Predictors of stages of adoption of colorectal cancer screening among adults attending primary healthcare centers in Turkey.

Abstract

Background: Despite the proven effectiveness of colorectal cancer (CRC) screening in reducing mortality, adherence rates for fecal occult blood testing (FOBT) and colonoscopy remain low among Turkish adults. This study aimed to assess the stages of adoption of CRC screening behaviors, identify the factors influencing adoption, and examine the perceived benefits and barriers to screening.

Methods: A cross-sectional study was conducted in Istanbul's Anatolian region from May to June 2022, involving 498 adults aged 50-70 years. Multistage cluster sampling was used to select 20 primary healthcare centers. A structured questionnaire was administered to assess sociodemographic characteristics, health perceptions, knowledge of colorectal cancer (CRC) screening, and readiness for screening based on the transtheoretical model. The benefits and barriers to screening were evaluated using the Turkish version of "The Instruments to Measure CRC Screening Benefits and Barriers."

Results: The participants (mean age: 59.10 ± 5.71 years) showed greater recognition of colonoscopy (68.7%) than FOBT (39.8%). Most participants were in the precontemplation stage for FOBT (58.6%) and colonoscopy (63.9%). Perceptions of benefits were associated with education, employment, income, health status, familial CRC history, and screening knowledge (p < 0.05). Perceived barriers were linked to lack of knowledge and provider recommendations (p < 0.05). The participants in the precontemplation stage reported fewer benefits and more barriers compared to those in advanced stages (p < 0.05).

Conclusions: Colonoscopy is more widely recognized than FOBT among the Turkish adult population; however, a significant proportion remains in the precontemplation stage for screening. Perceptions of benefits and barriers are influenced by sociodemographic factors, health status, and CRC knowledge. Interventions addressing these barriers and raising awareness could improve CRC screening uptake and help reduce the disease burden.