Barrier-focused intervention to increase colonoscopy attendance among nonadherent high-risk populations

Table 1 Main barriers to colonoscopy among high-risk subjects (n = 407)

Barriers	n(%)
Subjective barriers
“I am not at risk for CRC”: no symptoms	185 (45.45)
Fear of finding cancer and subsequent surgery	10 (2.46)
Fear of some complications related to colonoscopy	9 (2.21)
Other personal health concerns1	9 (2.21)
Embarrassment	2 (0.49)
Total	215 (52.83)
Objective barriers
Intolerance of pain or discomfort	112 (27.52)
Busy on working days	50 (12.29)
Intolerance of bowel preparation or diet control	14 (3.44)
Inconvenience and complexity of colonoscopy procedure	14 (3.44)
Transportation problems	2 (0.49)
Total	192 (47.17)

¹Subjects preferred to focus on current health problems, such as diabetes, and fractures. CRC: Colorectal cancer.

Table 2 Barrier-focused intervention program

Barriers	Special measures	General measures
Subjective barriers	Explanation and education
“Not at risk for CRC”: no symptoms	Explain benefits and importance of screening, and give results of previous screening	Answering questions about the screening
Fear of finding cancer	Explain that early detection of CRC leads to good prognosis	Reminding of upcoming appointments
Fear of complications or perforation	Explain that complications in colonoscopy examination are rare	Arranging on-site consultations from the physician and epidemiologists if necessary
Embarrassment	Ensure that the patient’s confidence will be well protected	Providing guidance
Objective barriers	Improving objective condition
Intolerance of pain	Arranging painless colonoscopy1
Lack of time on working days	Arranging examination at weekends
Intolerance of bowel preparation	Simplifying bowel preparation
Inconvenience and complexity of colonoscopy procedure	Providing guidance

¹Painless colonoscopy: Intravenous general anesthesia was performed during colonoscopy.

Table 3 Baseline characteristics of eligible subjects (n = 1430)

Characteristics	n(%)
Age (yr)
40-59	687 (48.04)
60-74	743 (51.96)
Sex
Male	511 (35.73)
Female	919 (64.27)
High-risk factors
FDRs diagnosed with CRC	240 (16.78)
Personal history of intestinal polyps	105 (7.34)
Personal history of other cancers	136 (9.51)
Positive for questionnaire1	839 (58.67)
Positive for iFOBT	241 (16.85)
Characteristics of barriers
With subjective barriers	646 (45.17)
With objective barriers	714 (49.93)
Without barriers	70 (4.90)

¹Positive for questionnaire refers to having ≥ 2 of the following six items: (1) chronic diarrhea; (2) chronic constipation; (3) mucous or bloody stools; (4) personal history of appendicitis or appendectomy; (5) personal history of chronic cholecystitis or cholecystectomy; (6) history of psychiatric trauma. iFOBT: Immunochemical fecal occult blood testing.

Table 4 Variation in intervention effects (n = 1430)

Characteristics	Adjusted OR	95% CI	P value
Age (yr)
40-59	1.000	0.643-1.133	0.273
60-74	0.853
Sex
Male	1.000
Female	0.955	0.706-1.292	0.767
High-risk factors
FDRs diagnosed with CRC	1.778	1.010-3.131	0.046
Personal history of intestinal polyps	3.815	1.994-7.300	0.000
Personal history of other cancers	1.444	0.745-2.799	0.277
Positive for questionnaire1	1.589	0.925-2.727	0.093
Positive for iFOBT	2.718	1.479-4.996	0.001
Characteristics of barriers
With subjective barriers	1.000
With objective barriers	34.590	23.204-51.563	0.000
Without barriers	132.421	59.709-293.681	0.000

¹Positive for questionnaire refers to having ≥ 2 of the following six items: (1) chronic diarrhea; (2) chronic constipation; (3) mucous or bloody stools; (4) personal history of appendicitis or appendectomy; (5) personal history of chronic cholecystitis or cholecystectomy; (6) history of psychiatric trauma. FDRs: First-degree relatives.