title: Barrier-focused intervention to increase colonoscopy attendance among nonadherent high-risk populations.
abstract: OBJECTIVE
  To increase attendance for colonoscopy among nonadherent high-risk individuals for colorectal cancer (CRC) screening in China.
  
  
  METHODS
  During the first 12 mo without intervention, only 428 of the 2398 high-risk subjects attended a scheduled colonoscopy examination. The 1970 subjects who did not attend for CRC screening were enrolled in the present study. Prior barrier investigation was performed to ascertain the reasons for nonadherence. A barrier-focused intervention program was then established and implemented among eligible nonadherent subjects by telephone interviews and on-site consultations. The completion rates of colonoscopy during the first 12 mo without intervention and the second 12 mo with intervention were compared. Variations in the effect of the intervention on some high-risk factors and barrier characteristics were analyzed using logistic regression.
  
  
  RESULTS
  540 subjects who were not eligible were excluded from the study. The colonoscopy attendance rate was 23.04% (428/1858) during the first 12 mo without intervention, and 37.69% (539/1430) during the second 12 mo with intervention (P < 0.001). Logistic regression analysis showed that the intervention was more effective among subjects with only objective barriers (OR: 34.590, 95% CI: 23.204-51.563) or subjects with some specific high-risk characteristics: first-degree relatives diagnosed with CRC (OR: 1.778, 95% CI: 1.010-3.131), personal history of intestinal polyps (OR: 3.815, 95% CI: 1.994-7.300) and positive result for immunochemical fecal occult blood testing (OR: 2.718, 95% CI: 1.479-4.996).
  
  
  CONCLUSIONS
  The barrier-focused telephone or on-site consultation intervention appears to be a feasible means to improve colonoscopy attendance among nonadherent high-risk subjects for CRC screening in China.
authors.affiliation: Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Meng
authors.forename: Xi-Wen
authors.initials: XW
authors.lastname: Bi
authors.forename: Xiao-Yin
authors.initials: XY
authors.lastname: Bai
authors.forename: Hua-Feng
authors.initials: HF
authors.lastname: Pan
authors.forename: Shan-Rong
authors.initials: SR
authors.lastname: Cai
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhao
authors.forename: Su-Zhan
authors.initials: SZ
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D003113:Colonoscopy / Q000523:psychology / Q000706:statistics & numerical data; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012044:Regression Analysis; D012307:Risk Factors
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