Knowledge of, attitudes toward, and barriers to participation of colorectal cancer screening tests in the Asia-Pacific region: a multicenter study.
BACKGROUND
The rapid increase in the incidence of colorectal cancer (CRC) in the Asia-Pacific region in the past decade has resulted in recommendations to implement mass CRC screening programs. However, the knowledge of screening and population screening behaviors between countries is largely lacking.


OBJECTIVE
This multicenter, international study investigated the association of screening test participation with knowledge of, attitudes toward, and barriers to CRC and screening tests in different cultural and sociopolitical contexts.


METHODS
Person-to-person interviews by using a standardized survey instrument were conducted with subjects from 14 Asia-Pacific countries/regions to assess the prevailing screening participation rates, knowledge of and attitudes toward and barriers to CRC and screening tests, intent to participate, and cues to action. Independent predictors of the primary endpoint, screening participation was determined from subanalyses performed for high-, medium-, and low-participation countries.


RESULTS
A total of 7915 subjects (49% male, 37.8% aged 50 years and older) were recruited. Of the respondents aged 50 years and older, 809 (27%) had undergone previous CRC testing; the Philippines (69%), Australia (48%), and Japan (38%) had the highest participation rates, whereas India (1.5%), Malaysia (3%), Indonesia (3%), Pakistan (7.5%), and Brunei (13.7%) had the lowest rates. Physician recommendation and knowledge of screening tests were significant predictors of CRC test uptake. In countries with low-test participation, lower perceived access barriers and higher perceived severity were independent predictors of participation. Respondents from low-participation countries had the least knowledge of symptoms, risk factors, and tests and reported the lowest physician recommendation rates. "Intent to undergo screening" and "perceived need for screening" was positively correlated in most countries; however, this was offset by financial and access barriers.


CONCLUSIONS
Ethnic heterogeneity may exist in each country that was not addressed. In addition, the participation tests and physician recommendation recalls were self-reported.


CONCLUSIONS
In the Asia-Pacific region, considerable differences were evident in the participation of CRC tests, physician recommendations, and knowledge of, attitudes toward, and barriers to CRC screening. Physician recommendation was the uniform predictor of screening behavior in all countries. Before implementing mass screening programs, improving awareness of CRC and promoting the physicians' role are necessary to increase the screening participation rates.
Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. kenjhkoo@yahoo.com.au
Jenn Hian
JH
Koo
Rupert W L
RW
Leong
Jessica
J
Ching
Khay-Guan
KG
Yeoh
Deng-Chyang
DC
Wu
Abdullah
A
Murdani
Quancai
Q
Cai
Han-Mo
HM
Chiu
Vui Heng
VH
Chong
Rungsun
R
Rerknimitr
Khean-Lee
KL
Goh
Ida
I
Hilmi
Jeong-Sik
JS
Byeon
Saad K
SK
Niaz
Arif
A
Siddique
Kai Chun
KC
Wu
Takahisa
T
Matsuda
Govind
G
Makharia
Jose
J
Sollano
Sang-Kil
SK
Lee
Joseph J Y
JJ
Sung
D000328:Adult; D000368:Aged; D001210:Asia, Southeastern; D001315:Australia; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000191:economics / Q000523:psychology*; D005202:Asia, Eastern; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D007194:India; D033182:Intention; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010154:Pakistan; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D010358:Patient Participation / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D018709:Statistics, Nonparametric; D055815:Young Adult