Protective Motivation Theory In Colorectal Cancer Screening Intention Among Chinese Urban Residents

Objective This study was to investigate the knowledge of colorectal cancer and screening and influencing factors of colorectal cancer screening intention among urban residents in China.The protection motivation theory(PMT)framework was utilized to explain determinants associated with colorectal cancer screening intention,providing advice for health education and related prevention and treatment of colorectal cancer in urban area.Methods A questionnaire survey based on the Program of Cancer Screening in Urban China was conducted among recruited urban residents aged 40-74 in Wuhan City,Hubei Province,carried out from December 2018 to April 2019.The baseline data of the study samples including demographic data,dietary and living habits,psychological states and previous history were obtained from the risk assessment questionnaire of Cancer Screening Program in Urban China,and the intention of colorectal cancer screening was obtained from the self-designed questionnaire among urban residents in China.Epidata3.2 software was use to input data.SAS9.4 software package was used for statistical analysis of the data,and Amos21.0 software was used for structural equation model.Cronbach’s alpha coefficient,Corrected Item-Total Correlation and split-half reliability were used for reliability evaluation of the scale.Confirmatory factor analysis and Pearson correlation coefficient were used to evaluate the validity of the scale.Descriptive statistical analysis was used for baseline data,knowledge of colorectal cancer and screening.One-way anova and multiple linear regression analysis were used to analyze the influencing factors of screening intention.Structural equation model(SEM)was used to identify how PMT subconstructs explain colorectal cancer screening intention.Results(1)The scale to examine colorectal cancer screening intention for urban residents contains 6 subconstructs and 17 items.There were 2 items for Risk Perception(Cronbach’sα=0.59),2 items for Severity Perception(Cronbach’sα=0.72),3 items for Fear Arousal(Cronbach’sα=0.62),3 items for Response Efficiency(Cronbach’sα=0.74),3 items for Response Cost(Cronbach’sα=0.71),and 5 items for Self-efficacy(Cronbach’sα=0.74).Through confirmatory factor analysis,the scale was well fitted to the framework of protection motivation theory:GFI was 0.97,AGFI was 0.95,CFI was 0.97,NFI was 0.93,χ~2/df was 1.63,RMR was 0.04,RMSEM was 0.03,and all fitting indexes were better than reference values.The discriminant validity also shows that different subconstructs are independent,as well as contribute to the scale.(2)There were 478 samples(83.42%) showed intention to participate in colorectal cancer screening,expressing a well screening condition.One-way ANOVA showed that samples with a high salt diet,regular physical activity,and a family history of cancer had stronger intention to participate in colorectal cancer screening(F=5.57,p<0.01;F=4.83,p<0.05;F=4.56,p=<0.05).People with a higher level of knowledge of colorectal cancer risk factors,colorectal cancer symptom and colorectal cancer screening(F=8.97,p<0.01;F=7.20,p<0.01;F=5.33,p<0.01)had stronger intention to participate in colorectal cancer screening.Multiple linear regression results showed that age,occupation,knowledge of colorectal cancer risk factor and colorectal cancer screening were influencing factors of urban residents’intention to colorectal cancer screening.Older people(β=0.01,p<0.05),farmers(β=0.36,p<0.05),a high level of knowledge of colorectal cancer risk factors(β=0.04,p<0.01)and colorectal cancer screening(β=0.08,p<0.05)had stronger intention to participate in colorectal cancer screening.The results of structural equation model analysis showed that the PMT model fitted well,with GFI of 0.93,AGFI of 0.91,CFI of 0.91,NFI of 0.82,χ~2/df of 1.82 and RMSEM of 0.04.Age,social status(education level and occupation),diet and living habits,previous history and knowledge can all have an indirect effect on screening intentions through Perceived Severity and Self-efficacy;diet habits and related knowledge also had positive direct effects on colorectal cancer screening intention.Conclusion The reliability and validity of the self-designed scale was good,and could be used to evaluate colorectal cancer intention of urban residents.People’s intention to screen for colorectal cancer was influenced by age,occupation,diet and lifestyle habits,previous history,and related knowledge.Based on the protection motivation theory,to increase the rate of colorectal cancer intention and screening for urban residents,we should insisted on education to all,especially for people with poor health awareness to improve urban residents’understanding of screening importance,reduce the possible obstacles in the screening process and enhance their confidence in screening participation.