In Trinidad and Tobago, colorectal cancer is the second leading cause of death from cancer; therefore attempts must be made to decrease this rate with the use of prevention and screening which is still the best methods according to research done to fight this disease. The purpose of the study was to explore the knowledge, attitudes, and practice of men towards CRC and its prevention in Tobago.
Methods: A descriptive, quantitative and cross-sectional study. Colorectal is a prevalent condition that can be identified and definitively treated during an asymptomatic phase, thereby preventing the morbidity and mortality associated with the unscreened clinical course of the disease ( Taha et al; 2015; Rogers et al ;2014; Tam et al;2011;). Varied literature on colorectal cancer and it effects was reviewed. Limited knowledge about the importance of colorectal screening and the methods used which includes colonoscopy and faecal occult blood test( FOBT) was identified as major issues as it relates to the person accessing CRC screening (Muliira et al; 2016; Ghahramani et al; 2015; Şahin et al; 2015; Andriole et al; 2012; Salimzadeh et al; 2012;) there was no relationship between gender, health insurance status, family history of individuals and their knowledge about CRC (Bidouei et al;2014;this was a similarity also found in the present study. Fear as it relates to a positive screening test result, failure of physicians to recommend screening, scheduling difficulties, cost, lack of insurance coverage, gaps in knowledge, embarrassment, pain, aversion, lack of symptoms, and perceived low risk was identified as a reason for the limited uptake (Gordon et al; 2015; McClellan et al., (2015), Vrinten et al; 2014; Wong et al; 2013;).
Person perception about the need for screening was also identified the most cited reasons for not having screening tests was “did not have any symptoms or problem” and “did not think it was needed” “never think of the test,” “doctor did not recommend the test,” (Bidouei et al; 2014; Salimzadeh et al; 2012 ;).
It was found that there is a common thread throughout the literature: that colorectal cancer is a preventable disease and there are screening options, which if accessed, can help to drastically reduce the number of persons affected by this disease (Tsai; 2015; Lasser et al; 2011; Winterich et al; 2011;). Each individual is responsible for his or her health and wellbeing and CRC can be prevented by the modification of one’s lifestyle. This includes changes in diet: increase in fibre intake; decrease in consumption of fatty and processed food; cessation of smoking and alcohol use; and early screening for persons who are at increased risk due to family history( Wutayd et al;2015 ; Wong et al;2013;)
Education and teaching initiatives developed with the target audience in mind both individual and healthcare professionals, that focuses on educating the public about how to reduce their risk of contracting this non-communicable disease, in my opinion, is the way forward and was also recommended in a study done by (Barros et al; 2014; Souza et al 2012; Ravichandran et al; 2011).
Target Population for the study included men aged between 19-45 years of age, who are residing in Tobago. An estimated sample of 200 men residing in Tobago was the sample size. The subject was chosen by non-random sampling method called convenient sampling or volunteer sampling. The subjects in the convenient sample were volunteers who were readily accessible to the nurse researcher. A cross-sectional study was conducted in Tobago with 200 male participants ranging from ages 19-45 years old, males who visit the mall/ shopping centre and residents of Tobago. Data was collected using an in-depth self-administered KAP questionnaire. Participants’ demographic characteristics assessed in Section A.
Section B of the questionnaire consisted of 30 items, which identified the knowledge and practice of colorectal cancer among the respondent. With response option and points given for UNSURE =3 points, TRUE= 2 points, FALSE = 1 point. This was then divided into four subsection (i) knowledge of colorectal cancer questions, (ii) Colorectal symptoms, (iii) Colorectal risk factors and (iv) Colorectal Screening tests.
Section C had ten statements on attitude towards detection of CRC. It is a 5 point Likert scale ranging from strongly disagree to strongly agree. Strongly agree has a score of 5, agree a score of 4, undecided a score of 3, disagree ia score of 2 and strongly disagree a score of 1.
Ethical approval was obtained from UWI Campus Ethics Committee as well as the Public administrative body/ administration of the malls of Tobago to conduct the study and from the study respondents who were willing to participate in the study. Scoring and Interpretation of reliability & validity of the tool was established through test retest method. Data were analyzed using SPSS.
Multivariable statistical methods were applied to identify independent predictors for CRC screening among participants.
Limitations of the study is that it focused on the geographical region of Tobago which may not necessarily be applicable to other Caribbean territories.
Results:
Majority of the respondents 185(92.5%) are employed, only 15(7.5%) retired or unemployed. And maximum respondents 179(89.5%) do not have a family history of colorectal cancer. When respondents were asked about whether they participated in any cancer screening in past 2 years, most of them 162(81%) replied that they didn’t participated in any such study , only 58(19%) said that they did participated. When they were asked about whether they had colonoscopy in the past, 185(92.5%) said no or they don’t know, only 15(7.5%) replied as yes. When respondents were asked about whether they ever done FOBT or bowel cancer screening test, 190(95%) of them responded as no or they don’t know, only 10(5%) answered as Yes. When they were asked about whether they know someone in the family has cancer, 135(67.5 %) replied as no and 65(32.5%) replied as yes.
T-values were found significant in the means of knowledge and practice towards colorectal cancer( 58.17+26.68) and its symptoms ( 47.50+26.46) and risk factors ( 53.50+26.60) and but reinforcement needed on colorectal screening tests, which were much below 50% (21.78+11.57).
Attitude of respondents towards CRC screening among the study respondents revealed the following. When people were asked whether they understand the severity of colorectal cancer, 133(66.5%) said that they understand its severity. Nearly, 128(64%) people replied that they will get themselves tested for colorectal cancer. While 91(45.5 %) said that doctor did not recommended the test for them, while 95(47.5%) respondents thought that the test was not needed for them. Nearly, 116(58%) respondents said that they never thought of the test and 113(56.5%) people think that they do not have any symptoms or problems as of now. Almost half of the respondents 98(49%) have a fear of developing the colorectal cancer. And half of the respondents 61(51.5%) are not sure about the cost of the test. Almost 100(50% ) respondents thought if they get colorectal cancer then their career or life will not be over. Majority, 149(74.5%) respondents agreed that screening tests would decrease their chances of dying with colorectal cancer. Hence it can be concluded that respondents had an understand about the severity of colorectal cancer and they had a positive attitude towards the screening test.
Conclusion:
Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum. Screening tests can find precancerous polyps so that they can be removed before they turn into cancer. Screening tests also can find colorectal cancer early, when treatment works best.
As such, the findings of the study are crucial to policy makers and educators, particularly in efforts geared towards holding preventive campaigns highlighting the main cancer risk factors (tobacco, alcohol, diet, physical inactivity, obesity); key socio-demographic factors; and health sector plans, policies and services for cancer. The findings demonstrate that the participants had good attitudes about CRC screening, but their experiences and knowledge regarding CRC screening as it relates to colonoscopy and Faecal occult blood test (FOBT) was inadequate. Culturally sensitive health education messages should be tailored to fulfil the knowledge gap among all population strata.