Applying a stage model of behavior change to colon cancer screening

Mary E. Costanza, University of Massachusetts Medical School
Roger Luckmann, University of Massachusetts Medical School
Anne M. Stoddard
Jill S. Avrunin
Mary Jo White, University of Massachusetts Medical School
Jennifer Rider Stark, University of Massachusetts Medical School
Lynn Clemow
Milagros C. Rosal, University of Massachusetts Medical School

Abstract

BACKGROUND: There has been limited use of stages of change models in characterizing colorectal cancer (CRC) screening. We assess the applicability of the Precaution Adoption Model (PAPM) by determining the distribution of stages of adoption and by elucidating differences among stages.

METHODS: The study is based on 1394 responses (69%) to a survey mailed in 2002 to patients in a primary care population. Survey measures included: self-reported CRC screening, sociodemographic characteristics, health system characteristics, attitudes and beliefs about CRC screening, perceived vulnerability to CRC, and worry about CRC. The main outcome was PAPM stage of adoption of CRC screening based on the ACS preferred guidelines: colonoscopy every 10 years alone or the combination annual FOBT plus sigmoidoscopy every 5 years.

RESULTS: 57% were up-to-date with at least one test; 36% were up-to-date with the ACS preferred guidelines; provider recommendation, positive family history of CRC, and positive decisional balance score were significantly associated with higher compared to lower PAPM stages.

CONCLUSIONS: The combination of PAPM stage assignment and other factors provides useful information for designing tailored interventions. There are special challenges in developing and interpreting PAPM stage assignments when a guideline offers multiple pathways to adherence and recommends a combination of two tests as a preferred option.