Comparing Colonoscopy-Related Embarrrassment and Barriers to Colonoscopy between Men and Women

Tuesday, 14 July 2009

Kimberly A. Mitchell
Nursing, Saint Francis Medical Center College of Nursing, Peoria, IL
Susan Rawl, PhD, RN
School of Nursing, Indiana University, Indianapolis, IN

Learning Objective 1: identify differences in colonoscopy-related embarrassment between men and women.

Learning Objective 2: state gender differences in perceived barriers to colonoscopy.

Purpose: Experts estimate that 76-90% of colorectal cancer could be prevented with the identification and removal of adenomatous polyps via colonoscopies. However, less than 60% of individuals older than 50 years old have ever had a colonoscopy. Embarrassment has been identified as one important barrier to colonoscopy, but little is known about embarrassment in this context. The purposes of this study were to: 1) examine the differences in colonoscopy-related embarrassment between men and women, and 2) assess gender differences in perceived barriers to colonoscopy. The Health Belief Model and Transtheoretical Model of Change were the theoretical underpinnings of this study.

Methods: Participants were HMO members aged 50-65 years (n=234). Using a cross-sectional, descriptive research design, data were collected using a mailed survey consisting of the Colonoscopy Embarrassment Scale (CES) and the Barriers to Colonoscopy Scale. Reliability coefficients for the scales were .89 and .77 respectively. The response rate was 56%. Data were analyzed using independent samples t-tests and Chi Square.

Results: Nearly 37% of the population reported that a colonoscopy was embarrassing, but there was no significant difference in the mean CES scores by gender (p=.75). However, a higher proportion of women said they would be embarrassed to have a colonoscopy "if they passed gas during the test" (p=.02), "if they had to be awake for the test" (p=.02),  "because they might smell" (p=.02), and "because of the size/appearance of their buttocks" (p=.01). There was no significant difference in the mean Barriers Scale scores (p=.09) between genders, but a significantly higher proportion of women reported that "having to take the laxative would be hard" (p=.05).

Conclusion: Certain aspects of having colonoscopy were more embarrassing for women than men. Gender-specific education and insurance of privacy may help reduce embarrassment for women resulting in greater compliance with colonoscopy and lower mortality.