Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening tests in the Asia-Pacific region: A multicenter study

Jenn Hian Koo, Rupert W.L. Leong, Jessica Ching, Khay Guan Yeoh, Deng Chyang Wu, Abdullah Murdani, Quancai Cai, Han Mo Chiu, Vui Heng Chong, Rungsun Rerknimitr, Khean Lee Goh, Ida Hilmi, Jeong Sik Byeon, Saad K. Niaz, Arif Siddique, Kai Chun Wu, Takahisa Matsuda, Govind Makharia, Jose Sollano, Sang Kil LeeJoseph J.Y. Sung

Research output: Contribution to journalArticle

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Abstract

Background: The rapid increase in the incidence of colorectal cancer (CRC) in the Asia-Pacific region in the past decade has resulted in recommendations to implement mass CRC screening programs. However, the knowledge of screening and population screening behaviors between countries is largely lacking. Objective: This multicenter, international study investigated the association of screening test participation with knowledge of, attitudes toward, and barriers to CRC and screening tests in different cultural and sociopolitical contexts. Methods: Person-to-person interviews by using a standardized survey instrument were conducted with subjects from 14 Asia-Pacific countries/regions to assess the prevailing screening participation rates, knowledge of and attitudes toward and barriers to CRC and screening tests, intent to participate, and cues to action. Independent predictors of the primary endpoint, screening participation was determined from subanalyses performed for high-, medium-, and low-participation countries. Results: A total of 7915 subjects (49% male, 37.8% aged 50 years and older) were recruited. Of the respondents aged 50 years and older, 809 (27%) had undergone previous CRC testing; the Philippines (69%), Australia (48%), and Japan (38%) had the highest participation rates, whereas India (1.5%), Malaysia (3%), Indonesia (3%), Pakistan (7.5%), and Brunei (13.7%) had the lowest rates. Physician recommendation and knowledge of screening tests were significant predictors of CRC test uptake. In countries with low-test participation, lower perceived access barriers and higher perceived severity were independent predictors of participation. Respondents from low-participation countries had the least knowledge of symptoms, risk factors, and tests and reported the lowest physician recommendation rates. "Intent to undergo screening" and "perceived need for screening" was positively correlated in most countries; however, this was offset by financial and access barriers. Limitations: Ethnic heterogeneity may exist in each country that was not addressed. In addition, the participation tests and physician recommendation recalls were self-reported. Conclusions: In the Asia-Pacific region, considerable differences were evident in the participation of CRC tests, physician recommendations, and knowledge of, attitudes toward, and barriers to CRC screening. Physician recommendation was the uniform predictor of screening behavior in all countries. Before implementing mass screening programs, improving awareness of CRC and promoting the physicians' role are necessary to increase the screening participation rates.

Original languageEnglish
Pages (from-to)126-135
Number of pages10
JournalGastrointestinal Endoscopy
Volume76
Issue number1
DOIs
Publication statusPublished - 2012 Jul 1

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Early Detection of Cancer
Multicenter Studies
Colorectal Neoplasms
Physicians
Brunei
Physician's Role
Mass Screening
Philippines
Indonesia
Malaysia
Pakistan
Cues
India
Japan
Interviews
Incidence
Population

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Koo, Jenn Hian ; Leong, Rupert W.L. ; Ching, Jessica ; Yeoh, Khay Guan ; Wu, Deng Chyang ; Murdani, Abdullah ; Cai, Quancai ; Chiu, Han Mo ; Chong, Vui Heng ; Rerknimitr, Rungsun ; Goh, Khean Lee ; Hilmi, Ida ; Byeon, Jeong Sik ; Niaz, Saad K. ; Siddique, Arif ; Wu, Kai Chun ; Matsuda, Takahisa ; Makharia, Govind ; Sollano, Jose ; Lee, Sang Kil ; Sung, Joseph J.Y. / Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening tests in the Asia-Pacific region : A multicenter study. In: Gastrointestinal Endoscopy. 2012 ; Vol. 76, No. 1. pp. 126-135.
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title = "Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening tests in the Asia-Pacific region: A multicenter study",
abstract = "Background: The rapid increase in the incidence of colorectal cancer (CRC) in the Asia-Pacific region in the past decade has resulted in recommendations to implement mass CRC screening programs. However, the knowledge of screening and population screening behaviors between countries is largely lacking. Objective: This multicenter, international study investigated the association of screening test participation with knowledge of, attitudes toward, and barriers to CRC and screening tests in different cultural and sociopolitical contexts. Methods: Person-to-person interviews by using a standardized survey instrument were conducted with subjects from 14 Asia-Pacific countries/regions to assess the prevailing screening participation rates, knowledge of and attitudes toward and barriers to CRC and screening tests, intent to participate, and cues to action. Independent predictors of the primary endpoint, screening participation was determined from subanalyses performed for high-, medium-, and low-participation countries. Results: A total of 7915 subjects (49{\%} male, 37.8{\%} aged 50 years and older) were recruited. Of the respondents aged 50 years and older, 809 (27{\%}) had undergone previous CRC testing; the Philippines (69{\%}), Australia (48{\%}), and Japan (38{\%}) had the highest participation rates, whereas India (1.5{\%}), Malaysia (3{\%}), Indonesia (3{\%}), Pakistan (7.5{\%}), and Brunei (13.7{\%}) had the lowest rates. Physician recommendation and knowledge of screening tests were significant predictors of CRC test uptake. In countries with low-test participation, lower perceived access barriers and higher perceived severity were independent predictors of participation. Respondents from low-participation countries had the least knowledge of symptoms, risk factors, and tests and reported the lowest physician recommendation rates. {"}Intent to undergo screening{"} and {"}perceived need for screening{"} was positively correlated in most countries; however, this was offset by financial and access barriers. Limitations: Ethnic heterogeneity may exist in each country that was not addressed. In addition, the participation tests and physician recommendation recalls were self-reported. Conclusions: In the Asia-Pacific region, considerable differences were evident in the participation of CRC tests, physician recommendations, and knowledge of, attitudes toward, and barriers to CRC screening. Physician recommendation was the uniform predictor of screening behavior in all countries. Before implementing mass screening programs, improving awareness of CRC and promoting the physicians' role are necessary to increase the screening participation rates.",
author = "Koo, {Jenn Hian} and Leong, {Rupert W.L.} and Jessica Ching and Yeoh, {Khay Guan} and Wu, {Deng Chyang} and Abdullah Murdani and Quancai Cai and Chiu, {Han Mo} and Chong, {Vui Heng} and Rungsun Rerknimitr and Goh, {Khean Lee} and Ida Hilmi and Byeon, {Jeong Sik} and Niaz, {Saad K.} and Arif Siddique and Wu, {Kai Chun} and Takahisa Matsuda and Govind Makharia and Jose Sollano and Lee, {Sang Kil} and Sung, {Joseph J.Y.}",
year = "2012",
month = "7",
day = "1",
doi = "10.1016/j.gie.2012.03.168",
language = "English",
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Koo, JH, Leong, RWL, Ching, J, Yeoh, KG, Wu, DC, Murdani, A, Cai, Q, Chiu, HM, Chong, VH, Rerknimitr, R, Goh, KL, Hilmi, I, Byeon, JS, Niaz, SK, Siddique, A, Wu, KC, Matsuda, T, Makharia, G, Sollano, J, Lee, SK & Sung, JJY 2012, 'Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening tests in the Asia-Pacific region: A multicenter study', Gastrointestinal Endoscopy, vol. 76, no. 1, pp. 126-135. https://doi.org/10.1016/j.gie.2012.03.168

Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening tests in the Asia-Pacific region : A multicenter study. / Koo, Jenn Hian; Leong, Rupert W.L.; Ching, Jessica; Yeoh, Khay Guan; Wu, Deng Chyang; Murdani, Abdullah; Cai, Quancai; Chiu, Han Mo; Chong, Vui Heng; Rerknimitr, Rungsun; Goh, Khean Lee; Hilmi, Ida; Byeon, Jeong Sik; Niaz, Saad K.; Siddique, Arif; Wu, Kai Chun; Matsuda, Takahisa; Makharia, Govind; Sollano, Jose; Lee, Sang Kil; Sung, Joseph J.Y.

In: Gastrointestinal Endoscopy, Vol. 76, No. 1, 01.07.2012, p. 126-135.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening tests in the Asia-Pacific region

T2 - A multicenter study

AU - Koo, Jenn Hian

AU - Leong, Rupert W.L.

AU - Ching, Jessica

AU - Yeoh, Khay Guan

AU - Wu, Deng Chyang

AU - Murdani, Abdullah

AU - Cai, Quancai

AU - Chiu, Han Mo

AU - Chong, Vui Heng

AU - Rerknimitr, Rungsun

AU - Goh, Khean Lee

AU - Hilmi, Ida

AU - Byeon, Jeong Sik

AU - Niaz, Saad K.

AU - Siddique, Arif

AU - Wu, Kai Chun

AU - Matsuda, Takahisa

AU - Makharia, Govind

AU - Sollano, Jose

AU - Lee, Sang Kil

AU - Sung, Joseph J.Y.

PY - 2012/7/1

Y1 - 2012/7/1

N2 - Background: The rapid increase in the incidence of colorectal cancer (CRC) in the Asia-Pacific region in the past decade has resulted in recommendations to implement mass CRC screening programs. However, the knowledge of screening and population screening behaviors between countries is largely lacking. Objective: This multicenter, international study investigated the association of screening test participation with knowledge of, attitudes toward, and barriers to CRC and screening tests in different cultural and sociopolitical contexts. Methods: Person-to-person interviews by using a standardized survey instrument were conducted with subjects from 14 Asia-Pacific countries/regions to assess the prevailing screening participation rates, knowledge of and attitudes toward and barriers to CRC and screening tests, intent to participate, and cues to action. Independent predictors of the primary endpoint, screening participation was determined from subanalyses performed for high-, medium-, and low-participation countries. Results: A total of 7915 subjects (49% male, 37.8% aged 50 years and older) were recruited. Of the respondents aged 50 years and older, 809 (27%) had undergone previous CRC testing; the Philippines (69%), Australia (48%), and Japan (38%) had the highest participation rates, whereas India (1.5%), Malaysia (3%), Indonesia (3%), Pakistan (7.5%), and Brunei (13.7%) had the lowest rates. Physician recommendation and knowledge of screening tests were significant predictors of CRC test uptake. In countries with low-test participation, lower perceived access barriers and higher perceived severity were independent predictors of participation. Respondents from low-participation countries had the least knowledge of symptoms, risk factors, and tests and reported the lowest physician recommendation rates. "Intent to undergo screening" and "perceived need for screening" was positively correlated in most countries; however, this was offset by financial and access barriers. Limitations: Ethnic heterogeneity may exist in each country that was not addressed. In addition, the participation tests and physician recommendation recalls were self-reported. Conclusions: In the Asia-Pacific region, considerable differences were evident in the participation of CRC tests, physician recommendations, and knowledge of, attitudes toward, and barriers to CRC screening. Physician recommendation was the uniform predictor of screening behavior in all countries. Before implementing mass screening programs, improving awareness of CRC and promoting the physicians' role are necessary to increase the screening participation rates.

AB - Background: The rapid increase in the incidence of colorectal cancer (CRC) in the Asia-Pacific region in the past decade has resulted in recommendations to implement mass CRC screening programs. However, the knowledge of screening and population screening behaviors between countries is largely lacking. Objective: This multicenter, international study investigated the association of screening test participation with knowledge of, attitudes toward, and barriers to CRC and screening tests in different cultural and sociopolitical contexts. Methods: Person-to-person interviews by using a standardized survey instrument were conducted with subjects from 14 Asia-Pacific countries/regions to assess the prevailing screening participation rates, knowledge of and attitudes toward and barriers to CRC and screening tests, intent to participate, and cues to action. Independent predictors of the primary endpoint, screening participation was determined from subanalyses performed for high-, medium-, and low-participation countries. Results: A total of 7915 subjects (49% male, 37.8% aged 50 years and older) were recruited. Of the respondents aged 50 years and older, 809 (27%) had undergone previous CRC testing; the Philippines (69%), Australia (48%), and Japan (38%) had the highest participation rates, whereas India (1.5%), Malaysia (3%), Indonesia (3%), Pakistan (7.5%), and Brunei (13.7%) had the lowest rates. Physician recommendation and knowledge of screening tests were significant predictors of CRC test uptake. In countries with low-test participation, lower perceived access barriers and higher perceived severity were independent predictors of participation. Respondents from low-participation countries had the least knowledge of symptoms, risk factors, and tests and reported the lowest physician recommendation rates. "Intent to undergo screening" and "perceived need for screening" was positively correlated in most countries; however, this was offset by financial and access barriers. Limitations: Ethnic heterogeneity may exist in each country that was not addressed. In addition, the participation tests and physician recommendation recalls were self-reported. Conclusions: In the Asia-Pacific region, considerable differences were evident in the participation of CRC tests, physician recommendations, and knowledge of, attitudes toward, and barriers to CRC screening. Physician recommendation was the uniform predictor of screening behavior in all countries. Before implementing mass screening programs, improving awareness of CRC and promoting the physicians' role are necessary to increase the screening participation rates.

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