Surveying barriers to Colorectal Cancer screening in Jordan Öffentlichkeit
Harper, Rebecca (Summer 2022)
Abstract
Colorectal cancer (CRC) is the most common cancer for men in Jordan, and the second most common for women (Globocan, 2020). There is a need to better understand the underlying factors that have resulted in very low screening rates, with studies indicating a 12.6% referral rate and a 9.1% uptake rate (Ahmad, 2015). Patients are hesitant to receive CRC screenings because of poor public awareness of the risk factors and screening options(Abuadas et al., 2018; Omran et al., 2015), while also experiencing practical obstacles to meeting routinely with providers (Hammad et al., 2022). Similarly, reduced supportive resources for providers and workloads create barriers to higher CRC screening advocacy to patients(Abuadas & Abuadas, 2019; Ahmad et al., 2015). The intention of this work was to better understand the motivators and barriers to CRC screening as perceived by healthcare providers in Jordan.
We conducted a cross sectional survey of 153 primary healthcare providers in two Jordanian health governates that applied social implementation principals to assess factors that influence their decision to discuss CRC screening with their patients. The Theoretical Domain Framework (TDF) is a social-behavioral implementation framework used to understand the mechanics of specific behaviors with 12 of the 14 main domains representing various personal, social, and psychological factors, which were used in this survey to evaluate the context of practice for Jordanian providers. Attested knowledge varied between different types of Jordanian providers, while confidence in the reliability and availability of all screening options remained high. Responses also strongly indicated that providers were aware of social and personal concerns around CRC screenings but felt unsure of their ability to relieve these concerns. Respondents included 46% male providers and 54% female providers, with the majority of those being physicians (69%). Practice distribution among respondents was 45% urban, 42% rural, and 11% indicating practice in other areas. Concerns with resources capacities, knowledge levels between provider types, and logistical issues for patients strongly indicated that additional public health education and clinical support measures are needed to improve the uptake of CRC screenings in Jordan.
Table of Contents
Chapter 1: Introduction 1
Problem Statement 1
Purpose Statement and Aims 2
Significance Statement 3
Chapter 2: Literature Review 4
Burden of colorectal cancer 4
Colorectal cancer types and biology 7
Etiology and primary prevention 8
Screening and Early detection 9
Barriers to Screening CRC 11
References 54
Chapter 3: Manuscript 16
Abstract 16
Background 16
Purpose 17
Methods 17
Results 17
Conclusion 18
Background 18
Methods 19
Study Design 19
Study population and sample 20
Survey tool and data collection 20
Underpinning theory for survey: 20
Survey development: 21
Knowledge 21
Skills 22
Optimism 23
Motivation and Goals 23
Reinforcement and Memory, Attention, or Decision-making Processes 24
Professional Role 25
Emotions 25
Social Influence 25
Environmental Context and Resources 25
Divisions between provider groups 26
Non-TDF variables 27
Practice Setting 27
Profession 27
Recent screening referrals 27
Data Collection: 28
Data Management and Statistical Analysis 28
Results 29
Participants’ characteristics 29
Barriers to colorectal cancer screening as perceived by healthcare providers 29
Knowledge 29
Skills 30
Beliefs in Capabilities 30
Motivation and goals 31
Reinforcement 31
Memory, Attention, or Decision-making processes 32
Behavioral Regulation 33
Professional role 33
Emotions 33
Environmental Context and Resources 34
Discussion 34
Recommendations 37
Conclusions 38
Table 1 – Characteristics of the study population (N%) 40
Table 2 – Percentage of provider agreement to questions within domains of the Theoretical Domains Framework (TDF) 41
Chapter 4: Discussion 46
Discussion 46
Strengths & Limitations 50
Recommendations 51
Conclusions 52
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