title: Socio-psychological factors in the Expanded Health Belief Model and subsequent colorectal cancer screening.
abstract: OBJECTIVE
  CRC screening interventions tailored to the Expanded Health Belief Model (EHBM) socio-psychological factors have been developed, but the contributions of individual factors to screening outcomes are unclear.
  
  
  METHODS
  In observational analyses of data from a randomized intervention trial, we examined the independent associations of five EHBM factors - CRC screening knowledge, self-efficacy, stage of readiness, barriers, and discussion with a provider - with objectively measured CRC screening after one year.
  
  
  RESULTS
  When all five factors were added simultaneously to a base model including other patient and visit characteristics, three of the factors were associated with CRC screening: self-efficacy (OR=1.32, p=0.001), readiness (OR=2.72, p<0.001), and discussion of screening with a provider (OR=1.59, p=0.009). Knowledge and barriers were not independently associated with screening. Adding the five socio-psychological factors to the base model improved prediction of CRC screening (area under the curve) by 7.7%.
  
  
  CONCLUSIONS
  Patient CRC screening self-efficacy, readiness, and discussion with a provider each independently predicted subsequent screening.
  
  
  CONCLUSIONS
  Self-efficacy and readiness measures might be helpful in parsimoniously predicting which patients are most likely to engage in CRC screening. The importance of screening discussion with a provider suggests the potential value of augmenting patient-focused EHBM-tailored interventions with provider-focused elements.
authors.affiliation: Community Health and Social Medicine, Sophie Davis School of Biomedical Education, City College of New York, New York, USA. Electronic address: nsohler@med.cuny.edu.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Sohler
authors.affiliation: Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, USA. Electronic address: afjerant@ucdavis.edu.
authors.forename: Anthony
authors.initials: A
authors.lastname: Jerant
authors.affiliation: Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Franks
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000523:psychology / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology*; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D008962:Models, Theoretical; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D020377:Self Efficacy; D014481:United States
keywords: Colorectal cancer; Expanded Health Belief Model; Screening behavior; Socio-psychological factors; Theoretical models