MODELING ADHERENCE TO COLORECTAL-CANCER SCREENING

Background. An explanatory framework referred to as the Preventive Hea lth Model was used to identify factors associated with prospective adh erence to colorectal cancer screening. Methods. Data on sociodemograph ic, psychosocial, social influence, and program factors were collected via telephone survey for 501 older adult members of an independent pr actice association-type health maintenance organization. Subjects were later mailed fecal occult blood tests for completion and return. Adhe rence was defined as the return of the tests within 90 days. Results. Structural analysis shows that for men (N = 145), perceived self-effic acy (OR = 1.4), salience and coherence of testing (OR = 2.3 for a 5-po int increment on a 30-point scale), and exposure to health education i nterventions (OR = 6.8) were significant independent predictors of int ention to adhere and of adherence. Among women (N = 185), predictors w ere age (OR = 1.8) and salience and coherence of testing (OR = 1.8 for a 5-point increment on a 30-point scale). Conclusions. These findings indicate that for both men and women, adherence is influenced strongl y by the extent to which the behavior is judged to make sense in every day life. It also appears that additional education and encouragement may persuade men and younger women to participate in screening. (C) 19 94 Academic Press, Inc.