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Cited by 12Colorectal Cancer Screening and DetectionGlobal Cancer Incidence and ScreeningHealth Promotion and Cardiovascular Prevention

Mediators of screening uptake in a colorectal cancer screening intervention among Hispanics

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Shokar, Navkiran K., Salinas, Jennifer, Dwivedi, Alok·2022·BMC Cancer
DOI 10.1186/s12885-021-09092-wPMC PMC8729110
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Abstract

Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the USA. Although a number of CRC screening tests have been established as being effective for CRC prevention and early detection, rates of CRC screening test completion in the US population remain suboptimal, especially among the uninsured, recent immigrants and Hispanics. In this study, we used a structural equation modelling approach to identify factors influencing screening test completion in a successful CRC screening program that was implemented in an uninsured Hispanic population. This information will enhance our understanding of influences on CRC screening among historically underscreened populations. Methods: We used generalized structural equation models (SEM) utilizing participant reported information collected through a series of surveys. We identified direct and indirect pathways through which cofactors, CRC knowledge and individual Health Belief Model constructs (perceived benefits, barriers, susceptibility, fatalism and self-efficacy) and a latent psychosocial health construct mediated screening in an effective prospective randomized CRC screening intervention that was tailored for uninsured Hispanic Americans. Results: Seven hundred twenty-three participants were eligible for inclusion; mean age was 56 years, 79.7% were female, and 98.9% were Hispanic. The total intervention effect was comparable in both models, with both having a direct and indirect effect on screening completion (n = 715, Model 1: RC = 2.46 [95% CI: 2.20, 2.71, p < 0.001]; n = 699, Model 2 RC =2.45, [95% CI: 2.18, 2.72, p < 0.001]. In Model 1, 32% of the overall effect was mediated by the latent psychosocial health construct (RC = 0.79, p < 0.001) that was in turn mainly influenced by self-efficacy, perceived benefits and fatalism. In Model 2, the most important individual mediators were self-efficacy (RC = 0.24, p = 0.013), and fatalism (RC = 0.07, p = 0.033). Conclusion: This study contributes to our understanding of mediators of CRC screening and suggests that targeting self-efficacy, perceived benefits and fatalism could maximize the effectiveness of CRC screening interventions particularly in Hispanic populations.

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  • Fatalism is an emotional barrier.

    “Emotional barriers include fear of cancer, screening results and treatment [8,9,15] and fatalism [10,24].”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [24]

    The Measures and data collection section identifies fatalism as an additional barrier to colorectal cancer screening. It defines fatalism as a belief that life events are determined by fate, but does not classify it as an emotional barrier. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Educational interventions work best when the level of previous knowledge is low.

    “Educational programmes are likely to be most effective when the level of prior knowledge is low [24, 64] and might not have desired effects if the level of knowledge is already high.”

    From Improving cancer screening uptake: A behavioural and cultural insights perspective and rapid review (2026) · cites this paper as [24]

    The Discussion (page unavailable) says knowledge may have a greater influence on colorectal cancer screening when baseline knowledge is low. That supports the direction of the claim, but it is a tentative statement about knowledge’s influence on screening, not a finding that educational programmes generally work best for people with low prior knowledge. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Cited by

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Authors
Shokar, N. K., Salinas, J., & Dwivedi, A.
Affiliations
  • The University of Texas at Austin (US)
  • Texas Tech University Health Sciences Center (US)
Corresponding author
Shokar, Navkiran K.
ORCID
Venue
BMC Cancer
Publisher
Springer Science and Business Media LLC
Published
2022-01-05
Volume
22
Issue
1
Pages
37-37
ISSN
1471-2407 (ISSN-L)
DOI
10.1186/s12885-021-09092-w
PMC
PMC8729110
OpenAlex
W4205233697
Cited by
12
References
0
Citations by year
2026: 3 · 2025: 1 · 2024: 4 · 2023: 2 · 2022: 2
FWCI
0.94
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Cancer (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Cancer Prevention and Research Institute of Texas (PP110156)
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords
colorectal cancer screening, screening uptake, Hispanic Americans, uninsured population, Health Belief Model, self-efficacy, fatalism, perceived benefits, psychosocial health, screening interventions, mediation analysis, colorectal cancer knowledge
MeSH terms
Latent Class Analysis, Female, Hispanic or Latino, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Prospective Studies, Colorectal Neoplasms, Medically Uninsured, Early Detection of Cancer

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