Examining Factors Contributing to Adherence to Colorectal Cancer Screening Among Older Korean Americans Using Andersen's Behavioral Model of Healthcare Services Utilization

Background and Purpose: Routine uptake of colorectal cancer (CRC) screening saves people’s lives through early detection and removal of precancerous polyps. Despite the benefit from having the screening, adherence to CRC screening guidelines for older Korean Americans (KAs) remains suboptimal, lagging significantly behind the national goal (70.5%). Research has shown that the suboptimal screening outcomes are closely linked to their personal characteristics, cultural belief systems, and environmental factors. However, little is known about the factors that enable older KAs to adhere to CRC screening. Understandings of these enabling factors provide useful information for developing interventions designed to facilitate CRC screening adherence among KAs. Thus, this study employed the Andersen’s Behavioral Model of Healthcare Services Utilization as a theoretical framework to predict factors contributing to adhere to CRC screening among KAs.

Methods: Convenience sampling was performed to recruit KAs aged 50 and 75 from a metropolitan area in the Southeastern U.S. A total of 433 KAs completed a cross-sectional survey asked to self-report information regarding predisposing variables (i.e., age, gender, marital status, and education), need variables (i.e., family cancer history and self-rated health status), and enabling variables (i.e., income, health insurance, annual health check-up, physician recommendation, English proficiency, screening knowledge, self-efficacy, and decisional balance), and the outcome variable (CRC screening adherence). Descriptive analyses were conducted to describe the characteristics of the variables. Multiple logistic regression analyses were implemented to investigate the enabling factors predicting CRC screening adherence among the participants. All analyses were conducted with Stata/SE 14.2, and a 5% significance level was used as a criterion for all statistical tests in the study. 

Results: Descriptive analyses showed that most participants were female (62%), married (84%), and insured (74%). The mean age of participants was 58.7 (SD=8.02). About 59% had bachelor’s degree, and 42% had an annual household income below $40,000. Approximately 43% of the participants had annual health check-up; 49% received physician recommendation to be screened. One half of the participants had had family cancer history. Only 8.4% reported having bad or very bad health status. Also, 48% reported having bad or very bad English level. About 46% of participants adhered to CRC screening. Multiple logistic regression analyses showed that CRC screening adherence was positively associated with several enabling factors, including physician recommendation (OR = 8.26, p < .001, 95% CI [4.41, 15.45]), self-efficacy (OR = 2.82, p < .05, 95% CI [1.11, 7.20]), and decisional balance (OR = 4.61, p < .01, 95% CI [1.49, 14.30]), respectively, controlling for other variables. 

Conclusions and Implications: This study found physician recommendation, self-efficacy, and decisional balance to be a factor contributing to CRC screening adherence among older KAs, guided by the Andersen’s Behavioral Model. The findings highlight the significant role of social workers in facilitating CRC screening adherence among older KAs by bolstering patient-doctor communications and relationships. The findings also suggest culturally-competent interventions directed toward lowering barriers to accessing screening services and improving culture-interwoven attitudes/beliefs toward CRC screening that may enable KAs to adhere to regular uptake of CRC screening.