肠癌筛查率优于背景筛查率，但第二年筛查率的下降表明需要进一步研究以了解干预效果的决定因素。
