Differences in Behavioral Outcomes Between First-Year and Second-Year Participants in a Community-based Colorectal Cancer Education Intervention

Introduction: Colorectal cancer (CRC) is the third most prevalent cancer in China, and the fifth most lethal among all cancers. Community-based health education is helpful for health planners to promote cancer screening, yet relatively few studies tapped the temporal pattern of intervention effectiveness in a multiyear CRC education program. Using data from a two-year CRC community education, this study was aimed at exploring whether the health education intervention effectiveness differs between first-year and the second-year participants. Method: A two-year health education intervention was carried out in four communities in Shanghai, China. The health education focused on raising awareness about CRC, the principles of fecal occult blood test (FOBT) screening, and instruction about use of the FOBT kit. Local community health service centers conducted the lectures once a month. All adult residents were invited to attend these lectures. At the end of the first year and the second year, structured in-person interviews were conducted for the residents who attended the lectures. There were 205 enrollees who completed the first-year interviews and 836 enrollees who completed the second-year interviews. Logistic regression was used to compare the attitudinal and behavioral outcomes of enrollees in years 1 and 2. Result: Of the 1041 respondents, 24.5% had received FOBT during the program period, while 12% had received colonoscopy check, both substantially higher than the background screening rate in Shanghai. Respondents in year 2 were less willing to take FOBT than those in year 1 (O.R. = 0.618, p<0.01), but there was no significant difference in terms of willingness to take colonoscopy after adjustment for covariates in logistic regression. Multiple logistic regression also showed that respondents in year 2 were significantly less likely to take FOBT than those in year 1 (O.R. = 0.263, p<0.01) and a similar tendency was noted for colonoscopy (O.R. = 0.600, p=0.074). Conclusion: The CRC screening rate after the health education compared favorably with the background screening rate, yet the decline in screening rate in year 2 indicates that further study is needed to understand the determinants of intervention effectiveness.