Colorectal cancer screening in workers : using a stage model approach to examine the ecological predictors of behavior

Abstract

This study was a cross-sectional study that aims to identify colorectal cancer screening (CRCS) stages and to predict factors that affect the respective stages. Data were collected from 314 manual workers at 32 medium and small-sized workplaces located in Seoul, Gyeonggi Province, North Chungcheong Province and South Chungcheong Province. The dependent variable was the stage of CRCS –① unawareness; ② unengaged, undecided, and decided not to act; ③ decided to act; and ④ acting and maintenance stages--to which the precaution adoption process model was applied. Independent variables were based on the ecological model. The collected data were analyzed by the use of multilevel multinomial logistic regression models.The followings show the results of this study: 1. With regard to the demographic characteristics of the workers, the proportion of workers aged 50 and above was found to be 54.9%, and 69.7% of the workers were men. With regard to work-related characteristics, 53.7% workers had permanent employment, with a mean work period of 5.9 years and mean work hours per week of 51.8 hours. With regard to workplace characteristics, we found that 43.8% workplaces were manufacturing businesses, 50% were located in rural areas, 40.6% were subcontract workplaces, and 78.1% were small-sized workplaces with less than 49 employees. The proportion of workers in the unawareness stage of CRCS was 22%, the unengaged stage was 8.9%, the undecided stage was 24.2%, the decided not to act was 1.3%, the decided to act was 14%, and the acting/maintenance was 29.6%. 2. At the intrapersonal level, workers who had experienced cancer screening (OR = 0.53), received a notice from the National Cancer Screening (OR = 0.26) and had lower stress (OR=2.26) had a higher chance to enter the unengaged, undecided, and decided not to act stages, instead of the unawareness stage. In addition, workers who had a preference for a fecal occult blood test (OR = 0.18) and colonoscopy (OR = 0.13) were more likely to enter the unengaged, undecided, and decided not to act stages compared to workers who did not have a preference for CRCS methods. At the organizational level, workers at the business facilities management and business support services (BFMBSS) (OR = 30.91) and at workplace with administrators with a higher attitude towards cancer screening (OR = 10.47) were more likely to be in the unawareness stage than in the unengaged, undecided, and decided not to act stages, in comparison with workers in the manufacturing industry. 3. At the intrapersonal and interpersonal levels, workers who had longer work hours (OR = 1.10), higher stress (OR = 3.48), or who had family members carrying out regular cancer screening (OR = 3.29) were more likely to be in the decided to act stage compared with the unengaged, undecided, and decided not to act stages. At the organizational level, workers at a workplace with BFMBSS (OR = 128.72) and transportation (OR=133.28) were more likely to be in the decided to act stage than were manufacturing workers. Furthermore, workers in nonsmoking workplaces (OR = 29.37) and in workplaces with administrators with a higher attitude towards cancer screening (OR = 28.32) were more likely to be in the decided to act stages than in the unengaged, undecided, and decided not to act stages. However, workers in workplaces with a consideration of the support budget for health checkup and cancer screening (HCCS) (OR = 0.02) and a presence of a budget for HCCS within their workplace (OR = 0.01) were less likely to be in the decided to act stage than in the unengaged, undecided, and decided not to act stages. 4. At the intrapersonal level, workers with high school diplomas (OR = 0.19), who increased their work hours per week (OR = 0.89) or who felt stress (OR = 0.39) were less likely to be in the acting/maintenance stages than in the decided to act stage. At the organizational level, workers of medium-sized workplaces (50 to 99 employees) were more likely to be in the acting/maintenance stages than workers in workplaces with more than 100 employees (OR = 772.89). In addition, workers whose administrators were securing the HCCS budget in their workplace (OR = 29.88) and considering it (OR = 21.74) were more likely to be in the acting/maintenance stages, rather than in the decided to act stage. In contrast, workers in workplaces with nonsmoking areas were less likely to be in the acting/maintenance stages than in the decided to act stage (OR = 0.06). 5. The variance between workplaces explained 30.1% of the total variance for the staging of the behavior towards CRCS in workers. This study raised 2 issues. First, workers will finally undergo CRCS after passing through several behavioral stages. Second, the respective stages are affected by different intrapersonal, interpersonal, and organizational factors. Thus, reviewing workplace environments and their organizational levels prior to the Implementation of CRCS promotion programs may derive better results.