Chen Hanbin, Jiang Yiming, Wang Jingyi, Tang Chen, Pan Xinlong, Zhang Wei, Zheng Shuanghui, Zhong Jun, Feng Bilong
Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
BMC Public Health. 2025 Feb 25;25(1):773. doi: 10.1186/s12889-025-21820-6.
A family history of colorectal cancer among first-degree relatives is recognized as one of the most significant and prevalent risk factors for colorectal cancer in China. Colonoscopy remains the most crucial screening method, as early colonoscopy screening can effectively reduce the risk of advanced colorectal cancer. However, the factors influencing the decision-making behavior of first-degree relatives regarding colonoscopy screening have predominantly been examined through quantitative studies, while mixed-methods research remains scarce. This study aimed to evaluate the decision-making behaviors of first-degree relatives of patients with colorectal cancer and to identify the factors influencing these behaviors.
An explanatory sequential design was adopted within a mixed-methods framework. For the quantitative phase, convenience sampling was used to select 272 first-degree relatives of colorectal cancer patients who were treated at a tertiary hospital's gastrointestinal surgery department in Wuhan, China from March to December 2023, for a questionnaire survey. For the qualitative component, a maximum variation purposive sampling method, guided by the Protection Motivation Theory, was employed to select 16 participants from the initial survey group for semi-structured interviews.
Our findings revealed that participants had a high health belief score. Key factors influencing their decision to undergo colonoscopy screening included marital status, average monthly household income, medical payment method, and perceived severity. The qualitative study identified six core themes: perceived susceptibility, perceived severity, internal and external rewards, response efficacy, response costs, and self-efficacy.
Medical staff should focus on first-degree relatives of colorectal cancer who are unmarried or widowed, have lower family income, have lower reimbursement rate of medical insurance, and lack of disease severity perception. Through establishing social support system, issuing subsidies for colonoscopy screening, increasing reimbursement rate of medical insurance, emphasizing the severity of colorectal cancer, to enhance their health belief level and promote colonoscopy screening decision-making behavior.
Not applicable.
在中国，一级亲属中有结直肠癌家族史被认为是结直肠癌最重要且最普遍的危险因素之一。结肠镜检查仍然是最关键的筛查方法，因为早期结肠镜检查筛查可有效降低晚期结直肠癌的风险。然而，影响一级亲属进行结肠镜检查筛查决策行为的因素主要通过定量研究进行了考察，而混合方法研究仍然很少。本研究旨在评估结直肠癌患者一级亲属的决策行为，并确定影响这些行为的因素。
在混合方法框架内采用解释性序列设计。在定量阶段，采用便利抽样法，选取2023年3月至12月在中国武汉一家三级医院胃肠外科接受治疗的272名结直肠癌患者的一级亲属进行问卷调查。在定性部分，采用以保护动机理论为指导的最大变异目的抽样法，从初始调查群体中选取16名参与者进行半结构化访谈。
我们的研究结果显示参与者的健康信念得分较高。影响他们决定进行结肠镜检查筛查的关键因素包括婚姻状况、家庭月平均收入、医疗支付方式和感知严重性。定性研究确定了六个核心主题：感知易感性、感知严重性、内部和外部奖励、反应效能、反应成本和自我效能。
医务人员应关注未婚或丧偶、家庭收入较低医疗保险报销率较低且缺乏疾病严重性认知的结直肠癌患者一级亲属。通过建立社会支持系统、发放结肠镜检查筛查补贴、提高医疗保险报销率、强调结直肠癌的严重性，以提高他们的健康信念水平并促进结肠镜检查筛查决策行为。
不适用。
