Methodological Issues in Colorectal Cancer Screening Research: Implications for Researchers, Practitioners and Policymakers.

Cancer Screening Survey Methodology Colorectal Cancer;Public Health;Social Sciences;Health Behavior & Health Education

Watts, Elizabeth A.West, Brady T. ;

University of Michigan

关键词: Cancer Screening Survey Methodology Colorectal Cancer;    Public Health;    Social Sciences;    Health Behavior & Health Education;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/108940/eabecker_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

This dissertation explores three distinct, but interrelated, areas of research that provide important additions to the current colorectal cancer (CRC) screening literature.The first study reveals the problematic nature of the common practice of ignoring the impetus for CRC testing when specifying outcomes in survey design and analysis.The results show significant overestimation of true screening rates, high rates of diagnostic testing and disproportionate rates of screening among those with less socioeconomic privilege when compared with those with more socioeconomic resources.The second study finds that survey measurements often mistake diagnostic testing referrals for true screening recommendations, resulting in significant misperception about who is likely to receive a screening recommendation.Finally, the third study showed that although individuals with multiple chronic conditions are more likely to engage in diagnostic testing, their overall rates of true screening are higher than the general population.Based on our findings, we recommend immediate changes to survey methodology, specifically collecting data that allow researchers to clearly differentiate diagnostic testing and true screening. Furthermore, behavioral researchers need to reanalyze additional NHIS data to determine the extent to which diagnostic testing has misestimated improvements in CRC screening rates across time.Researchers exploring psychosocial and instrumental barriers and facilitators of CRC screening need to actively engage with individuals from many sociodemographic groups.Our results show troubling variation in screening uptake and recommendations across groups.We need to understand the source of this variation in order to design and target interventions appropriately.We further recommend that policymakers reconsider their approach to federal screening goals.Specifically, a one-size-fits-all goal that averages very high and very low rates across sociodemographic groups fails to acknowledge the challenges we face in improving public health across levels of privilege.Significant gaps in screening rates will continue to persist if resources are not allocated to addressing these disparities. Finally, our results show we must continue to explore contextual factors such as MCC as we seek to identify influential factors at multiple levels that influence the recommendation and delivery of CRC screening services.