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Predictors of Stage of Adoption for Colorectal Cancer Screening Among African American Primary Care Patients

Wang, Hsiao-Lan PhD, RN, CMSRN, HFS; Christy, Shannon M. MA; Skinner, Celette S. PhD; Champion, Victoria L. PhD, RN, FAAN; Springston, Jeffrey K. PhD; Perkins, Susan M. PhD; Tong, Yan PhD; Krier, Connie BS; Gebregziabher, Netsanet MS; Rawl, Susan M. PhD, RN, FAAN

doi: 10.1097/NCC.0b013e3182a40d8d
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Background: Compared with other racial groups, African Americans have the highest colorectal cancer (CRC) incidence and mortality rates coupled with lower screening rates.

Objective: Our study examined the predictors of stage of adoption for fecal occult blood testing (FOBT) and colonoscopy among African American primary care patients who were nonadherent to published screening guidelines.

Methods: Baseline data (N = 815) in a randomized clinical trial were analyzed. Participants were categorized into precontemplation, contemplation, and preparation stages for FOBT and colonoscopy. Predictor variables were demographics, clinical variables, CRC health beliefs and knowledge, and social support. Hierarchical modeling was to identify significant predictors of stage of adoption.

Results: Older, male, Veterans Affairs participants and those with higher perceived self-efficacy, family/friend encouragement, and a provider recommendation had higher odds of being at a more advanced stage of adoption for FOBT. Patients with a history of cancer and higher perceived barriers had higher odds of being at an earlier stage of adoption for FOBT. Predictors of more advanced stage of adoption for colonoscopy included higher perceived benefits, higher perceived self-efficacy, family/friend encouragement, and a provider recommendation for colonoscopy. Higher income (>30 000 vs <15 000) was predictive of earlier stage of adoption for colonoscopy.

Conclusions: Enhancing self-efficacy, encouragement from family and friends, and provider recommendations are important components of interventions to promote CRC screening.

Implications for Practice: Nurses can use knowledge of the characteristics associated with stage of adoption to educate and motivate their African American primary care patients to complete CRC screening tests.

Author Affiliations: University of South Florida College of Nursing, Tampa (Dr Wang); Department of Psychology, Purdue University School of Science, Indiana University–Purdue University, Indianapolis (Ms Christy); University of Texas Southwestern Medical Center, Harold C. Simmons Cancer Center, Dallas (Dr Skinner); Indiana University School of Nursing, Indianapolis (Drs Champion and Rawl and Ms Krier); Indiana University Simon Cancer Center, Indianapolis (Drs Champion, Perkins, and Rawl); Grady College of Journalism and Mass Communication, University of Georgia, Athens (Dr Springston); Indiana University School of Medicine, Indianapolis (Drs Perkins and Tong and Ms Gebregziabher).

Dr Wang, a postdoctoral fellow, received a grant from the National Institute of Nursing Research (T32 NR007066) at Indiana University School of Nursing to prepare the manuscript. Ms Christy, a doctoral student, was funded by the Training in Research for Behavioral Oncology and Cancer Control Program (R25 CA117865-06). Dr Rawl received a grant to support this study from the National Cancer Institute (R01 CA115983).

The authors have no conflicts of interest to disclose.

Correspondence: Hsiao-Lan Wang, PhD, RN, CMSRN, HFS, University of South Florida College of Nursing, 12901 Bruce B Downs Blvd, MDC22, Tampa, FL 33612 (hwang5@health.usf.edu).

Accepted for publication July 6, 2013.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins