title: Adherence to cancer screening guidelines and predictors of improvement among participants in the Kansas State Employee Wellness Program.
abstract: BACKGROUND
  Employee wellness programs (EWPs) have been used to implement worksite-based cancer prevention and control interventions. However, little is known about whether these programs result in improved adherence to cancer screening guidelines or how participants' characteristics affect subsequent screening. This study was conducted to describe cancer screening behaviors among participants in a state EWP and identify factors associated with screening adherence among those who were initially nonadherent.
  
  
  METHODS
  We identified employees and their dependents who completed health risk assessments (HRAs) as part of the Kansas state EWP in both 2008 and 2009. We examined baseline rates of adherence to cancer screening guidelines in 2008 and factors associated with adherence in 2009 among participants who were initially nonadherent.
  
  
  RESULTS
  Of 53,095 eligible participants, 13,222 (25%) participated in the EWP in 2008 and 6,205 (12%) participated in both years. Among the multiyear participants, adherence was high at baseline to screening for breast (92.5%), cervical (91.8%), and colorectal cancer (72.7%). Of participants who were initially nonadherent in 2008, 52.4%, 41.3%, and 33.5%, respectively, became adherent in the following year to breast, cervical, and colorectal cancer screening. Suburban/urban residence and more frequent doctor visits predicted adherence to breast and colorectal cancer screening guidelines.
  
  
  CONCLUSIONS
  The effectiveness of EWPs for increasing cancer screening is limited by low HRA participation rates, high rates of adherence to screening at baseline, and failure of nonadherent participants to get screening. Improving overall adherence to cancer screening guidelines among employees will require efforts to increase HRA participation, stronger interventions for nonadherent participants, and better access to screening for rural employees.
authors.affiliation: Fox Chase Cancer Center, Department of Psychosocial and Behavioral Medicine, 333 Cottman Ave, Young Pavilion 4141, Philadelphia, PA 19111, USA. SKAzor.Hui@fccc.edu
authors.forename: Siu-kuen Azor
authors.initials: SK
authors.lastname: Hui
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Engelman
authors.forename: Theresa I
authors.initials: TI
authors.lastname: Shireman
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
mesh_terms: D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007615:Kansas / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000175:diagnosis*; D009786:Occupational Health Services / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D018570:Risk Assessment