title: Knowledge, perception and practices of colorectal cancer screening in an ethnically diverse population.
abstract: BACKGROUND
  Colorectal cancer (CRC) screening improves survival and its success depends on the participation of the at-risk population. Few studies have adequately assessed screening knowledge, perception and participation according to birthplace. This study assesses the knowledge and perception of CRC in an ethnically diverse population, and evaluates the association with screening participation and intention. Identification of specific predictors of screening may aid the development of interventions to improve overall CRC screening.
  
  
  METHODS
  An interview-based survey, conducted on subjects aged 30-70 years, assessed knowledge and perception towards CRC and screening tests. Primary endpoints were screening participation and intent. Statistical methods used were Chi-square, Mann-Whitney U and logistic regression.
  
  
  RESULTS
  A total of 543 subjects (43% males, 53% Australian-born (AB), 63% aged 50 years and above) were recruited. Compared with AB, non-Australian-born (NAB) respondents had poorer knowledge, and NAB background predicted for poorer knowledge independent of sex, education, media and familiarity with CRC patient. Compared with AB respondents aged 50 years and above, NAB respondents had lower screening participation (17.4% vs. 31.8%; P=0.01), lesser intention (75.8% vs. 90.5%; P<0.001), and had received fewer doctors' screening recommendations (16.5% vs. 27.1%; P=0.04). In multivariate analysis, doctors' recommendation, media and improved perception independently predicted screening participation; knowledge and media exposure predicted intent.
  
  
  CONCLUSIONS
  The knowledge of CRC and screening is significantly poorer in the immigrant population. Knowledge predicts for greater screening intent. Therefore, implementing language- and culture-specific educational programs involving medical practitioners and media are necessary to improve CRC screening participation rates.
authors.affiliation: Gastroenterology and Liver Services, Sydney South West Area Health Service, Liverpool BC, NSW, Australia. kenjhkoo@yahoo.com.au
authors.forename: Jenn Hian
authors.initials: JH
authors.lastname: Koo
authors.forename: Mal M
authors.initials: MM
authors.lastname: Arasaratnam
authors.forename: Ken
authors.initials: K
authors.lastname: Liu
authors.forename: Diane M
authors.initials: DM
authors.lastname: Redmond
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Connor
authors.forename: Joseph J Y
authors.initials: JJ
authors.lastname: Sung
authors.forename: Rupert W L
authors.initials: RW
authors.lastname: Leong
mesh_terms: D000328:Adult; D000368:Aged; D001208:Asia / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D012307:Risk Factors