Wong Reuben K, Wong Mee Lian, Chan Yiong Huak, Feng Zhu, Wai Chun Tao, Yeoh Khay Guan
Division of Gastroenterology and Hepatology, University Medical Cluster, National University Health System, Singapore, Singapore.
BMC Public Health. 2013 Jul 23;13:677. doi: 10.1186/1471-2458-13-677.
Colorectal Cancer (CRC) is rapidly rising in Asia, but screening uptake remains poor. Although studies have reported gender differences in screening rates, there have been few studies assessing gender specific perceptions and barriers towards CRC screening, based on behavioral frameworks. We applied the Health Belief Model to identify gender-specific predictors of CRC screening in an Asian population.
A nationwide representative household survey was conducted on 2000 subjects aged 50 years and above in Singapore from 2007 to 2008. Screening behaviour, knowledge and beliefs on CRC screening were assessed by face-to-face structured interviews. The response rate was 88.2%.
26.7 percent had undergone current CRC screening with no gender difference in rates. Almost all agreed that CRC would lead to suffering (89.8%), death (84.6%) and would pose significant treatment cost and expense (83.1%). The majority (88.5%) agreed that screening aids early detection and cure but only 35.4% felt susceptible to CRC. Nearly three-quarters (74.3%) of the respondents recalled reading or hearing information on CRC in the print or broadcast media. However, only 22.6% were advised by their physicians to undergo screening. Significantly more women than men had feared a positive diagnosis, held embarrassment, pain and risk concerns about colonoscopy and had friends and family members who encouraged screening. On multivariate analysis, screening uptake showed a positive association with worry about contracting CRC and a physician's recommendation and a negative association with perceived pain about colonoscopy for both genders. For women only, screening was positively associated with having attended a public talk on CRC and having a family member with CRC, and was negatively associated with Malay race and perceived danger of colonoscopy.
CRC screening remains poor despite high levels of awareness of its benefits in this Asian population. Race, worry about contracting cancer, psychological barriers, and cues from the doctor and a public talk on CRC were associated with screening with gender specific differences. Strategies to increase CRC screening uptake should consider gender specific approaches to address psychological barriers and increase disease susceptibility through public health education and active promotion by physicians.
结直肠癌（CRC）在亚洲的发病率正在迅速上升，但筛查的接受率仍然很低。尽管研究报告了筛查率的性别差异，但基于行为框架评估性别特异性对CRC筛查的认知和障碍的研究却很少。我们应用健康信念模型来确定亚洲人群中CRC筛查的性别特异性预测因素。
2007年至2008年，在新加坡对2000名50岁及以上的受试者进行了一项全国代表性的家庭调查。通过面对面的结构化访谈评估了对CRC筛查的行为、知识和信念。回应率为88.2%。
26.7%的人目前接受了CRC筛查，筛查率无性别差异。几乎所有人都认为CRC会导致痛苦（89.8%）、死亡（84.6%），并会带来巨大的治疗成本和费用（83.1%）。大多数人（88.5%）同意筛查有助于早期发现和治愈，但只有35.4%的人认为自己易患CRC。近四分之三（74.3%）的受访者回忆起在印刷或广播媒体上阅读或听到过有关CRC的信息。然而，只有22.6%的人被医生建议进行筛查。女性比男性更担心阳性诊断，对结肠镜检查感到尴尬、疼痛和有风险担忧，并且有朋友和家人鼓励筛查。多因素分析显示，筛查接受率与担心患CRC和医生的建议呈正相关，与对结肠镜检查的感知疼痛呈负相关，这在两性中均如此。仅对女性而言，筛查与参加过关于CRC的公开讲座以及有家庭成员患CRC呈正相关，与马来族裔和对结肠镜检查的感知危险呈负相关。
尽管该亚洲人群对CRC筛查的益处有较高的认识，但筛查接受率仍然很低。种族、担心患癌、心理障碍以及医生的提示和关于CRC的公开讲座与筛查存在性别特异性差异相关。提高CRC筛查接受率的策略应考虑采用针对性别特异性的方法来解决心理障碍，并通过公共卫生教育和医生的积极推广来增加疾病易感性。
