Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 21, 2009; 15(31): 3920-3925
Published online Aug 21, 2009. doi: 10.3748/wjg.15.3920
Barrier-focused intervention to increase colonoscopy attendance among nonadherent high-risk populations
Wen Meng, Xi-Wen Bi, Xiao-Yin Bai, Hua-Feng Pan, Shan-Rong Cai, Qi Zhao, Su-Zhan Zhang
Wen Meng, Xi-Wen Bi, Xiao-Yin Bai, Hua-Feng Pan, Shan-Rong Cai, Su-Zhan Zhang, Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang Province, China), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Wen Meng, Department of Cardiothoracic Surgery, Hangzhou No. 1 People Hospital, Hangzhou 310006, Zhejiang Province, China
Qi Zhao, Xiacheng District Center for Disease Control and Prevention, Hangzhou 310003, Zhejiang Province, China
Author contributions: Meng W and Bi XW contributed equally to this work; Meng W, Bi XW, and Zhang SZ designed the research; Meng W, Bi XW, Bai XY, Pan HF, Cai SR and Zhao Q performed the intervention; Meng W and Bi XW analyzed the data and wrote the paper.
Correspondence to: Su-Zhan Zhang, Professor, Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. zhangsuzhan@yahoo.com
Telephone: +86-571-87214404
Fax: +86-571-87214404
Received: June 9, 2009
Revised: July 20, 2009
Accepted: July 27, 2009
Published online: August 21, 2009
Abstract

AIM: To increase attendance for colonoscopy among nonadherent high-risk individuals for colorectal cancer (CRC) screening in China.

METHODS: During the first 12 mo without intervention, only 428 of the 2398 high-risk subjects attended a scheduled colonoscopy examination. The 1970 subjects who did not attend for CRC screening were enrolled in the present study. Prior barrier investigation was performed to ascertain the reasons for nonadherence. A barrier-focused intervention program was then established and implemented among eligible nonadherent subjects by telephone interviews and on-site consultations. The completion rates of colonoscopy during the first 12 mo without intervention and the second 12 mo with intervention were compared. Variations in the effect of the intervention on some high-risk factors and barrier characteristics were analyzed using logistic regression.

RESULTS: 540 subjects who were not eligible were excluded from the study. The colonoscopy attendance rate was 23.04% (428/1858) during the first 12 mo without intervention, and 37.69% (539/1430) during the second 12 mo with intervention (P < 0.001). Logistic regression analysis showed that the intervention was more effective among subjects with only objective barriers (OR: 34.590, 95% CI: 23.204-51.563) or subjects with some specific high-risk characteristics: first-degree relatives diagnosed with CRC (OR: 1.778, 95% CI: 1.010-3.131), personal history of intestinal polyps (OR: 3.815, 95% CI: 1.994-7.300) and positive result for immunochemical fecal occult blood testing (OR: 2.718, 95% CI: 1.479-4.996).

CONCLUSION: The barrier-focused telephone or on-site consultation intervention appears to be a feasible means to improve colonoscopy attendance among nonadherent high-risk subjects for CRC screening in China.

Keywords: Colorectal cancer; Screening; Intervention; Colonoscopy; Attendance