Factors Associated With Colorectal Cancer Screening Behaviors Among Urban Populations in China: A Mixed-Methods Study Using the Health Belief Model.

Abstract

Objective: Adherence to guideline-recommended colorectal cancer screening (CRCS) among average-risk urban populations in China remains significantly suboptimal. This mixed-methods study aimed to investigate screening behaviors and associated factors among average-risk urban populations through a multi-center approach.

Methodology: From February to July 2024, 550 participants were recruited via stratified random sampling in Harbin, China. They completed questionnaires related to health beliefs and knowledge. Additionally, semi-structured interviews were conducted to explore CRCS behaviors, with data analyzed using directed content analysis based on the Health Belief Model (HBM).

Results: Five hundred twenty two participants (95.0%) completed the survey. Identified factors influencing screening behavior among average-risk urban populations included perceived severity of colorectal cancer (CRC), benefits of colon cancer surveillance, barriers to surveillance, and knowledge. Twenty-six individuals were engaged in qualitative interviews. Twenty-four themes were identified and categorized by frequency. Both quantitative and qualitative data suggest that CRCS behavior among urban average-risk populations is suboptimal, and the identified factors can be mapped onto the HBM.

Conclusions: This mixed-methods study demonstrates that key factors influencing screening behavior among urban average-risk populations align with the HBM. These identified factors should be meticulously considered in future systematic interventions to enhance screening behaviors.