title: Development of a brief survey on colon cancer screening knowledge and attitudes among veterans.
abstract: BACKGROUND
  Poor knowledge of and negative attitudes toward available screening tests may account in part for colorectal cancer screening rates being the lowest among 17 quality measures reported for the Department of Veterans Affairs health care system, the largest integrated health system in the United States. The purpose of this study was to develop a brief assessment tool to evaluate knowledge and attitudes among veterans toward colorectal cancer screening options.
  
  
  METHODS
  A 44-item questionnaire was developed to assess knowledge, attitudes, and beliefs about colorectal cancer and screening and was then administered as part of an ongoing randomized controlled trial among 388 veterans receiving care in a general medicine clinic. Sixteen candidate items on colorectal cancer knowledge, attitudes, and beliefs were selected for further evaluation using principal components analysis. Two sets of items were then further analyzed.
  
  
  RESULTS
  Because the Cronbach alpha for beliefs was low (alpha = 0.06), the beliefs subscale was deleted from further consideration. The final scale consisted of seven items: a four-item attitude subscale (alpha = 0.73) and a three-item knowledge subscale (alpha = 0.59). Twelve-month follow-up data were used to evaluate predictive validity; improved knowledge and attitudes were significantly associated with completion of flexible sigmoidoscopy (P = .004) and completion of either flexible sigmoidoscopy or colonoscopy (P = .02).
  
  
  CONCLUSIONS
  The two-factor scale offers a parsimonious and reliable measure of colorectal cancer screening knowledge and attitudes among veterans. This colorectal Cancer Screening Survey (CSS) may especially be useful as an evaluative tool in developing and testing of interventions designed to improve screening rates within this population.
authors.affiliation: Institute for Health Services Research and Policy Studies, Northwestern University, Feinberg School of Medicine, 676 N St Clair St, Suite 200, Chicago, IL 60611, USA. mswolf@northwestern.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: M Rosario
authors.initials: MR
authors.lastname: Ferreira
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Dolan
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Franklin
authors.initials: F
authors.lastname: Medio
authors.forename: Dachao
authors.initials: D
authors.lastname: Liu
authors.forename: June
authors.initials: J
authors.lastname: Lee
authors.forename: Marian
authors.initials: M
authors.lastname: Fitzgibbon
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D025341:Principal Component Analysis; D011594:Psychometrics; D012812:Sigmoidoscopy; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans