Description of the sample
Three hundred forty-one participants completed the follow-up interview at 4 years post-diagnosis, between April 2007 and September 2008 (). Of these, 64 were excluded from the analysis due to not having stage reported, being stage IV, or being stage 0 (N=40); not having had surgery (N=18); or not having responded to the intention question (N=6), yielding a final sample of 277 participants. Compared with participants who completed the one-year interview (and were not diagnosed with stage 0 or stage IV disease or did not have staging information), participants who completed the follow-up interview were more likely to have colon cancer but were otherwise comparable. ()
Participants were interviewed a mean of 45 months since diagnosis (standard deviation [s.d.] = 2.3 months) and a mean of 44 months since their primary cancer surgery (s.d. = 2.5 months). Most (72%) survivors had colon (non-rectal) cancer; 53% were female; and 79% were white. Virtually all (96%) had visited a primary care physician since their diagnosis, and 86% reported having had a colonoscopy since having surgery. Forty-eight percent reported that they had had screening for colorectal cancer before being diagnosed ().
Levels of intentions and health beliefs
Intentions to have a colonoscopy were very high; 88% reported that they were extremely likely to have a colonoscopy in the next 5 years. Participants strongly endorsed (mean = 4.72) benefits of colonoscopy. In general, participants reported few barriers to getting colonoscopy (mean = 1.66). () The cost of colonoscopy was the greatest barrier (mean = 2.13).
Mean values of health beliefs
Survivors felt their chance of getting colorectal cancer was, on average, between slight and moderate. However, they varied widely about their likelihood of getting colorectal cancer (s.d. = 0.98); 39% felt there was a slight chance or no chance of getting colorectal cancer again, whereas 28% felt there was a high chance or that they were certain they would get colorectal cancer again.
Participants reported feeling quite confident that they could obtain a colonoscopy when they were due (mean self-efficacy = 4.81). Ninety-two percent of participants reported that at least one doctor recommended routine colonoscopies.
Primary Hypotheses: Health beliefs and intentions
In bivariate analyses, most health beliefs were associated with intention to have a colonoscopy. Survivors who had higher perceived likelihood (OR=2.02, 95% CI = 1.29–3.18), greater perceived benefits (OR = 2.54. 95% CI = 1.26–5.14), lower perceived barriers (OR=0.28, 95% CI = 0.16–0.50), and a recommendation for a colonoscopy from a physician (OR=14.85, 95% CI = 5.91–37.31) were more likely to have greater intentions to undergo colonoscopy. Self-efficacy was not associated with intentions to have a colonoscopy in the future.
In multivariable analyses (), greater perceived likelihood of getting colorectal cancer again was associated with higher expectations of receiving a colonoscopy (OR = 1.83, p <0.05). Perception of barriers, perception of benefits, physician recommendation, and self-efficacy were not associated with intentions.
Multivariable health belief predictors of intention to have colonoscopy in 5 years. a (N=273)
Secondary hypotheses: Health care use and intentions
In bivariate analyses, having seen a primary care physician in the year since diagnosis was not associated with expectations to have colonoscopies in the future. Those who had a colonoscopy after diagnosis were more likely to have greater intentions to have a colonoscopy in the future (OR = 10.33, 95% CI = 4.62–23.1). Having had screening before diagnosis was not associated with intentions.
Similarly, in multivariable analyses, having seen a primary care physician since diagnosis and having been screened before diagnosis were unrelated to participants’ surveillance intentions. Those who had colonoscopy since surgery for their disease had greater intentions of having colonoscopy in the future (OR=9.47, 95% CI = 2.08–43.16).