FACTORS DETERMINING COLORECTAL CANCER SCREENING AMONG SECONDARY SCHOOL TEACHERS IN KIRKUK CITY

ORIGINAL ARTICLE

FACTORS DETERMINING COLORECTAL CANCER SCREENING AMONG SECONDARY SCHOOL TEACHERS IN KIRKUK CITY

Aynar Khaleel Shakeer¹, Arkan Bahlol Naji ² *

1. Kirkuk Health Directorate, Kirkuk General Hospital, City of Kirkuk, Iraq;
2. Department of Community Health Nursing, College of Nursing, University of Baghdad, City of Baghdad, Iraq.

Corresponding author: Aynar Khaleel Shakeer

Email: arkan_nagi_web2009@yahoo.com

ORCID

ABSTRACT

Study Design: A descriptive predictive design was used to guide this study.

Study Objectives: This study to (1) identify the association between teachers’ age, body mass index, years of employment, and their intention to undergo colorectal cancer screening, and (2) investigate the difference in teachers’ health beliefs about colorectal cancer screening between the groups of gender, educational qualification, marital status, and family history of having colorectal cancer.

Setting: This study was conducted in secondary schools in Kirkuk City.

Sample and Sampling: The study included a convenience sample of 397 secondary school teachers.

Study Instrument: The study instrument is composed of teachers’ sociodemographic sheet, the body mass index, and the Health Beliefs Scale for Colorectal Cancer Screening.

Data Collection: Data were collected using an online survey “Google form”. Data were collected for the period from March 6th, 2021 to April 10th, 2021.

Study Results: There was a statistically significant positive association between participants’ age and their Perceived Susceptibility of contracting colorectal cancer. On the other hand, there was a statistically significant inverse association between participants’ body mass index and their Perceived Susceptibility of contracting colorectal cancer. There was a statistically significant inverse association between participants’ years of employment and their Perceived Benefits of colorectal screening.

Conclusions: The student researcher recommends that there is a need to devote health promotion activities, particularly that encourage older teachers, those who are overweight and/or obese, those who have a family history of colorectal cancer, single, and have lower educational qualification to undergo colorectal screening..

Received - 05-06-2021, Reviewed - 08/07/2021, Revised/ Accepted- 03/08/2021

INTRODUCTION

Colorectal cancer is the commonest malignancy in the gastrointestinal tract and the third leading cause of cancer associated death in the world. Usually, CRC is thought as a common disease affecting old people, with most cases diagnosed during the 5th and 6th decades and a higher prevalence among men (Campos et al., 2017).

During the past decades, there is a trend in decreasing the incidence of CRC in older people with an opposite effect among adolescents and young adults (Fancher et al., 2011), a change that has been attributed to an inadequate screening and lifestyle risk factors related to obesity and diet profile (Hubbard & Grothey, 2013).

The overall crude incidence of colorectal cancer increased in most European countries over the last decade. The annual increase ranged in different countries between 0.4% and 3.6%. The recent introduction of CRC screening in most European countries will likely reverse this trend. These screening programs typically target subjects aged 50 years and above. In several parts of the world, the CRC incidence has also risen in individuals below 50 years of age. In the USA, the incidence of colon cancer increased since 1974 with 1.0%–2.4% annually and the incidence of rectal cancer with 3.2% (Vuik et al., 2019).

In the worldwide, nearly 800,000 new CRC cases occur each year, comprising 10% of all cancer malignancies with nearly 450,000 cases mortality annually. Totally, CRC is the fourth commonest form of cancer occurring worldwide. Furthermore, cancer incidence data and death rate in Asian countries may be underestimated (Tahmasebi et al., 2016).

In recent years, alterations in diet, sedentary lifestyles, and the rising prevalence of obesity have been hypothesized to impact molecular and physiological characteristics influencing the risk of CRCs and other cancer types in younger populations. Additional insights into the clinicopathology and speculated etiology and risk factors of early-onset colorectal cancers have been comprehensively reviewed (Loomans-Kropp & Umar, 2019).

Global patterns vary widely and are strongly linked to human development index level, reflecting the adoption of western lifestyles that accompany economic transition and elevate risk. In general, CRC incidence is rising in low-income and middle-income countries but beginning to stabilize or decline in high-income countries, especially those that have implemented screening. However, accumulating evidence from studies of cancer registry data indicates that favorable overall trends are masking an increase in young-onset CRC in the USA, Australia and Canada (Siegel et al., 2019).

The possible reasons for this increasing incidence are unknown but may be related to the increasing prevalence of obesity, lack of exercise and to dietary factors such as alcohol and processed meat. Further-more, urbanization and pollution have been implicated in the overall increase in cancer incidence. CRC in young adults is in part due to hereditary cancer syndromes, but most cases are sporadic (Vuik et al., 2019).

Beliefs provide a crucial link between socialization and behavior. Beliefs are enduring individual characteristics that shape behavior and can be acquired through primary socialization. Beliefs are also modifiable and can differentiate between individuals from the same background. If persuasive techniques can be used to change behavior related beliefs and such interventions result in behavior change, this provides a theoretical and practical basis for evidence-based health education (Abraham, & Sheeran, 2015).

The HBM had the advantage of specifying a discrete set of common-sense beliefs that appear to explain, or mediate, the effects of demographic variables on health behavior patterns and are amenable to change through educational intervention. The model could be applied to a range of health behavior's and so provided a framework for shaping behavior patterns relevant to public health as well as training health care professionals to work from their patients’ subjective perceptions of illness and treatment. Consensus regarding the utility of the HBM was important for public health research and, simultaneously, placed cognition modelling at the center of health service research (Orji et al., 2012).

This study aims to (1) identify the association between teachers’ age, body mass      index, years of employment, and their intention to undergo colorectal cancer screening, and (2) investigate the difference in teachers’ health beliefs about colorectal cancer screening between the groups of gender, educational qualification, marital status, and family history of having colorectal cancer.

METHOD

-Study Design:

A descriptive predictive design was used to guide this study.

-Study Objectives:

This study to :

(1) identify the association between teachers’ age, body mass index, years of employment, and their intention to undergo colorectal cancer screening.

(2) investigate the difference in teachers’ health beliefs about colorectal cancer screening between the groups of gender, educational qualification, marital status, and family history of having colorectal cancer.

-Study Setting:

This study was conducted in secondary schools in Kirkuk City.

Sample and Sampling: The study included a convenience sample of 397 secondary school teachers.

-Study Instrument:

The study instrument is composed of teachers’ sociodemographic sheet, the body mass index, and the Health Beliefs Scale for Colorectal Cancer Screening.

-Data Collection:

Data were collected using an online survey “Google form”. Data were collected for the period from March 6th, 2021, to April 10th, 2021.

Statistical analysis

The collected data were compiled and analysed using percentages, mean, median, and Chi-square tests using SPSS version 21. P values of 0.05 were used as a cut-off point for the significance of the statistical test.

RESULTS

Table 1 shows the mean age is 40.14 ± 6.57; most age 35-43-years (n = 308; 77.6%), followed by those wo age 44-52-years (n = 56; 14.1%), and those who age 53-62-years (n = 33; 8.3%).

Concerning gender, most are females (n = 257; 64.7%) compared to males (n = 140; 35.3%). Regarding marital status, most are married (n = 287; 72.3%), followed by those who are Widows/Widowers (n = 65; 16.4%), those who are divorced (n = 30; 7.5%), and those who are not married (n = 15; 3.8%).

Regarding family’s monthly income, around two-fifth reported that their family monthly income ranges between 601.000 – 900.000 (n = 158; 39.8%), followed by those whose monthly income ranges between 901.000 – 1.200.000 (n = 100; 25.2%), those whose monthly income is 1.501.000 or higher (n = 60; 15.1%), those whose monthly income ranges between 300.000 – 600.000 (n = 48; 12.1%), and those whose monthly income ranges between 1.201.000 – 1.500.000 (n = 31; 7.8%).

Table 2 shows there is a statistically significant positive association between participants’ age and their Perceived Susceptibility of contracting colorectal cancer (r = 0.01). On the other hand, there is a statistically significant inverse association between participants’ body mass index and their Perceived Susceptibility of contracting colorectal cancer (r = 0.05).

Table 3 shows there is a statistically significant inverse association between participants’ years of employment and their Perceived Benefits of colorectal screening (r = 0.01). On the other hand, there is a statistically significant positive association between participants’ body mass index and their Perceived Benefits of colorectal screening (r = 0.01).

Table 4 shows there are statistically significant differences subjects’ Perceived Susceptibility of contracting colorectal cancer and Perceived Benefits of colorectal screening between the groups of gender (p = 0.01, 0.01) respectively.

Table 5 shows there are statistically significant differences in subjects’ Perceived Susceptibility of contracting colorectal cancer and Perceived Benefits of colorectal screening between the family history of colorectal cancer (p = 0.05, 0.01) respectively.

Table 6 shows there are statistically significant differences in subjects’ Perceived Barriers to colorectal screening, Perceived Susceptibility of contracting colorectal cancer, and Perceived Benefits of colorectal screening among the marital status groups (p = 0.01, 0.01, 0.01) respectively.

Table 6 shows there are statistically significant differences in subjects’ Perceived Barriers to colorectal screening and Perceived Benefits of colorectal screening among the educational qualification groups (p = 0.01, 0.01) respectively.

Table 1. Participants’ sociodemographic characteristics (N = 397)

Table 2. Association between participants’ age, years of employment, body mass index, and their Perceived Susceptibility of contracting colorectal cancer

Table 3. Association between participants’ age, years of employment, body mass index, and their Perceived Benefits of colorectal screening

Table 4. Differences in Perceived Barriers to colorectal screening, Perceived Susceptibility of contracting colorectal cancer, and Perceived Benefits of colorectal screening between the gender groups

Table 5. Differences in Perceived Barriers to colorectal screening, Perceived Susceptibility of contracting colorectal cancer, and Perceived Benefits of colorectal screening between the family history of colorectal cancer groups

Table 6. Differences in Perceived Barriers to colorectal screening, Perceived Susceptibility of contracting colorectal cancer, and Perceived Benefits of colorectal screening among the marital status groups

Table 7. Differences in Perceived Barriers to colorectal screening, Perceived Susceptibility of contracting colorectal cancer, and Perceived Benefits of colorectal screening among the educational qualification groups