Background
Methods
Participants and procedure
Measures
Variable | Items | Cronbach’s α | Factor loading | Explained variance (%) |
---|---|---|---|---|
Beliefs | ||||
Perceived susceptibility | 3 | .90 | .87–.93 | 82.90 |
Perceived severity | 4 | .86 | .83–.87 | 71.31 |
Perceived benefits | 3 | .94 | .94–.96 | 90.00 |
Perceived barriers | 4 | .89 | .84–.91 | 75.23 |
Mediators | ||||
Cues to action | 3 | .90 | .89–.94 | 83.56 |
Self-efficacy | 3 | .94 | .94–.96 | 89.21 |
Dependent variable | ||||
Likelihood of FOBT uptake | 3 | .91 | .89–.95 | 85.44 |
Data analyses
Results
Background information
Characteristics | All (N = 391) | Health professionals (N = 191) | Healthcare volunteers (N = 200) | χ2 |
p
|
---|---|---|---|---|---|
n (%) | n (%) | n (%) | |||
Gender | 5.79 | .016 | |||
Male | 75 (19.20) | 46 (24.08) | 29 (14.50) | ||
Female | 316 (80.80) | 145 (75.92) | 171 (85.50) | ||
Age group (years) | 60.92 | < .001 | |||
50–59 | 259 (66.20) | 163 (85.43) | 96 (48.00) | ||
≥ 60 | 132 (33.80) | 28 (14.66) | 104 (52.00) | ||
Educational level a | 62.11 | < .001 | |||
Year 12 or below | 249 (64.62) | 84 (44.92) | 165 (83.33) | ||
College or above | 136 (35.32) | 103 (55.08) | 33 (16.67) | ||
Occupation a | 173.79 | < .001 | |||
Full-time employment | 199 (51.00) | 162 (85.30) | 37 (18.50) | ||
Other | 191 (49.00) | 28 (14.80) | 163 (81.50) | ||
Living conditions a | 2.79 | .095 | |||
With family | 362 (93.10) | 181 (95.30) | 181 (91.00) | ||
Other | 27 (6.90) | 9 (4.70) | 18 (9.00) | ||
Marital status a | 3.21 | .073 | |||
Married | 364 (93.80) | 174 (91.60) | 190 (96.00) | ||
Other | 24 (6.20) | 16 (8.40) | 8 (4.00) | ||
Colorectal polyps | 1.51 | .219 | |||
Yes | 21 (5.40) | 13 (6.80) | 8 (4.00) | ||
No | 370 (94.60) | 178 (93.20) | 192 (96.00) | ||
Family history of CRC (first-degree relative) a | .05 | .817 | |||
Yes | 32 (8.30) | 15 (7.90) | 17 (8.60) | ||
No | 355 (91.70) | 174 (92.10) | 181 (91.40) | ||
BMI (> 27 kg/m2) a | .59 | .441 | |||
Overweight | 76 (19.90) | 34 (18.30) | 42 (21.40) | ||
Normal | 306 (80.10) | 152 (81.70) | 154 (78.60) | ||
Smoking | .01 | .911 | |||
Current or ex-smoker | 22 (5.60) | 11 (5.80) | 11 (5.50) | ||
Non-smoker | 369 (94.40) | 180 (94.20) | 189 (94.50) |
1 | 2 | 3 | 4 | 5 | 6 | 7 | |
---|---|---|---|---|---|---|---|
1. Perceived susceptibility | 1 | .09 | .03 | .14** | .02 | - .05 | .00 |
2. Perceived severity | 1 | .34** | - .16** | .21** | .26** | .28** | |
3. Perceived benefits | 1 | - .28** | .27** | .33** | .41** | ||
4. Perceived barriers | 1 | - .37** | - .39** | - .31** | |||
5. Cues to action | 1 | .44** | .27** | ||||
6. Self-efficacy | 1 | .60** | |||||
7. Likelihood of an FOBT uptake | 1 |
Measurement model of latent constructs
Structural equation model
Paths | All (R2 = .45, 95% CI = .33–.55) | Health professionals (R2 = .44, 95% CI = .26–.58) | Healthcare volunteers (R2 = .50, 95% CI = .30–.66) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
β | L | U | Result | β | L | U | Result | β | L | U | Result | |
Susceptibility → Likelihood of an FOBT uptake | .02 | −.08 | .10 | NS | .01 | −.10 | .13 | NS | .01 | −.12 | .15 | NS |
Severity → Likelihood of an FOBT uptake | .08 | −.02 | .20 | NS | .14 | −.04 | .34 | NS | .03 | −.11 | .17 | NS |
Benefits → Likelihood of an FOBT uptake | .21** | .10 | .36 | S | .21** | .06 | .41 | S | .17* | .02 | .37 | S |
Barriers → Likelihood of an FOBT uptake | −.03 | −.15 | .08 | NS | −.13* | −.29 | −.01 | S | .07 | −.10 | .27 | NS |
Cues to action → Likelihood of an FOBT uptake | −.04 | −.17 | .09 | NS | −.06 | −.29 | .11 | NS | −.01 | −.19 | .16 | NS |
Self-efficacy → Likelihood of an FOBT uptake | .53** | .35 | .69 | S | .44** | .24 | .69 | S | .66** | .41 | .83 | S |
Susceptibility → Cues to action | .05 | −.05 | .15 | NS | .05 | −.13 | .21 | NS | .06 | −.08 | .22 | NS |
Severity → Cues to action | .11 | −.04 | .25 | NS | .14 | −.05 | .33 | NS | .09 | −.09 | .33 | NS |
Benefits → Cues to action | .15* | .03 | .29 | S | .08 | −.11 | .30 | NS | .25** | .11 | .41 | S |
Barriers → Cues to action | −.26** | −.41 | −.12 | S | −.30** | −.51 | −.10 | S | −.23* | −.42 | −.04 | S |
Susceptibility → Self-efficacy | −.04 | −.13 | .06 | NS | .00 | −.16 | .14 | NS | −.05 | −.18 | .10 | NS |
Severity → Self-efficacy | .15* | .02 | .32 | S | .21* | .03 | .41 | S | .07 | −.09 | .28 | NS |
Benefits → Self-efficacy | .19** | .06 | .34 | S | .23** | .07 | .45 | S | .18* | .01 | .36 | S |
Barriers → Self-efficacy | −.32** | −.46 | −.19 | S | −.32** | −.52 | −.18 | S | −.33** | −.54 | −.13 | S |
All, β (95% CI) | Professionals, β (95% CI) | Volunteers, β (95% CI) | |||||||
---|---|---|---|---|---|---|---|---|---|
Direct | Indirect | Total | Direct | Indirect | Total | Direct | Indirect | Total | |
Susceptibility | .02 (−.08, .10) | −.02 (−.08, .03) | .00 (−.11, .10) | .01 (−.10, .13) | .00 (−.07, .06) | .01 (−.11, .14) | .01 (−.12, .15) | −.03 (−.13, .06) | −.02 (−.18, .14) |
Severity | .08 (−.02, .20) | .08* (.01, .18) | .16* (.01, .33) | .14 (−.04, .34) | .08* (.01, .20) | .22* (.02, .46) | .03 (−.11, .17) | .05 (−.05, .20) | .08 (−.11, .27) |
Benefits | .21** (.10, .36) | .09** (.03, .18) | .30** (.16, .48) | .21** (.06, .41) | .10** (.03, .24) | .31** (.11, .54) | .17* (.03, .37) | .12* (.01, .24) | .29** (.13, .51) |
Barriers | −.03 (−.15, .08) | −.16** (−.27, −.09) | −.19** (−.33, −.08) | −.13* (−.29, −.01) | −.12** (−.27, −.04) | −.25** (−.46, −.11) | .07 (−.10, .27) | −.22** (−.40, −.11) | −.15 (−.34, .03) |
Cues to action | −.04 (−.17, .09) | – | −.04 (−.17, .09) | −.06 (−.29, .11) | – | −.06 (−.29, .11) | −.01 (−.19, .16) | – | −.01 (−.19, .16) |
Self-efficacy | .53** (.35, .69) | – | .53** (.35, .69) | .44** (.24, .69) | – | .44** (.24, .69) | .66** (.41, .83) | – | .66** (.41, .83) |
Multi-group analyses
Model | χ2 | df | CFI | Nested models | △χ2 | △df | p | |
---|---|---|---|---|---|---|---|---|
1 | Baseline: unconstrained | 844.49 | 454 | .95 | ||||
2 | Factor loadings constrained equal | 860.54 | 466 | .95 | 2–1 | 16.06 | 12 | .189 |
3 | Factor loadings, factor correlations constrained equal | 879.45 | 479 | .94 | 3–2 | 18.90 | 13 | .126 |
4 | Factor loading, factor correlations, measurement error constrained equal | 896.61 | 495 | .94 | 4–3 | 17.17 | 16 | .375 |
5 | Factor loading, factor correlations, measurement error, structural coefficients constrained equal | 920.79 | 510 | .94 | 5–4 | 24.18 | 15 | .062 |
6a | Susceptibility → Likelihood of an FOBT uptake | 896.61 | 496 | .94 | 6a-4 | .00 | 1 | .967 |
6b | Severity → Likelihood of an FOBT uptake | 897.82 | 496 | .94 | 6b-4 | 1.20 | 1 | .272 |
6c | Benefits → Likelihood of an FOBT uptake | 896.61 | 496 | .94 | 6c-4 | .00 | 1 | .988 |
6d | Barriers → Likelihood of an FOBT uptake | 900.95 | 496 | .94 | 6d-4 | 4.34 | 1 | .037 |
6e | Cues to action → Likelihood of an FOBT uptake | 896.75 | 496 | .94 | 6e-4 | .14 | 1 | .713 |
6f | Self-efficacy → Likelihood of an FOBT uptake | 905.18 | 496 | .94 | 6f-4 | 8.57 | 1 | .003 |
6 g | Susceptibility → Cues to action | 896.61 | 496 | .94 | 6 g-4 | .00 | 1 | .960 |
6 h | Severity → Cues to action | 896.73 | 496 | .94 | 6 h-4 | .12 | 1 | .733 |
6i | Benefits → Cues to action | 900.04 | 496 | .94 | 6i-4 | 3.43 | 1 | .064 |
6j | Barriers → Cues to action | 898.26 | 496 | .94 | 6j-4 | 1.65 | 1 | .199 |
6 k | Susceptibility → Self-efficacy | 896.80 | 496 | .94 | 6 k-4 | .19 | 1 | .664 |
6 l | Severity → Self-efficacy | 898.31 | 496 | .94 | 6 l-4 | 1.70 | 1 | .192 |
6 m | Benefits → Self-efficacy | 896.81 | 496 | .94 | 6 m-4 | .20 | 1 | .654 |
6n | Barriers → Self-efficacy | 898.61 | 496 | .94 | 6n-4 | 2.00 | 1 | .158 |
6o | Gender → Likelihood of an FOBT uptake | 896.64 | 496 | .94 | 6o-4 | .03 | 1 | .856 |
Discussion
Author (year) | Type of participants | Dependent variable | Significant HBM-related factors |
---|---|---|---|
The present study (2019) | Health professionals aged 50–75 years | Likelihood of FOBT uptake | Self-efficacy, perceived severity, benefits, and barriers |
Healthcare volunteers aged 50–75 years | Likelihood of FOBT uptake | Self-efficacy, and perceived benefits. | |
Sohler et al. (2015) [29] | Patients aged 50–75 years | Uptake of CRC screening (medical record review) | Self-efficacy, and cues to action (discussion of screening with healthcare provider) |
Wong et al. (2013) [18] | Residents aged ≥50 years | Uptake of CRC screening (Colonoscopy) | Cues to action (physician’s recommendation), perceived susceptibility, and perceived barriers |
Cyr et al. (2010) [25] | Residents (91.3% ≥36 years) | Intention to undergo genetic testing for CRC | Perceived benefits and barriers |
Sung et al. (2008) [30] | Residents aged 30–65 years | Uptake of CRC testing | Cues to action (physician’s recommendation), perceived severitya, and perceived barriers |
Manne et al. (2003) [31] | Siblings (aged ≥35 years) of individuals with CRC | Colonoscopy Intentions | Perceived severity, benefits, and barriers |
Codori et al. (2001) [32] | First-degree relatives of patients with CRC aged 18–86 years | Past CRC Endoscopic Screening | Perceived susceptibility |