Acceptance of flexible sigmoidoscopy screening for colorectal cancer

This study was conducted in the Kaiser Permanente Medical Care Program of Northern California to identify patient characteristics that explain interest in flexible sigmoidoscopy (FS) screening. A mailed screening invitation to 6837 age-eligible patients elicited responses from 49%. Efforts to reach and interview both eligible respondents and non-respondents resulted in 2728 computer-assisted telephone interviews (CATI), with 60% indicating interest in FS screening. Five components of the Integrated Behavioral Model were measured with respect to FS screening: attitude, affect, social influence, facilitators/barriers, and perceived risk of colorectal cancer. All five model components were significantly and independently associated with interest in FS, with patient attitude being the strongest predictor. Of the 32 items comprising the model components, nine items having the highest correlations with FS interest were identified as potentially important issues to address by efforts to increase interest in screening. Six of these were attitudinal beliefs. The findings from this theory-driven study provide specific targets for the design of interventions to increase FS interest and screening rates.