title: The interrelationships between and contributions of background, cognitive, and environmental factors to colorectal cancer screening adherence.
abstract: OBJECTIVE
  We examined the interrelationships between and contributions of background, cognitive, and environmental factors to colorectal cancer (CRC) screening adherence.
  
  
  METHODS
  In this study, 2,416 average risk patients aged 50-75 from 24 Veterans Affairs medical facilities responded to a mailed survey with phone follow-up (response rate 81%). Survey data (attitudes, behaviors, demographics) were linked to facility (organizational complexity) and medical records data (diagnoses, screening history). Patients with a fecal occult blood test within 15 months, sigmoidoscopy or barium enema within 5.5 years, or colonoscopy within 11 years of the survey were considered adherent. Logistic regressions estimated the association between adherence and background, cognitive, and environmental factors. Deviance ratios examined interrelationships between factors. Population attributable risks (PAR) were used to identify intervention targets.
  
  
  RESULTS
  The association of background factors with adherence was partially explained by cognitive and environmental factors. The association of environmental factors with adherence was partially explained by cognitive factors. Cognitive and environmental factors contributed equally to adherence. Factors with the highest PARs for non-adherence were age 50-64, less than two comorbidities, and lack of physician recommendation.
  
  
  CONCLUSIONS
  Efforts to increase physician screening recommendations for younger, healthy patients at facilities with the lowest screening rates may improve CRC adherence in this setting.
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417, USA. melissa.partin@va.gov
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Partin
authors.forename: Siamak
authors.initials: S
authors.lastname: Noorbaloochi
authors.forename: Joseph
authors.initials: J
authors.lastname: Grill
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Burgess
authors.forename: Michelle
authors.initials: M
authors.lastname: van Ryn
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
authors.forename: Joan M
authors.initials: JM
authors.lastname: Griffin
authors.forename: Adam A
authors.initials: AA
authors.lastname: Powell
authors.forename: Krysten
authors.initials: K
authors.lastname: Halek
authors.forename: Ann
authors.initials: A
authors.lastname: Bangerter
authors.forename: Sally W
authors.initials: SW
authors.lastname: Vernon
mesh_terms: D000368:Aged; D001466:Barium Sulfate; D003113:Colonoscopy / Q000523:psychology / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D004733:Enema / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D012944:Social Support; D012959:Socioeconomic Factors
chemical_list: D001466:Barium Sulfate